Advances in the treatment of blunt thoracic aortic injuries

Challoumas, Dimitrios; Dimitrakakis, Georgios

doi:10.1016/j.injury.2014.10.065

Cited by 9 publications

(7 citation statements)

References 54 publications

(151 reference statements)

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“…The Society for Vascular Surgery published clinical practice guidelines stating that TEVAR should be preferentially used over open repair and nonoperative management and that repair should be urgently performed within 24 h after the injury [ 12 ]. However, Di Eusanio et al [ 13 ] and Challoumas and Dimitrakakis [ 14 ] stated that delayed repair 15 to 302 days after the injury was associated with satisfactory outcomes. The timing of repair depends on the extent of injury of the thoracic aorta and other organs.…”

Section: Discussionmentioning

confidence: 99%

Open stent graft repair with upper-half Sternotomy for blunt thoracic aortic injury: a case report

Komatsu

Tamaki

Kehara

et al. 2017

J Cardiothorac Surg

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BackgroundThoracic endovascular aortic repair is now widely applied to the treatment of blunt aortic injury. However, its long-term outcomes remain unclear. Endoleakage and migration might occur in the long term, especially when younger patients undergo endovascular aortic repair. In open stent grafting, the proximal end of the open stent graft is directly sutured to the native aorta, which may reduce the risk of endoleakage and migration. We applied open stent grafting to the treatment of blunt aortic injury in the subacute phase and herein report the patient’s clinical course.Case PresentationA 20-year-old man with a developmental disorder collided with a steel tower while skiing. He was transferred to our hospital by helicopter. X-ray examination and computed tomography revealed fractures of left humeral head and femoral neck and aortic isthmus dissection. We did not perform an acute-phase operation because of the presence of multiple trauma and instead performed open stent grafting with an upper-half sternotomy 42 days after the injury. He recovered uneventfully without psychological problems other than his preexisting developmental disorder. No endoleakage or aneurysm was observed during an 18-month follow-up period.ConclusionsOpen stent grafting might be an alternative to open surgery and thoracic endovascular aortic repair for blunt chest trauma, although intensive follow-up is needed.

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Section: Discussionmentioning

confidence: 99%

Open stent graft repair with upper-half Sternotomy for blunt thoracic aortic injury: a case report

Komatsu

Tamaki

Kehara

et al. 2017

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…3 Thoracic endovascular repair has been associated with fewer early postoperative complications when compared with open repair. [4][5][6][7] Grading of blunt aortic injuries by computed tomography allows for selective nonoperative treatment of lowrisk lesions (intimal tears and intramural hematoma). 5,6 Medical treatment with β-blockade targeting a systolic blood pressure of 100 to 120 mm Hg with delayed repair may be preferred in patients with high-risk lesions (pseudoaneurysms and rupture) who are stable or have significant associated injuries.…”

mentioning

confidence: 99%

“…[4][5][6][7] Grading of blunt aortic injuries by computed tomography allows for selective nonoperative treatment of lowrisk lesions (intimal tears and intramural hematoma). 5,6 Medical treatment with β-blockade targeting a systolic blood pressure of 100 to 120 mm Hg with delayed repair may be preferred in patients with high-risk lesions (pseudoaneurysms and rupture) who are stable or have significant associated injuries. 5 Factors associated with a high risk of progression in patients with pseudoaneurysms include hypotension, a large pseudoaneurysm, and extensive mediastinal hematoma.…”

mentioning

confidence: 99%

“…It is also associated with lower rates of renal failure and spinal cord ischemia. 6,7 Guidelines of the Society for Vascular Surgery recommend thoracic endovascular repair as the preferred treatment modality in all patients with suitable anatomic criteria, regardless of age. 6,8 Patient Outcome This patient subsequently underwent abdominal wall closure and definitive repair of his orthopedic injuries.…”

mentioning

confidence: 99%

“…6,7 Guidelines of the Society for Vascular Surgery recommend thoracic endovascular repair as the preferred treatment modality in all patients with suitable anatomic criteria, regardless of age. 6,8 Patient Outcome This patient subsequently underwent abdominal wall closure and definitive repair of his orthopedic injuries. This case highlights the importance of careful imaging in multiple-trauma patients with severe deceleration injuries, with liberal use of computed tomography and the need for careful decision making in these patients who have multiple life-threatening injuries.…”

mentioning

confidence: 99%

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