Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort

Boutin, Louis; Caballero, Marie-Josée; Guarrigue, Delphine; Hammad, Emmanuelle; Rennuit, Isabelle; Delhaye, Nathalie; Neuschwander, Arthur; Meyer, Alain; Bitot, Valérie; Mathais, Quentin; Boutonnet, Mathieu; Julia, Pierre; Mercier, Olaf; Duranteau, Jacques; Hamada, Sophie

doi:10.1016/j.ejvs.2021.09.043

Cited by 11 publications

(3 citation statements)

References 28 publications

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“…Therefore, the diagnosis of this potentially fatal condition at an appropriate time is not always straightforward. On the other hand, early diagnosis, especially in severe cases, has been associated with a significant reduction in the risk of morbidity and mortality [ 10 ]. The initial evaluation almost always begins with an anteroposterior chest X-ray.…”

Section: Discussionmentioning

confidence: 99%

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Sadeghian,

Ebrahimi,

Soltani

et al. 2024

Int J Emerg Med

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Background Blunt traumatic aortic injury (BTAI) is the second leading cause of death due to traumas in young patients. The primary presentation might be chest or interscapular pain, difficulty in breathing, and, in severe cases, hypotension. Considering the rapid deterioration of these patients’ clinical conditions, prompt diagnosis and treatment initiation are crucial. In these injuries, the most involved parts of the aorta are the isthmus (distal to the left subclavian artery) and the descending part in the thorax. Therefore, the main diagnostic strategies include transthoracic echocardiography, CT angiography, and endovascular diagnostic approaches. Case presentation The patient was a 19-year-old male presenting with the symptoms of chest pain, dyspnea, and extremities excruciating pain after a car turnover. The initial evaluation showed no abnormal cardiovascular finding except bilateral hemothorax, addressed with chest tubes. Twelve hours later, when the patient was under observation for orthopedic surgeries, his chest pain and dyspnea started, and TTE and CTA showed a grade three descending aneurysm of the aorta. The patient was treated immediately with an endovascular procedure of stent implantation. A delayed debranching surgery was also performed, which resulted in desirable outcomes and uneventful follow-up. Conclusion Although open thoracic surgery is the main and almost the only option for treating aneurysms of the aorta in hemodynamically unstable patients, the endovascular procedure has shown superior outcomes in selected patients with appropriate anatomy. Debranching surgery, which can be done simultaneously or with delay after the initial procedure, has proven protective against thromboembolic cerebral events. Clinical key point Patients with an aneurysm of the aorta should be transported to a medical center with a multidisciplinary team for an urgent evaluation and treatment. The initial resuscitation and diagnosis are challenging, considering the fatal nature of these injuries, and the selection of the treatment is based on the patient's clinical condition and evaluated anatomy in cardiovascular imaging.

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Section: Discussionmentioning

confidence: 99%

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Sadeghian,

Ebrahimi,

Soltani

et al. 2024

Int J Emerg Med

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“…The diagnosis of this TAI largely depends on the initial CT and clinical manifestations such as a hemorrhagic shock after injury. For acute BTAI, only about 20% of patients can make it to the hospital, and more than 40% die during their hospital stay ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Wang¹,

Wu²,

Guo³

et al. 2022

J Thorac Dis

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Background: Delayed thoracic aortic injury (DTAI) induced by left closed rib fractures (RFs) is a clinically rare blunt injury to the thoracic aorta with an insidious onset. DTAI is very prone to missed diagnosis due to the unreliability of using the initial post-injury computed tomography (CT) scan to explicitly detect any signs of an aortic injury, potentially leading to a fatal hemorrhage. Timely diagnosis and treatment are therefore key to preventing such deadly complications. With that said, not all cases of left RFs lead to delayed aortic injuries, so how can surgeons tell which cases are to be culled and focused on? Also, what kinds of treatment should be administered upon detection? Methods: A retrospective analysis was performed on the clinical data of DTAI cases induced by left closed RF that were admitted to our Hospital from June 2015 through June 2020. Injuries to the aortic tunica adventitia or the elastic layer were intraoperatively confirmed. CT scan findings, locations and numbers of RFs, as well as the choices of surgical procedure were reviewed postoperatively. In addition, a literature review was conducted to analyze characteristics shared by similar cases.Results: This study included 7 patients treated by our hospital and 8 reported in the literature. The broken ends of RFs causing aortic wall injury (including the tunica adventitia) were all found in the medial to the lateral erector spinae. All patients in our hospital received internal fixation for RFs and thoracoscopic removal of free bone fragments (if any). Concomitant injuries were managed either by simultaneous or staged surgery.Conclusions: For multiple left RFs with the broken ends located in the inside of the lateral erector spinae, the number of fractured ribs ≥4 and a smaller number of fractured ribs with multiple fractures in a single rib are important factors for DTAI. Active surgical intervention is recommended for patients with these important factors. The specific intervention is tailored to each patient's particular needs to eliminate the risk of developing life-threatening thoracic aortic injury (TAI) and rupture.

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“…Early diagnosis of BTAI is crucial to reduce mortality rates, particularly in severely diseased patients. Boutin et al, in fact, in their multicenter retrospective study, found that the time to diagnosis increased with the severity of the aortic injury and the clinical severity of the patients [10].…”

Section: Diagnosismentioning

confidence: 97%

Blunt Thoracic Aortic Injury

Mazzaccaro

Righini

Fancoli

et al. 2023

JCM

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Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI.

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Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort

Cited by 11 publications

References 28 publications

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Blunt Thoracic Aortic Injury

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