The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Mid-Term Results of Endovascular Repair for Traumatic Aortic Injury

외상성 대동맥 손상 환자에서 시행한 혈관 내 치료의 중기결과

  • Kim, Seon-Hee (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute) ;
  • Song, Seung-Hwan (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute) ;
  • Kim, Sang-Pil (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute) ;
  • Lee, Chung-Won (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute) ;
  • Choi, Jeong-Cheon (Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute) ;
  • Ahn, Jin-Hee (Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute) ;
  • Lee, Han-Cheol (Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute)
  • 김선희 (부산대학교 의과대학 흉부외과학교실) ;
  • 송승환 (부산대학교 의과대학 흉부외과학교실) ;
  • 김상필 (부산대학교 의과대학 흉부외과학교실) ;
  • 이충원 (부산대학교 의과대학 흉부외과학교실) ;
  • 최정천 (부산대학교 의과대학 내과학교실 순환기분과) ;
  • 안진희 (부산대학교 의과대학 내과학교실 순환기분과) ;
  • 이한철 (부산대학교 의과대학 내과학교실 순환기분과)
  • Published : 2012.08.01
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Abstract

Background/Aims: Traumatic aortic injury (TAI) is rarely seen clinically, but is highly fatal. In determining how to treat TAI, there are many factors to consider, due to the complexity of concomitant injuries. The Society of Vascular Surgery recommends that thoracic endovascular aortic repair (TEVAR) should be preferentially performed over open surgical repair. We evaluated the efficacy of TEVAR based on our experiences in TAI treatment. Methods: Between July 2008 and August 2011, we conducted a retrospective analysis of the patients who underwent TEVAR following TAI and analyzed factors including TAI type and sites, time from injury to repair, Injury Severity Score, and complications. Seven patients with multiple injuries underwent TEVAR in the acute setting. Follow-up was accomplished regularly by computed tomographic angiography (CTA). Results: Type III aortic injury, rib fractures, and hemothorax were found in all patients. TEVAR was successfully performed. Completion angiography demonstrated complete exclusion of pseudoaneurysm without endoleakage, and perfusion of aortic arch vessels was maintained. There was no in-hospital mortality or evidence of spinal cord ischemia. The average follow-up duration was $30.4\;{\pm}\;23.9$ months, and regular CTA revealed good durability of the stent-graft without late complications such as endoleakage, stent migration, or pseudoaneurysm formation. Conclusions: Through this study, we were able to identify good mid-term results of TEVAR in our hospital. TEVAR is thought to be a good modality with which to treat acute traumatic aortic injury, especially given the consideration of bleeding risk in trauma patients with multiple injuries.

목적: 외상성 대동맥 손상은 그 빈도가 흔하지 않으며 다른 장기나 골격에 다발성 손상을 동반하는 경우가 많아 치료방법을 결정함에 있어 고려해야 할 점이 많다. The Society of Vascular $Surgery^{(R)}$의 2010년 guideline에 따르면 외상성 대동맥 손상 환자에서 흉부 혈관내 대동맥 성형술(thoracic endovascular repair, TEVAR)를 우선적으로 시행할 것을 추천하고 있다. 이에 본원에서 이루어진 시술 결과를 바탕으로 유용성을 알아보고자 한다. 방법: 2008년 7월부터 2011년 8월까지 외상성 대동맥 손상으로 TEVAR를 시행 받은 환자들을 대상으로 대동맥 손상의 형태와 위치, 손상부터 시술까지의 시간, 외상의 중증도 (injury severity score), 합병증 등의 자료를 후향적으로 분석하였다. 총 7명의 외상성 대동맥 손상 환자가 TEVAR를 시행 받았고 그들은 모두 하나 이상의 사지골절과 장기손상을 동반하고 있었다. TEVAR는 모두 응급 상황에서 시행하였고 흉부대동맥 스텐트-도관(thoracic aortic stent graft)를 사용하였다. 이후 정해진 간격으로 컴퓨터 단층 촬영을 하여 추적관찰하였다. 결과: 모든 환자는 grade III의 대동맥 손상이었으며, 동반된 골절로는 늑골골절이 가장 많았고 다양한 사지 골절과 장기 손상을 동반하고 있었다. TEVAR는 모든 환자에서 성공적으로 시행되었다. 완료대동맥혈관조영(completion angiography)상 endoleak은 없었고 대동맥 아치혈관의 혈류도 원활하였다. 입원기간 내 사망은 없었으며 허혈성 척수 손상도 발견되지 않았다. 평균 추적관찰 기간은 $30.4\;{\pm}\;23.9$개월이었으며 정기적으로 시행한 컴퓨터 단층촬영상 대동맥 시술부위에 합병증이 관찰된 경우는 없었다. 결론: 본원에서 시행한 외상성 대동맥 손상의 혈관 내 성형술의 결과 및 예후는 우수하였다. 외상성 대동맥 손상 환자에서 다른 장기에 출혈과 손상이 있는 것을 고려하면 혈관 내 성형술은 좋은 치료방법으로 생각된다.

Keywords

References

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