Traumatic Thoracic Aortic Coarctation after Blunt Thoracic Aortic Injury Mandates Emergent Thoracic Endovascular Aortic Repair.

Autor:	Bhatt MN; Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN., Byerly S; Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center, Memphis, TN., Filiberto DM; Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center, Memphis, TN., Afzal MO; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN., Fabian TC; Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center, Memphis, TN., Croce MA; Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center, Memphis, TN., Mitchell EL; Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Sep 01; Vol. 280 (3), pp. 424-431. Date of Electronic Publication: 2024 Jun 12.
DOI:	10.1097/SLA.0000000000006403
Abstrakt:	Objective: This study sought to elucidate clinical and imaging findings predictive for malperfusion syndrome after blunt thoracic aortic injury (BTAI). Background: There is limited literature on malperfusion syndrome after BTAI, and the timing of thoracic endovascular aortic repair (TEVAR) in patients with this condition has not been defined. Methods: A retrospective analysis of prospectively collected data of patients with BTAI treated between January 2021 and October 2023. Clinical and thoracic aortic (TA) imaging data, time to TEVAR, in-hospital death, and malperfusion/reperfusion sequelae (paraplegia, renal/visceral/limb ischemia, and compartment syndromes) were assessed. Correlations between clinical and imaging findings, time to TEVAR, and outcomes were evaluated. Results: Of the 19,203 trauma patients evaluated, 13,717 (71%) had blunt injuries and 77 (0.6%) had BTAI. The majority (67.5%) were male, with a median age of 40 years (IQR: 33-55). TEVAR was performed in 42 (54.5%) patients. Seven (9.1%) patients presented with clinical and TA imaging criteria for traumatic thoracic aortic coarctation (TTAC), including diminished/absent femoral pulses and TA luminal narrowing of 50% to 99%. The median time to TEVAR was 9 (IQR: 5-32), 11, and 4 hours for all non-TTAC and TTAC BTAI patients, respectively ( P =0.037). Only TTAC patients presented/developed malperfusion/reperfusion sequelae. In-hospital mortality rates were 7.8%, 5.8%, and 29% for all non-TTAC and TTAC BTAI patients, respectively ( P =0.09). Aortic-related mortality occurred in only 2 (2.6%) TTAC patients. Conclusions: Patients with clinical and TA imaging manifestations of TTAC are predisposed to malperfusion/reperfusion sequelae if TEVAR is delayed. We recommend the emergent repair of all BTAIs with TTAC. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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