Complete Occlusion after Blunt Injury to the Abdominal Aorta

Meghoo, Colin A.; Gonzalez, Ernest A.; Tyroch, Alan; Wohltmann, Christopher

doi:10.1097/01.ta.0000039053.32562.c0

Cited by 32 publications

(7 citation statements)

References 24 publications

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“…9,10,15 Primary aortic repairs have been reported in adults but are less frequently performed, likely related to the higher incidence of concomitant atherosclerotic aortic disease found in approximately half of adult patients with BAAI. 9,15 Only a few cases of primary aortic repair in pediatric patients with vague follow-up are available for review. These were similarly treated with endarterectomy and in one case of aortic rupture, the repair was performed by thrombectomy and direct reanastomosis.…”

Section: Discussionmentioning

confidence: 99%

Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair

West

Johnson

Doucet

et al. 2011

Journal of Vascular Surgery

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Abdominal aortic injury as a result of blunt trauma is a rare event and has been described in few children. A 6-year-old girl presented with acute bilateral lower extremity ischemia, and a triad of acute aortic occlusion, intra-abdominal visceral injury, and a lumbar chance fracture after sustaining a seat belt injury from a motor vehicle collision. An emergency aortic thromboendarterectomy and primary repair were performed. This represents one of the few reports of acute traumatic aortic thrombosis in a child and highlights the surgical treatment of acute abdominal aortic injury in a pediatric patient.

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Section: Discussionmentioning

confidence: 99%

Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair

West

Johnson

Doucet

et al. 2011

Journal of Vascular Surgery

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“…7 Motor vehicle crashes cause half of these injuries, with forces in excess of 2,500 mm Hg, and other reported sources of trauma include cycling crashes, repetitive direct blows to the abdomen as in abuse, and crush injuries. 8,9 In a review of blunt aortic injury in children, the most frequent sites of injury were the abdominal aorta at the inferior mesenteric artery (37.5%), or near the renal arteries (37.5%). Injury below the inferior mesenteric artery at the aortic bifurcation was least common (25%).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Blunt Abdominal Aortic Trauma

Burjonrappa

Vinocur

Smergel

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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A ortic injury is a rare finding after blunt traumatic injury in children. Ninety-five percent of aortic injuries in blunt trauma occur in the thorax just distal to the left subclavian artery, at the junction of the tethered and mobile segments of the aorta. 1 Feczko, in an autopsy case review of 142 blunt injuries of the aorta, noted that only 6% were found in the abdominal segment. 2 Only 10 cases of blunt injuries to the abdominal aorta in the pediatric age group were identified in a review of the English language literature since 1960. We report a case with discussion on the clinical and radiologic findings, and the available treatment options. CASE REPORTA 9-year-old boy was brought to our Level I pediatric trauma resource center after a bicycle versus motor vehicle crash. The child had hit the front end of the vehicle and sustained injury to his abdomen. His primary survey revealed no cardiorespiratory instability (pulse of 90 bpm, a blood pressure of 90/60 mm Hg, and respirations of 22 breaths/min) and a Glasgow Coma Score (GCS) of 15. On secondary survey, his abdominal examination revealed a large bruise across the midportion of the abdomen. There was no distension, tenderness (except over the bruise) or guarding. His pelvis was stable, and he had palpable peripheral pulses, with ankle brachial indices (ABIs) of 1.0 bilaterally and no distal neurologic deficit. His hemoglobin at admission was 12.2 g/dL with a hematocrit of 36%. His medical history was significant for attention deficit disorder and an inpatient admission 6 months earlier for blunt abdominal trauma, caused by a handlebar injury, where he had contused his pancreatic parenchyma. A computed tomography (CT) scan (Fig 1) of the abdomen was obtained. It showed a localized dissection of the infrarenal aorta with an intimal flap. In addition it showed a large abdominal wall bruise and a Grade I laceration of the liver. In addition, there was a localized dissection of the infrarenal aorta with an intimal flap. The distal aorta demonstrated normal caliber and contrast opacification. Review of the CT done 6 months earlier revealed a pancreatic injury, and showed an intimal flap that had been missed. A magnetic resonance (MR) angiogram demonstrated a nearly 50% narrowing of the aorta at the site of injury with preserved flow distally (Fig 2). Considering the stable nature of the lesion during a period of 6 months, we elected a conservative strategy of observation in the intensive care unit, with serial hematocrits, ABIs, and clinical examination. The patient remained stable for 72 hours and was commenced on a regular diet before discharge. A vascular ultrasound examination performed before discharge demonstrated the intimal flap. A follow-up vascular ultrasound examination performed at 18 months showed a stable intimal flap and no pseudoaneurysm formation (Fig 3).

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“…Patients present with absent femoral and distal pulses in association with lower extremity neuropathy. Intervention commonly involves bypass grafting (2).…”

Section: Discussionmentioning

confidence: 99%

“…When this injury results in complete vessel occlusion, the presentation is dramatic. Timely intervention is essential (2).…”

Section: Introductionmentioning

confidence: 99%

Traumatic occlusion of the right external iliac and common femoral arteries

2009

IJTCVS

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Complete Occlusion after Blunt Injury to the Abdominal Aorta

Abstract: Complete occlusion after blunt trauma to the abdominal aorta is rare. Neurologic deficits most commonly arise from peripheral nerve ischemia. Reperfusion within 6 hours confers a greater chance of limb salvage and neurologic recovery.

Cited by 32 publications

References 24 publications

Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair

Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair

Pediatric Blunt Abdominal Aortic Trauma

Traumatic occlusion of the right external iliac and common femoral arteries

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