腹部大動脈外傷の全国外傷データベースにおける転帰

Abdominal aortic trauma (AAT), although rare, is associated with high mortality. This descriptive study aims to assess the outcomes of patients with AAT who received either open repair or endovascular aortic repair (EVAR). We hypothesize that EVAR is associated with lower injury severity and better patient outcomes.

In this retrospective study, the American College of Surgeons Trauma Quality Improvement Program database (2017-2020) was utilized to identify patients ≥18 y who had AAT and received either open repair or EVAR. The overall mortality until discharge was analyzed based on the mechanism of injury, injury severity, and types of procedures received. Multivariable logistic regression was used to assess the independent association between each variable and in-hospital mortality. Patients who died before arriving at the operating room were excluded.

A total of 369 patients were included, with a median age of 32 y. The mechanisms of injury included gunshot wounds (46.3%), blunt trauma (39.6%), and stab wounds (14.1%). EVAR was performed in 14.9% and open repair in 81.0%. Overall mortality was 47.5%. On multivariable analysis, age ≥65 y (adjusted odds ratio [aOR]; 2.60; 95% confidence interval [CI], 1.09-6.21; P = 0.032), Glasgow Coma Scale ≤8 (aOR, 8.23; 95% CI, 4.50-15.05; P < 0.001), systolic blood pressure <90 mmHg (aOR, 3.76; 95% CI, 2.15-6.59; P < 0.001), blunt trauma (aOR, 3.48; 95% CI, 1.32-9.20; P = 0.012), and gunshot wounds (aOR, 3.87; 95% CI, 1.57-9.50; P = 0.003) were independently associated with increased mortality. EVAR was associated with lower mortality (aOR, 0.33; 95% CI, 0.13-0.83; P = 0.019) compared to open repair.

Among patients who survive the initial injury and make it to the operating room, AAT is still associated with significant mortality. EVAR was independently associated with a lower rate of mortality compared to open repair.