Clinical Research For The Endovascular Treatment With Aorta Stent Grafts In Blunt Traumatic Thoracic Aortic Transection

Blunt traumatic thoracic aortic transection is a potentially life-threateningcondition and associated with a high mortality rate, has been implicated as the secondmost common cause of death in trauma patients, behind only intracranial hemorrhage.Inthe past,conventional surgical repair is the ‘gold standard’, but is associated with highmortality and morbidity rates.Especially for those coexisting other server traumaticinjuries,mortality rate will apparent improvement. Despite recent advances in surgicaland anaesthetic technique, mortality and the incidence of complications was notsignificantly improve for TAT patients with conventional thoracotomy surgery.Thoracicendovascular aortic repair(TEVAR) has been afforded a minimally invasive、safety andefficient therapeutic method.The short-term effect of TEVAR has significant decreasedthe mortality and morbidity rates for TAT patients,but Its long-term effect remains to beseen.Objective: To summarize the experience and understanding in TEVAR treatmentof the blunt traumatic thoracic aortic transection in our department, explores clinicalapplication of the TEVAR in TAT patients.Methods:13TAT patients who hospitalized in the second hospital of the dalianmedical university during the February2007to August2012.All of them acceptingTEVAR.10patients were male,3females;average age46.9±13.2years(agedfrom22-64).All patients have carried out the contrast enhanced CT and confirmedexistence varying degrees aortic injuries.2aorta injury type I;10type III;1type IV. AllTEVAR operations are completing in general anesthesia.All stent-grafts selectshanghai Microport body bracket.All patients who accept TEVAR,will follow-up visitafter surgery1week,six months,one year,afterwards every one year review one time.Foraccepting conservative treatment patients will follow-up visit every six months afterleaving hospital.Through follow-up,we mainly observe the Surveying the patientsurvival condition,whether existence adverse reaction and morbidity,such as chest pain、symptom of critical limb ischemia and cerebral ischemia,observation the imagesof the aorta and endovascular stent,whether existence morbidity:such asendoleak,Stent-graft migration and Stent-graft infolding.Results:All patients carry out follow-up.No lost and death during thefollow-up.The longest follow-up is48months,the shortest follow-up is6months.About80%patients follow-up time exceed12months,average follow-up time is18±6months.13patients who accept TEVAR,have no paraplegia and chest pain recurrence,Byreviewing the contrast enhanced CT,endovascular stent fixed well,no endoleak、Stent-graft migration and Stent-graft infolding happening,no symptom of critical limbischemia and cerebral ischemia.Conclusion:TEVAR is reliable treatment for the blunt traumatic thoracic aortictransection,if the indication is clear and definite,it can take place the conventionalsurgical repair; TEVAR should be the preference for TAT patients who have serveassociated injury,...