Clinical Application Of TEVAR In Traumatic Aortic Injury

Objective: Analyze the clinical effect of TEVAR on traumatic aortic injury and summarize clinical experienceMethod:This article systematically summarized the clinical data of 35 patients who underwent TEVAR in interventional vascular surgery in our hospital from June 2008 to June 2019 due to aortic injury.There were 30 males(85.7%)and 5 females(14.3%),aged 22-75 years,with an average age of 45.5 ± 12.3 years,males with an average age of 43.7 ± 11.6 years,and females with an average age of 52.6 ± 10.2 years.One of the male patients died of falling into the air within 3 hours after admission due to severe head injury.The survival rate of the patients(97.1%),and the remaining 34 patients successfully underwent TEVAR surgery with a success rate of 100%.There were 28 cases of car collision injuries,3 cases of motorcycle collision injuries,2 cases of fall injuries(1 death),and 2 cases of pedestrian injuries.There were 3 cases with cerebral contusion,1 with spleen rupture,2 with large blood pneumothorax,31 with multiple rib fractures,28 with pulmonary contusion,1 with acute left upper limb ischemia,and 1 with acute renal ischemia.All patients were diagnosed by aortic CTA,including 2 cases of grade IV aortic injury and 32 cases of grade III aortic injury.5 cases of emergency TEVAR surgery(2 cases of simple aortic stent graft,3 cases of aortic stent graft + left subclavian artery stent),29 cases of TEVAR surgery(17 cases of simple aorta)Stent graft,2 cases received aortic stent graft + axillary axillary bypass,1 case received aortic stent graft + left common carotid artery bypass graft,9 cases received aortic stent graft + left subclavian artery stent Surgery).Postoperative review by telephone or outpatient follow-up,followed by 1 month,6 months,and 12 months.The follow-up includes: death,paraplegia,renal failure,stroke and other serious complications;CTA observation through outpatient review Location and shape of aortic stent graft,with or without endoleak and stent displacement,changes in maximum pseudocavity diameter,and patency of left subclavian artery stent and bypass vessels.Result:All patients were successfully treated with TEVAR,including 5 cases in the emergency TEVAR operation group,with TEVAR intervention time of 13.38 ± 5.21 h,intraoperative TEVAR repair time of 3.51 ± 1.46 h,total hospitalization time of 19.26 ± 5.34 days,and postoperative bedtime of 9.15 ± 1.86 days,ICU stay 5.24 ± 2.18 days,tracheal intubation time 2.89 ± 1.56 days,average diameter of preoperative dissection aneurysm 4.52 ± 0.18 cm,average diameter of maximum false cavity 1.51 ± 0.13 cm,diameter of proximal tumor neck during operation 3.19 ± 0.24 cm,the length of the dissecting aneurysm was 6.34 ± 1.25 cm,the length of the stent was 15.34 ± 1.71 cm,and the diameter of the proximal end of the stent was 3.31 ± 0.52 cm.Twenty-nine patients in the elective TEVAR surgery group were given TEVAR intervention time of 125.13 ± 70.62 h,intraoperative TEVAR repair time of 3.21 ± 1.08 h,total hospitalization time of 23.73 ± 8.29 days,postoperative bedtime of 12.35 ± 2.63 days,and ICU stay of 7.32 ± 1.95 days.The tracheal intubation time was 2.57 ± 1.31 days.The average diameter of the preoperative dissection aneurysm was 3.47 ± 0.21 cm,the average diameter of the largest false cavity was 1.32 ± 0.11 cm,the diameter of the proximal tumor neck during the operation was 3.16 ± 0.35 cm,and the length of the dissection aneurysm was 5.34.± 2.71 cm,the length of the stent is 14.52 ± 1.63 cm,and the diameter of the proximal end of the stent is 3.54 ± 0.32 cm.One patient was unable to follow-up due to loss of contact information after the operation.The remaining 33 patients did not experience any serious death,paraplegia,renal failure,or stroke during the follow-up of 1 month,6 months,and 12 months.Outpatient review of the CTA aortic stent graft and left subclavian artery stent was in good shape,without branch displacement and reverse tear dissection,bypass artery blood flow was smooth,and the maximum false lumen diameter was gradually reduced(for details,see Appendix Table 5).Conclusion:1.For patients with grade III or IV aortic injuries,TEVAR repair therapy is preferred,which has the advantages of less trauma,simple operation,fast postoperative recovery,and fewer complications.2.The timing of TEVAR surgery is for patients with grade IV aortic injury and a large number of pneumothorax patients.Once the diagnosis is clear,it is recommended to perform emergency TEVAR repair treatment(less than 24 hours)to restore the true aortic blood flow.For a class III aortic injury with one of the following symptoms:(1)the dissection involves an important branch of the aorta,leading to acute ischemia of the brain,limbs or abdominal organs;(2)the diameter of the dissection aneurysm exceeds 50% of the normal diameter Or the intermural hematoma increases progressively;(3)Unstable blood pressure or chest pain is difficult to control,there is restlessness,can not rest in bed;emergency TEVAR repair treatment is recommended(less than 24h).For patients with III aortic injury and stable hemodynamics,it is recommended to actively control blood pressure and heart rate,and to choose TEVAR repair therapy(more than 24 hours)after the condition is stable.3.For patients with insufficient proximal anchoring area and predominant left vertebral artery or previous cerebral infarction and left internal mammary artery bypass surgery,it is necessary to reconstruct the blood flow of the left subclavian artery.