Acute posttraumatic rupture of the thoracic aorta: The role of angiography in a 7-year review

Pozzato, C; Fedriga, E; Donatelli, Francesco; Gattoni, F

doi:10.1007/bf02577892

Cited by 18 publications

(3 citation statements)

References 17 publications

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“…1 CT angiography (CTA) has been shown to be more sensitive. 2 In a prospective study of over 490 patients with blunt aortic injury the reported sensitivity of CT was 100% compared with 92% for aortography. 3 With improvements in technology and image quality, CTA has replaced aortography as the primary screening modality.…”

Section: Q: What Additional Evaluation/imaging Is Necessary?mentioning

confidence: 99%

Blunt aortic injury

O’Connor

2015

Trauma

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Section: Q: What Additional Evaluation/imaging Is Necessary?mentioning

confidence: 99%

Blunt aortic injury

O’Connor

2015

Trauma

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“…Thoracic aortography is considered to be the gold standard for assessment of traumatic aortic injury. 18,50,51,67 It is accomplished by inserting a multisidehole pigtail catheter into the ascending aorta. This is usually done via a femoral approach, but an upper extremity approach can be advantageous in the setting of pseudocoarctation (narrowing of the aorta due to compression from surrounding pseudoaneurysm) or other cause of diminished femoral pulses.…”

Section: Definitive Imagingmentioning

confidence: 99%

Imaging and Endovascular Intervention for Thoracic Vascular Trauma

2003

Semin intervent Radiol

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This article describes mechanisms, manifestations, imaging, and endovascular treatment of thoracic vascular injuries. Improvements in automotive safety features have decreased the overall likelihood of traumatic rupture of the aorta (TRA) resulting from a collision. At the same time, reports of survival and successful repair after rupture of the ascending aorta have increased. Imaging of thoracic vascular injuries has also changed substantially during the last 5 to 10 years. Helical computed tomography (CT) now plays an extremely important role. After obtaining a high-quality contrast-enhanced helical CT, one can determine the presence or absence of TRA, quickly and noninvasively providing satisfactory information for surgical planning in most cases. Transesophageal echocardiography (TEE) is being investigated as a bedside modality to assess for TRA, but this method is limited by "blind spots" in the great vessels and the increasingly important ascending aorta. Arteriography is largely supplanted by CT in this clinical setting, but is still helpful in the unusual situation of equivocal CT results. Arteriography also provides access for a growing number of endovascular interventions. In small thoracic arteries where preservation of flow is not critical, such as in the internal mammary, embolotherapy can achieve hemostasis expediently. A growing number of case reports and small series describe the use of covered stents and stent grafts for endovascular repair of the thoracic aorta and great vessels where flow must be preserved. The major potential advantages are speed, minimal invasiveness, and a decrease in morbidity (such as paraplegia) and mortality. Although initial experience has been quite favorable, the long-term effects of these endoprostheses are unknown. Device refinements and prospective trials will be necessary to determine which of these devices are the best and/or most appropriate ones.Objectives: Upon completion of this article, the reader should be able to (1) describe the clinical setting and mechanisms by which TRAs occur, (2) correlate the pathologic and radiologic appearance with an understanding of the role of various imaging modalities (x-ray, CT, TEE), (3) discuss the evolving role of arteriography in diagnosis and endovascular treatment, and (4) list other injuries to the great vessels and consider interventional options for management. Accreditation: Tufts University School of Medicine (TUSM) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. TUSM takes responsibility for the content, quality, and scientific integrity of this CME activity. Credit: TUSM designates this educational activity for a maximum of 1 Category 1 credit toward the AMA Physicians Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.Downloaded by: Universite Laval. Copyrighted material.

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“…[21][22][23][24][25][26] Traditionally, angiography was the gold standard diagnostic test for BAI. [27][28][29] Angiography well defines the anatomy of the branches of the aortic arch and their possible involvement in the lesion. 22,30,31 Aortography can detect BAI with 96 per cent sensitivity and 98 per cent specificity.…”

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confidence: 99%

CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

Zaw

Stewart

Murry

et al. 2016

The American Surgeon™

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Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition. Rapid diagnosis is important to appropriately treat patients. The purpose of this study was to compare CT with intravenous contrast (CTI) to CT with angiography (CTA) in the initial evaluation of blunt chest trauma patients. This was a retrospective review of all blunt trauma patients who received a CTI or CTA during the initial evaluation at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Two-hundred and eighty-one trauma patients met inclusion criteria. Most, 167/281 (59%) received CTI and 114/281 (41%) received CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale in emergency department. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified an injury in 54 per cent compared with 46 per cent in CTA ( P = 0.05). Overall, 2 per cent of patients had BAI with similar rates in CTI and CTA (2% vs 2%, P = 0.80). BAI was not missed using either CTI or CTA. Trauma patients studied with CTI had similar diagnostic findings as CTA. CTI may be preferable to CTA during the initial assessment for possible BAI because of a single contrast injection for whole body CT.

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Acute posttraumatic rupture of the thoracic aorta: The role of angiography in a 7-year review

Cited by 18 publications

References 17 publications

Blunt aortic injury

Blunt aortic injury

Imaging and Endovascular Intervention for Thoracic Vascular Trauma

CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

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