Endovascular aortic repair for abdominal aortic injury complicated with bowel injury due to blunt abdominal trauma: A case report

Murata, Takaaki; Ogino, Hidemitsu; Isogai, Naoko; Kashiwagi, Hirokazu; Shimoyama, Rai; Kawachi, Jun

doi:10.1016/j.ijscr.2021.106216

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…The most common cause is motor vehicle accidents, with an incidence of 57.5% and mortality rates of 28%-73% at discharge [ 3 , 9 , 10 ]. The most significant predictor of mortality in patients with AAI is hemopneumothorax, followed by inferior vena cava injury [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and selecting the best treatment option for the patient are essential to improve the survival rate and prognosis [ 7 ]. If AAI is not diagnosed in time or the treatment is delayed, it can lead to death due to hemorrhage or ischemia of organs [ 7 ]. Flow-limiting conditions of the visceral vessels and lower limbs can be overlooked without contrast-enhanced CTA.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of trauma, AAI is usually not isolated and is often seen in combination with spine injuries, intraperitoneal and retroperitoneal organ injuries, and abdominal wall injuries [ 5 , 6 ]. No standard guidelines for the treatment of AAI are available [ 7 ]. Published data suggest that conservative treatment with patient observation in the case of small pseudoaneurysms and intimal flaps appears safe [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…As AAI is extremely rare, no established treatment guidelines exist, and the therapy is mainly dependent on the decision of the multidisciplinary team (MDT) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Aortic Repair After Abdominal Aortic Injury in a Patient With an Aberrant Renal Artery

Lučev¹,

Breznik²,

Lamanovska³

et al. 2022

Cureus

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Abdominal aortic injury (AAI) due to blunt trauma is rare and is often complicated by thrombosis within the true and false lumens and sometimes aortic rupture. No standard guidelines for treatment are available. We present the case of a 44-year-old female patient with posttraumatic dissection of the abdominal aorta, which was referred to our institution for endovascular aortic repair (EVAR). The patient was referred to our institution after emergency surgery following blunt abdominal trauma due to a car accident. Initial computed tomography (CT), performed at the referring hospital, showed multiple bone injuries with pneumothorax, liver and spleen lacerations, and rupture of the anterior abdominal wall with mesenteric injury and active intraperitoneal extravasation of contrast media from visceral arteries. Initial CT also showed dissection of the distal part of the abdominal aorta. Due to hemodynamic instability, emergency surgery was performed for intraperitoneal injuries. Control computed tomography angiography (CTA) after surgery confirmed a dissection of the distal part of the abdominal aorta at the level of the bifurcation protruding into the right common iliac artery with partial thrombosis of the right iliac artery and no active extravasation of the contrast media at the level of the aorta. An aberrant left renal artery was also identified.A hemodynamically stable patient was transferred to our institution for emergency EVAR which was performed without intraprocedural complications. Control CTA after EVAR showed a good result of the procedure with minimal type 2 endoleak and no extravasation. EVAR can also be used to treat AAI without active extravasation to prevent future total rupture of the aortic wall.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…As AAI is extremely rare, no established treatment guidelines exist, and the therapy is mainly dependent on the decision of the multidisciplinary team (MDT) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Aortic Repair After Abdominal Aortic Injury in a Patient With an Aberrant Renal Artery

Lučev¹,

Breznik²,

Lamanovska³

et al. 2022

Cureus

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A worldwide systematic review of blunt abdominal aortic injury and analysis of predictors for death

Wang

et al. 2023

Preprint

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Background Blunt abdominal aortic injury (BAAI) is characterized by diverse clinical manifestations, evaluations, and treatment criteria, while very high mortality. At present, there are few studies on BAAI, and most of them are case reports. Methods By including available case reports world widely, a systematic review regarding the data of BAAI patients in characteristics, treatments, and outcomes was performed. And regression analysis of predictors for death after BAAI was conducted. Results The systematic search of Excerpta Medica Database, PubMed, Web of Science and Cochrane Library resulted in 2,099 hits. There were 102 case reports and 1 conference abstract met the inclusion criteria and were eligible for analysis. After assessment using the Joanna Briggs Institute (JBI) checklist, no low-quality studies were found. Then the data of 133 BAAI patients were concluded and analyzed. The median age of these patients was 34, and there were 98 (73.7%) males. Their most common clinical manifestation was pain (65.6%). The most common severity of aortic lesion was grade A (intimal tear or intramural hematoma) (46.9%), and the most common location of aortic lesion was zone III (infrarenal aorta) (88.3%). The overall mortality after BAAI was 15.3%. On multivariable regression analysis, the risk of death after BAAI was increased in patients with lower limb ischemia [relative risk (RR), 7.137; 95% confidence interval (CI), 1.154–44.161], cardiopulmonary arrest (RR, 10.250; 95% CI, 1.452–72.344), and injuries to other parts (other than abdomen and lumbar spine) of body (RR, 2.593; 95% CI, 1.189–5.655). Then on subgroup analysis, patients with BAAI in the presence of lower limb ischemia or injuries to other parts of body, whether undergoing primary or secondary operation, had lower mortality than those who underwent conservative observation (P < 0.05), but the mortality of BAAI patients who presented with cardiopulmonary arrest would not be affected by different treatment modalities (P = 1.000). Conclusions BAAI is a fatal disease. The above three variables are risk factors for death after BAAI. Operation (in any form) to BAAI patients who have these risk factors may reduce their mortality risks.

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A systematic review of blunt abdominal aortic injury and analysis of predictors for death

Li,

Wang,

et al. 2023

Preprint

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At present, there are few studies on blunt abdominal aortic injury (BAAI), and most of them are case reports. Little is known about this disease. So, a systematic review was conducted through extensive search of major databases. All literature that provided individual (non-identifiable) data for BAAI patients could be included without being limited by study design. Additionally, regression analyses of predictors for death after BAAI were conducted. The search resulted in 2,099 hits, and 102 case reports and 1 conference abstract included in the review then. After assessment using the Joanna Briggs Institute checklist, no low-quality studies were found. A total of 133 patients were included, with a median age of 34 and 73.7% being males. Their most common clinical manifestation was pain (65.6%). The most common severity of aortic lesion was grade A (intimal tear or intramural hematoma, 46.9%), and the most common location of aortic lesion was zone III (infrarenal aorta, 88.3%). The overall mortality after BAAI was 15.3%. The following are the predictors for death after BAAI identified through multivariate regression analyses: lower limb ischemia [relative risk (RR), 7.137; 95% conﬁdence interval (CI), 1.154-44.161], cardiopulmonary arrest (RR, 10.250; 95% CI, 1.452-72.344), and injuries to other parts (other than abdomen and lumbar spine) of body (RR, 2.593; 95% CI, 1.189-5.655). In conclusion, this study provides a detailed quantitative summary of the characteristics of the clinical manifestations, diagnosis, treatment, and prognosis of BAAI, a deadly traumatic disease, and indicates that the three variables above are risk factors for death.

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Endovascular aortic repair for abdominal aortic injury complicated with bowel injury due to blunt abdominal trauma: A case report

Cited by 4 publications

References 13 publications

Endovascular Aortic Repair After Abdominal Aortic Injury in a Patient With an Aberrant Renal Artery

Endovascular Aortic Repair After Abdominal Aortic Injury in a Patient With an Aberrant Renal Artery

A worldwide systematic review of blunt abdominal aortic injury and analysis of predictors for death

A systematic review of blunt abdominal aortic injury and analysis of predictors for death

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