Management of Blunt Thoracic Aortic Injury

Nzewi, Onyekwelu; Slight, Robert; Zamvar, Vipin

doi:10.1016/j.ejvs.2005.06.031

Cited by 74 publications

(24 citation statements)

References 75 publications

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“…The 11% of patients with acute TATs and less serious associated injuries who survive for more than 6 h after trauma owe their lives to perivascular hematomas and the periadventitial tissues, which maintain blood within the aorta (1,2). Although the aortic isthmus (between the left subclavian and the third intercostal artery) is the injury site reported in 54% to 65% of acute TAT cases in autopsy series, it is the region involved in 84% to 100% of patients arriving at the hospital alive (1,3). This discrepancy is most likely explained by the protection conferred by the periadventitial aortic isthmus tissues against free rupture, which allows for transfer to a hospital (1).…”

mentioning

confidence: 82%

Unsuspected chronic traumatic aortic pseudoaneurysm – what to do about it. Late post-traumatic aortic pseudoaneurysm

Marcu

Nijveldt

Rossum

2008

Canadian Journal of Cardiology

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A 59-year-old man presented to his primary care physician with complaints of precordial discomfort, which occurred one week earlier while running to catch a bus. The discomfort, described as a "heavy weight on the chest", lasted for 5 min, was unrelated to position or respiration, subsided with rest and did not recur. His prior history included hypercholesterolemia, systemic hypertension, cigarette smoking (one pack per day for 35 years) and involvement in a serious motor vehicle accident 30 years previously.An electrocardiogram performed at rest demonstrated no abnormalities. The diagnosis of new-onset effort angina pectoris was made; atenolol 50 mg daily was added to the patient's previous medication regimen, which included acetylsalicylic acid 80 mg, hydrochlorothiazide 25 mg and atorvastatin 80 mg daily. The patient was referred for cardiac catheterization. Coronary angiography demonstrated 50% diameter stenosis of the mid-left anterior descending artery and 75% diameter stenosis of a small, heavily calcified first obtuse marginal branch. An ill-defined dense area was seen during fluoroscopy in the upper mediastinum. Chest radiography was performed and showed an area of calcification in the proximal descending aortic region ( Figures 1A and 1B).The patient was referred for cardiovascular magnetic resonance imaging (CMR) for better assessment of the aortic findings. CMR demonstrated an oval-shaped structure measuring 2.5 cm × 3 cm, situated on the medial aspect of the proximal descending thoracic aorta (aortic isthmus) and connected to the aortic lumen through a narrow 'neck' -a finding consistent with an aortic pseudoaneurysm (Figures 2A, 2B and 2C). The pseudoaneurysm was situated in the aortic isthmus, opposite from the insertion point of the ligamentum arteriosus, a typical location for deceleration aortic injury (1).The patient underwent adenosine technetium-99m myocardial perfusion imaging to assess the coronary stenosis functional significance while on beta-adrenoreceptor blocker therapy. Only a small area of mild, reversible defective activity in the inferolateral region (perfused by the obtuse marginal arteries) was demonstrated. Because the patient had no further anginal symptoms, no evidence of ischemia in the left anterior descending artery territory, and because the lesion of the obtuse marginal was not suitable for percutaneous revascularization, isosorbide dinitrate (30 mg orally once daily) was added to his previous medical regimen. In consultation with the cardiothoracic surgery service, a decision was made to treat the otherwise asymptomatic aortic pseudoaneurysm medically by controlling the patient's blood pressure using beta-blockers (target systolic blood pressure of lower than 120 mmHg) and follow up with a CMR examination of the aorta in six to 12 months. A 59-year-old man with multiple risk factors for coronary artery disease who had been in a motor vehicle accident 30 years earlier presented with new-onset angina pectoris. During cardiac catheterization, an ill-defined dense area was ...

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mentioning

confidence: 82%

Unsuspected chronic traumatic aortic pseudoaneurysm – what to do about it. Late post-traumatic aortic pseudoaneurysm

Marcu

Nijveldt

Rossum

2008

Canadian Journal of Cardiology

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“…[4] Eşlik eden şiddetli yaralanmalar ve diğer medikal problemlerin açık cerrahiyi yüksek riskli hale getirdiği durumlarda operasyonun geciktirilmesi önerilmektedir. [5] Cerrahi risk makul seviyeye ininceye dek hastaya tansiyon kontrolünün yanısıra kalbin inotropik gücünü de azaltmayı hedefleyen anti-impuls tedavi uygulanır. Böylece doku bütünlüğü bozulmuş aorta etki eden kuvvetler azaltılmakta, rüptür riski dü-şürülmektedir.…”

Section: Dr Siyami Ersek Göğüs Kalp Damar Cerrahisi Eğitim Ve Araştırmaunclassified

Endovascular repair in acute traumatic aortic transection: a case report

Sanioglu¹,

Şahin²,

Aydogan³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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1Yüksekten düşme sonucu 10. ve 11. torakal vertebralarda burst kırığı, parapleji ve akut aort transeksiyonu saptanan 38 yaşındaki erkek hasta, transeksiyon tedavisi amacıy-la merkezimize sevk edildi. Eşlik eden ciddi yaralanmalar nedeniyle cerrahi onarım yüksek riskli bulundu. Transeksiyon endovasküler yöntemle, 30x100 mm Vailant torasik endogreft, sol karotis arter ostiyumunun hemen distaline yerleştirilerek onarıldı. Hasta olağan seyreden servis takibinin ardından nöroşirürji servisine, parapleji tedavisinin devamı amacıyla geri gönderildi. Akut transeksiyon tedavisinde endovasküler yöntemler cerrahi onarı-ma oranla morbidite ve mortalitede önemli avantajlar sağ-lamaktadır. Ancak torasik endogreftlerin uzun dönem sonuçları halen bilinmemektedir. Orta dönemde elde edilen umut verici sonuçlar uzun dönemde de sağlanabilirse, endovasküler onarım altın standart haline gelebilir. A thirty-eight-year-old male patient who suffered from 10th and 11th thoracal vertebrae fractures, paraplegia and acute traumatic aortic transection because of accidental fall was referred to our hospital. Open surgical repair carried a very high risk due to severe coexisting injuries. Transection was treated with 30x100 mm Valiant thoracic endograft, which was deployed just distal to the ostium of the left carotid artery. The patient was transferred to the neurosurgery clinic for treatment of paraplegia after an uneventful recovery. Endovascular repair of acute transection confers substantial advantages in mortality and morbidity compared to surgical repair. However, the long-term durability of thoracic endografts remains unknown. If the long-term results are as satisfactory as the promising mid-term results, this technique may become the gold standard approach for the treatment of acute transection.

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“…1,2 Only 15 to 20% of the victims reach the hospital alive. The injury is located in the ascending aorta in only 3% of the survivors.…”

Section: Imaging In Cardiologymentioning

confidence: 99%

Traumatic ascending aortic transection in a patient with a subdural haematoma: timing of surgery

Jong¹,

Sloot²

2009

NHJL

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Management of Blunt Thoracic Aortic Injury

Cited by 74 publications

References 75 publications

Unsuspected chronic traumatic aortic pseudoaneurysm – what to do about it. Late post-traumatic aortic pseudoaneurysm

Unsuspected chronic traumatic aortic pseudoaneurysm – what to do about it. Late post-traumatic aortic pseudoaneurysm

Endovascular repair in acute traumatic aortic transection: a case report

Traumatic ascending aortic transection in a patient with a subdural haematoma: timing of surgery

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