覆膜支架主动脉腔内修复术治疗创伤性主动脉破裂

Endovascular aortic repair for acute thoracic aortic rupture

目的探讨覆膜支架主动脉腔内修复术（endovascularaoicrepair，EVAR）治疗创伤性胸主动脉损伤（traumaticthoracicaorticinjuries，1TrAI）的可行性和有效性。方法回顾性分析13例TFAI患者的临床资料，术前螺旋CT血管造影（CTA）对病变进行评估，术中数字减影血管造影（DSA）进一步评估及行EVAR。术后3，6，12个月以及其后每年随访CTA明确治疗效果。结果13例行EVAR均获成功。完全或部分遮蔽左锁骨下动脉4例，支架释放后即刻造影发现内漏3例，加短支架2次覆盖后内漏消失l例，行球囊扩张贴附后内漏明显减少1例，另1例微小内漏予观察随访。共12例获随访，无内漏、左上肢缺血、截瘫以及支架移位等并发症。结论EVR治疗TYAI安全性高，效果满意。

Objective To investigate feasibility and validity of endovascular aortic repair （EVAR） of traumatic thoracic aortic injuries （TTAI）. Methods A retrospective analysis was conduc- ted on data of 13 patients with TFAI. Pathological changes were evaluated by spinal CT angiography （CTA） preoperatively and re-evaluated by digital subtraction angiography （DSA） in EVAR. CTA was performed again to confirm therapeutic effects at postoperative 3, 6, 12 months and annually thereafter. Results All patients had successful EVAR. Complete or partial cover of left subclavian artery was observed in four patients. Endoleak in angiography shortly after stent delivery was noticed in three patients. However, endoleak disappeared in one patient after short stent placement for twice ; endoleak was evident ly decreased in one patient after balloon dilation. Follow-up was performed for another patient with slight endoleak. A total of 12 patients were followed up, which showed no complications, such as endoleak, ischemia of left upper extremity, paralysis or stentgraft migration. Conclusion EVR is safe and effective in treatment of TI＇AI.