Abstract：
BACKGROUND: Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma which warrants prompt recognition with expedited management. Clinical manifestations of BTAI may not be straightforward to detect and may be misdiagnosed. Therefore, diagnosis of BTAI requires a high index of suspicion based on the mechanism of injury along with urgent transfer to centers with appropriate expertise and facilities.
METHODS: We provide an expert-based narrative review on endovascular treatment of BTAI highlighting indications, techniques, results, and challenges.
RESULTS: Multiple imaging modalities can be used including computed tomography angiography, transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound. Whilst conservative pharmacological management can be a safe option in low-grade BTAI, thoracic endovascular aortic repair has become the gold-standard strategy in most cases, replacing open surgical repair. Nevertheless, it is important to account for patient demographics particularly age, severity of injury, choice of endograft including its type and size, and endovascular technique including landing zone and left subclavian artery revascularization.
CONCLUSIONS: Overall, TEVAR in BTAI has been shown to be an efficacious strategy with favorable early outcomes. In contrast, less is known on the long-term clinical outcomes of TEVAR in BTAI. Hence, despite the optimal early technical and clinical success rates, concerns remain about the need for long-term surveillance. The exact timing of follow-up and the integration of different modalities that can also investigate potential downstream cardiovascular effects remain hot topics for future research. Finally, industry should focus on developing more compliant endografts to improve the stiffness mismatch between the endograft and the aorta to optimize results.
METHODS: We provide an expert-based narrative review on endovascular treatment of BTAI highlighting indications, techniques, results, and challenges.
RESULTS: Multiple imaging modalities can be used including computed tomography angiography, transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound. Whilst conservative pharmacological management can be a safe option in low-grade BTAI, thoracic endovascular aortic repair has become the gold-standard strategy in most cases, replacing open surgical repair. Nevertheless, it is important to account for patient demographics particularly age, severity of injury, choice of endograft including its type and size, and endovascular technique including landing zone and left subclavian artery revascularization.
CONCLUSIONS: Overall, TEVAR in BTAI has been shown to be an efficacious strategy with favorable early outcomes. In contrast, less is known on the long-term clinical outcomes of TEVAR in BTAI. Hence, despite the optimal early technical and clinical success rates, concerns remain about the need for long-term surveillance. The exact timing of follow-up and the integration of different modalities that can also investigate potential downstream cardiovascular effects remain hot topics for future research. Finally, industry should focus on developing more compliant endografts to improve the stiffness mismatch between the endograft and the aorta to optimize results.
摘要：
背景：钝性胸主动脉损伤（BTAI）是血管创伤最具破坏性的情况之一，值得通过快速治疗迅速识别。BTAI的临床表现可能无法直接检测，可能会误诊。因此,BTAI的诊断需要基于损伤机制的高度怀疑指数,并紧急转移到具有适当专业知识和设施的中心。
方法：我们提供了关于BTAI血管内治疗的专家叙述性综述，突出适应症，技术,结果，和挑战。
结果：可以使用多种成像方式，包括计算机断层扫描血管造影，经食管超声心动图,磁共振成像，血管内超声.虽然保守的药理管理可以是一个安全的选择，在低等级的BTAI，在大多数情况下，胸主动脉腔内修复术已成为金标准策略，更换开放式手术修复。然而，重要的是要考虑患者的人口统计学，特别是年龄，损伤的严重程度,内移植物的选择，包括其类型和大小，血管内技术包括着陆区和左锁骨下动脉血运重建。
结论：总体而言，BTAI中的TEVAR已被证明是一种有效的策略，具有良好的早期结果。相比之下,对BTAI中TEVAR的长期临床结局知之甚少。因此，尽管早期技术和临床成功率最佳，人们仍然担心需要长期监测。随访的确切时间和不同模式的整合，也可以调查潜在的下游心血管影响仍然是未来研究的热门话题。最后,行业应专注于开发更柔顺的内移植物，以改善内移植物和主动脉之间的刚度不匹配，以优化结果。
方法：我们提供了关于BTAI血管内治疗的专家叙述性综述，突出适应症，技术,结果，和挑战。
结果：可以使用多种成像方式，包括计算机断层扫描血管造影，经食管超声心动图,磁共振成像，血管内超声.虽然保守的药理管理可以是一个安全的选择，在低等级的BTAI，在大多数情况下，胸主动脉腔内修复术已成为金标准策略，更换开放式手术修复。然而，重要的是要考虑患者的人口统计学，特别是年龄，损伤的严重程度,内移植物的选择，包括其类型和大小，血管内技术包括着陆区和左锁骨下动脉血运重建。
结论：总体而言，BTAI中的TEVAR已被证明是一种有效的策略，具有良好的早期结果。相比之下,对BTAI中TEVAR的长期临床结局知之甚少。因此，尽管早期技术和临床成功率最佳，人们仍然担心需要长期监测。随访的确切时间和不同模式的整合，也可以调查潜在的下游心血管影响仍然是未来研究的热门话题。最后,行业应专注于开发更柔顺的内移植物，以改善内移植物和主动脉之间的刚度不匹配，以优化结果。
