Single-Center Retrospective Analysis Of The Clinical Features And Prognosis Of 98 Cases Of Blunt Thoracic Aortic Injury

Background and objective:Blunt thoracic aortic injury is one of the severe fatal injuries of blunt chest trauma,with a low incidence but a very high mortality rate,often secondary to severe traffic injuries.There is no unified opinion on the disease classification of patients with blunt thoracic aortic injury and clinical treatment options for different classifications.Guidelines in Europe and the United States consider the need for emergency surgical intervention for patients with blunt thoracic aortic injury,but the results of numerous studies conflict with the guidelines,while there are no guidelines and opinions on the treatment of blunt thoracic aortic injury in China.The treatment of blunt thoracic aortic injury includes drug conservative treatment and surgical treatment.The conservative treatment method is to observe the development of patient’s condition under strict blood pressure,heart rate control and close imaging follow-up observation,and the traditional surgical modality includes open aortic repair and replacement,while with the rapid development of endoluminal technology,endoluminal thoracic aortic repair has become the main treatment modality for blunt thoracic aortic injury with more satisfactory early results.However,because blunt thoracic aortic injury is often combined with multiple systemic injuries,it is still controversial whether active surgical intervention is required for patients with blunt thoracic aortic injury with low degree of injury classification and the timing of surgical intervention for patients with blunt thoracic aortic injury requiring surgical treatment.In this study,we reviewed the clinical data of patients with blunt thoracic aortic injury from a single center and summarized the injury classification,treatment options,timing of surgery,surgical outcomes,and prognosis.Materials and Methods:Patients with blunt thoracic aortic injury at the First Affiliated Hospital of Zhengzhou University from October 2016 to April 2021 were collected,and patients>18 years old with a clear history of blunt trauma confirmed by CT angiography and with complete clinical and follow-up information were included.Patients who did not meet the inclusion criteria were excluded,and a total of 98 patients were included in the cohorts.Patients were grouped and their clinical data were compared and analyzed according to the patient’s tissue typing of aortic injury and the time of surgery(emergency TEVAR or delayed TEVAR),and the efficacy was analyzed according to the imaging findings during hospitalization.Follow-up visits were performed through regular outpatient visits during the period or by telephone to understand patient survival and to assess imaging findings including thoracic aortic stent and graft patency,presence of endoleaks and pseudoluminal thrombosis by follow-up thoracic aortic CTA.Results:A total of 98 patients with BTAI were included in this study,including 84 male patients(85.7%)and 14 female patients(14.3%)with a mean age of 50.9±12.8 years.A total of 49 cases were included in SVS grade Ⅰ and Ⅱ,including 18 cases in the conservative treatment group and 31 cases in the surgical treatment group.There was no significant difference between the conservative and surgical treatment groups in terms of past history and combined injuries,and the mortality rate in the conservative treatment group was less than that in the surgical treatment group(5.6%vs.32.3%;p=0.03).Of the 72 patients treated with TEVAR,a total of 24 were in the emergency TEVAR group and 48 were in the delayed TEVAR group.According to the 23 patients with emergency TEVAR versus 23 patients with delayed TEVAR obtained after 1:1 matching by propensity score,the total complication rate was significantly smaller in the delayed TEVAR group than in the emergency TEVAR group(OR 0.042,95%CI(0.005,0.363);p=0.006),and the mortality rate of patients in the delayed TEVAR group had a tendency to be lower than in the emergency TEVAR(OR 0.129,95%CI(0.014,1.174);P=0.068),but there was no statistically significant difference.At follow-up,there was no statistical difference in mortality between the emergency TEVAR group and the delayed TEVAR group at 1-year follow-up.Conclusion:There are few clinical reports on the treatment strategy of blunt thoracic aortic injury in China,and there is no uniform treatment opinion.Based on our center’s experience,we believe that for patients with BTAI with low SVS classification(gradeⅠ and Ⅱ),under the condition of stable hemodynamic status,conservative treatment can be adopted to treat BTAI and actively manage the combined injury at the same time.In patients with BTAI requiring TEVAR surgical intervention,delayed treatment is used to reduce perioperative complications in the presence of stable hemodynamic status.