Minimal Aortic Injury: A Lesion Associated with Advancing Diagnostic Techniques

Malhotra, Ajai K.; Fabian, Timothy C.; Croce, Martin A.; Weiman, Darryl S.; Gavant, Morris L.; Pate, James W.

doi:10.1097/00005373-200112000-00003

Cited by 118 publications

(115 citation statements)

References 31 publications

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“…Malhotra et al definen la lesión aórtica mínima (LAM) como el desgarro de la íntima de menos de un centímetro, sin anomalías aór-ticas ni sangrado periaórtico 7 . Algunos autores defienden el tratamiento conservador de la LAM en pacientes hemodinámicamente estables realizando un seguimiento por TACHT o ECOT 7,8 .…”

Section: Discussionunclassified

“…En el caso no intervenido, la lesión corresponde a una LAM y fue disminuyendo hasta desaparecer en la angio-RMN a los 15 días. La resolución espontánea de esta lesión ya ha sido considerada en otros trabajos 7,8 .…”

Section: Discussionunclassified

“…La gravedad de las lesiones asociadas no ha permitido en algunos casos un tratamiento quirúrgico con el que se obtengan buenos resultados 6 . Hay lesiones de aorta menos graves que se pueden tratar de forma conservadora 7,8 .…”

Section: Introductionunclassified

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Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

et al. 2008

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El traumatismo de aorta torácica es una lesión asociada a una alta morbimortalidad en el lugar del accidente. En los años noventa se generalizó el tratamiento mediante la colocación de un stent endovascular con buenos resultados. En este trabajo presentamos una serie de cinco casos clíni-cos de pacientes ingresados en la Unidad de Cuidados Intensivos de nuestro hospital durante el año 2006. De un total de 619 pacientes ingresados en el mismo periodo, 121 (19,5%) fueron traumá-ticos y 5 (4,13%) sufrían traumatismos de aorta torácica. Todos los pacientes fueron diagnosticados por tomografía computarizada helicoidal torácica al ingreso. Cuatro pacientes tenían un pseudoaneurisma de aorta y fueron intervenidos. Tres recibieron tratamiento endovascular dentro de las 36 primeras horas y el otro al vigesimoctavo día del ingreso. El quinto paciente presentó una lesión de la íntima y no se intervino. La evolución posterior fue buena en todos los casos.PALABRAS CLAVE: traumatismo de aorta torácica, tratamiento endovascular, politraumatismo. MANAGEMENT OF THORACIC AORTA TRAUMATISM IN 5 MULTIPLE TRAUMATIZED PATIENTSThoracic aorta traumatism is a lesion associated to high morbidity-mortality at the site of the accident. In the 90's, treatment by placement of an endovascular stent was generalized with good results. In this work, we present a series of 5 clinical cases of patients admitted to the Intensive Care Unit of our hospital during the year 2006. Out of a total of 619 patients admitted in the same period, 121 (19.5%) were traumatic and 5 (4.13%) had thoracic aorta traumatisms. All of the patients were diagnosed by thoracic helical computed tomography on admission. Four patients had a pseudoaneurism of the aorta and underwent an operation. Three received endovascular treatment within the first 36 hours and the fourth on day 28 of admission. The fifth patient had a lesion of the intima and was not operated on. Posterior evolution was good in all the cases. KEY WORDS: thoracic aorta traumatism, endovascular treatment, multiple traumatism.

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Section: Discussionunclassified

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Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

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“…7 With the higher mortality and paraplegia rates with open repair and the unknown durability of endovascular repair, attention is being refocused on the nonoperative management of selected patients with lesser degrees of BTAI, or minimal aortic injury (MAI). [8][9][10][11] The purpose of the present study was to review our centre's experience with nonoperative management of BTAIs and determine the natural history of these nonoperatively managed MAIs.…”

Section: Recherchementioning

confidence: 99%

“…8,9,11,[14][15][16][17] Most involved pa tients who were not surgical candidates for various reasons. An even smaller subset of studies involved the purposeful adoption of nonoperative management in MAI.…”

Section: Recherchementioning

confidence: 99%

Natural history of minimal aortic injury following blunt thoracic aortic trauma

Kidane

Abramowitz²,

Harris³

et al. 2012

Can J Surg

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Background: Endovascular repair of blunt traumatic thoracic aortic injuries (BTAI) is common at most trauma centres, with excellent results. However, little is known regarding which injuries do not require intervention. We reviewed the natural history of untreated patients with minimal aortic injury (MAI) at our centre. Methods:We conducted a retrospective database review to identify all patients with a BTAI between October 2008 and March 2010. The cohort comprised patients initially untreated because of the lesser degree of injury of an MAI. We reviewed initial and follow-up computed tomography (CT) scans and clinical information. Results:We identified 69 patients with a BTAI during the study period; 10 were initially untreated and were included in this study. Degree of injury included intimal flaps (n = 7, 70%), pseudoaneurysms with minimal hematoma (n = 2, 20%) and circumferential intimal tear (n = 1, 10%). Six (60%) patients were male, and the median age was 40 years. Duration of clinical follow-up ranged from 1 month to 6 years (median 2 mo) after discharge, whereas CT radiologic follow-up ranged from 1 week to 6 years (median 6 wk). Seven (70%) patients had complete resolution or stabilization of their MAI, 1 (10%) with circumferential intimal tear showed extension of the injury at 8 weeks postinjury and underwent successful repair, and 2 (20%) were lost to follow-up.Conclusion: There appears to be a subset of patients with BTAI who require no surgical intervention. This includes those with limited intimal flaps, which often resolve. Radiologic surveillance is mandatory to ensure MAI resolution and identify any progression that might prompt repair.Contexte : La plupart des centres de traumatologie ont souvent recours à la répara-tion endovasculaire des traumatismes fermés de l'aorte thoracique (TFAT), et cette dernière donne d'excellents résultats. Toutefois, on en connaît peu sur le type de blessures qui ne requièrent pas d'intervention. Nous avons passé en revue l'histoire naturelle des patients qui ont été vus dans notre centre pour un traumatisme léger de l'aorte, mais qui n'ont pas été traités.

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Thoracic Aortic Endografting for Trauma

Propper

Clouse²

2010

Arch Surg

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Endografting is the most frequently used method for repair of BAI. The use of TAET has led to reductions in operative mortality and spinal cord ischemia. Although experience seems promising, a new array of early and late complications must be considered. The positive experience with TAET thus far has provided impetus for endograft engineering and clinical trials specifically for BAI therapy. The ultimate late durability of TAET remains to be defined.

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Minimal Aortic Injury: A Lesion Associated with Advancing Diagnostic Techniques

Cited by 118 publications

References 31 publications

Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

Natural history of minimal aortic injury following blunt thoracic aortic trauma

Thoracic Aortic Endografting for Trauma

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