RESUMO
OBJECTIVES: The aim of this study was to analyse and report the changes in the management of blunt traumatic aortic injuries (BTAIs) in a single centre during the last 2 decades. METHODS: A retrospective analysis of all patients diagnosed with BTAI from January 1999 to January 2020 was performed. Data were collected from electronic/digitalized medical history records. RESULTS: Forty-six patients were included [median age 42.4 years (16-84 years), 71.7% males]. The predominant cause of BTAI was car accidents (54.5%, n = 24) and all patients presented with concomitant injuries (93% bone fractures, 77.8% abdominal and 62.2% pelvic injuries). Over 70% presented grade III or IV BTAI. Urgent repair was performed in 73.8% of patients (n = 31), with a median of 2.75 h between admission and repair. Thoracic endovascular repair (TEVAR) was performed in 87% (n = 49), open surgery (OS) in 10.9% (n = 5) and conservative management in 2.1% (n = 1). Technical success was 82.6% (92.1% TEVAR, 79% OS). In-hospital mortality was 19.5% (17.5% TEVAR, 40% OS). Of these, 3 died from aortic-related causes. Seven (15.2%) required an early vascular reintervention. The median follow-up was 34 months (1-220 months), with 19% of early survivors having a follow-up of >10 years. Only 1 vascular reintervention was necessary during follow-up: secondary TEVAR due to acute graft thrombosis. Of the patients who survived the initial event, 6.7% died during follow-up, none from aortic-related causes. CONCLUSIONS: Even with all the described shortcomings, in our experience TEVAR for BTAI proved to be feasible and effective, with few complications and stable aortic reconstruction at mid-term follow-up. With the current technical expertise and wide availability of a variety of devices, it should be pursued as a first-line therapy in these challenging scenarios.
Assuntos
Implante de Prótese Vascular , Procedimentos Endovasculares , Traumatismos Torácicos , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgiaRESUMO
The peroneal artery is an important outflow vessel for lower limb revascularization and limb salvage. This vessel is commonly reached using a medial, posterior, or lateral approach with resection of the fibula. We present a technique of lateral approach to the peroneal artery without fibular resection.