A Single-center Retrospective Analysis Of 36 Cases With Blunt Thoracic Aortic Injuries

Objective:Blunt Thoracic Aortic Injuries(BTAI)is one of surgical emergencies,and the mortality rate is extremely high.Most of the wounded died shortly after the injury,and could not even reach the hospital.In the past 10 years,the widespread application of Thoracic Endovascular Aortic Repair(TEVAR)has caused fundamental changes in the treatment of BTAI.Compared with traditional open surgery,TEVAR has generally improved the short-term prognosis of the wounded.However,there are very few data on the timing of BTAI endovascular repair and the results of medium and long-term follow-up.This study retrospectively analyzed the experience of TEVAR in treating BTAI in our hospital in the past 15 years.Methods:This study collected data on all BTAI cases admitted to hospital from January 1,2006 to September 30,2020,and admitted 36 wounded patients.According to the operation time(emergency TEVAR and delayed TEVAR),the relevant clinical data were compared and analyzed.At the same time,the results of TEVAR in the treatment of BTAI were discussed based on the imaging performance of the wounded.The follow-up was carried out by collecting computer tomography images of postoperative outpatient or hospitalization review and regular telephone contact.Result:Among the 36 BTAI casualties,27 were males(75%)and 9 females(25%).The average age is 45.33 years ±1.54 years(27-69 years).The imaging findings after TEVAR showed that the shape of the stent graft was remodeled around the BTAI breach,and the stent protruded from the tumor cavity at the lesion site.Among the 36 wounded,there were 9 cases of mediastinal hematoma and 27 cases of thoracic hemorrhage.Nine patients with mediastinal hematoma received delayed TEVAR and all recovered and were discharged.Of the 27 patients with thoracic hemorrhage,4 patients did not undergo emergency TEVAR because of other complicated life-threatening injuries.Death occurred during hospitalization.23 patients underwent emergency TEVAR.One casualty died suddenly due to rapid drainage of pleural hemorrhage after TEVAR.The remaining 22 casualties were successfully treated after TEVAR.The mortality rate of the emergency TEVAR group was 4.3%(1/23),which was significantly lower than that of the delayed group 30.8%(4/13).Conclusion:Aortic trauma caused by BTAI casualties is not limited to the intima,and there is also a certain degree of damage to the adventitia.The aorta of the BTAI casualty sent to the hospital may have a hidden rupture.For the wounded with mediastinal hematoma,the state around the aorta is temporarily stable,and other combined life-threatening injuries can be treated first under dynamic observation,and TEVAR can be performed after the patient’s state is relatively stable.For patients with pleural hemorrhage type BTAI,the risk of rupture is high and difficult to predict,and blood pressure is difficult to control.To ensure safety,it is recommended to implement TEVAR under emergency conditions as soon as possible after BTAI is clearly diagnosed;in addition,chest hemorrhage type BTAI should be avoided before TEVAR operation.Closed drainage,and careful implementation of closed thoracic drainage after TEVAR,controlled drainage can be adopted,that is,drainage is performed slowly in batches day by day to avoid sudden death due to secondary rebleeding of the wounded.