Τίτλος:
Endovascular Repair of Blunt Thoracic Aortic Trauma: Is Postimplant
Hypertension an Incidental Finding?
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Blunt thoracic aortic injury (BTAI) is the second most
common cause of death in trauma patients. Nowadays, thoracic
endovascular aortic repair (TEVAR) has become the treatment of choice
because of lower rates of mortality, paraplegia, and stroke. However,
concerns have been raised whether graft implantation is related to the
development of hypertension in the postoperative period. The aim of this
study was to report short-and long-term outcomes of patients undergoing
TEVAR for BTAIs at a tertiary hospital and to investigate postimplant
hypertension.
Methods: Between January 2005 and January 2016, 23 patients with blunt
thoracic aortic trauma underwent TEVAR. Median age was 44 years (range,
18-73). Among them, 14 (60.9%) patients were diagnosed with aortic
rupture, whereas 9 (39.1%) with pseudoaneurysm. A single thoracic stent
graft was deployed in 21 patients, and the rest 2 patients received 2
stent grafts.
Results: Complete exclusion of the injury was feasible in all subjects
(100% primary success). The left subclavian artery (SCA) was
intentionally covered in 6 patients (26%). Intraoperative complications
included one nonfatal stroke managed conservatively and one external
iliac artery rupture treated with iliofemoral bypass. One patient
(4.3%) died on the first postoperative day in the intensive care unit
(ICU) because of hemorrhagic shock. The overall 30-day mortality and
morbidity were 4.3% and 8.7%, respectively. New-onset postimplantation
arterial hypertension was observed in 8 (34.8%) previously
nonhypertensive patients. Younger age (P = 0.027) and SCA coverage (P =
0.01) were identified as potential risk factors for the development of
postimplant hypertension, whereas the presence of concomitant injuries
(P = 0.3) and intraoperative complications (P = 0.1) were not. After a
median follow-up of 100 months (range, 18-120), 6 of them still remain
on antihypertensive therapy, whereas the other 2 did not require
permanent treatment.
Conclusions: TEVAR is a safe approach in the treatment of BTAI
associated with low short- and long-term morbidity and mortality rates.
Lower age and SCA coverage may contribute to the development of
postimplant hypertension. Further larger cohort studies are warranted to
elucidate the underlying mechanisms of postimplant hypertension.
Συγγραφείς:
Tigkiropoulos, Konstantinos
Sigala, Fragiska
Tsilimigras,
Diamantis I.
Moris, Demetrios
Filis, Konstantinos
Melas,
Nikolaos
Karamanos, Dimitrios
Kontogiannis, Christos and
Lazaridis, Ioannis
Saratzis, Nikolaos
Περιοδικό:
Annals of Vascular Surgery
Εκδότης:
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI:
10.1016/j.avsg.2018.01.100
