Optimal Management of Traumatic Aortic Injury

Abstract

For many years traumatic aortic injury has been considered a highly lethal lesion and a potential cause of death in blunt chest trauma. Because of the lower invasivity endovascular repair can be applied in traumatic aortic injury with very low risk and limited impact on trauma destabilization. Long term follow-up seems indicate a substantial durability of the procedure.

Endovascular treatment for traumatic thoracic aortic pseudoaneurysm: a case report

“…The isthmus, a part of relatively mobile thoracic aorta joining the fixed arch and the insertion of the ligamentum arteriosus, becomes the most commonly injured site in deceleration accident, with an involved incidence of 80% and 90–95% in the pathological and clinical series, respectively [1-8]. …”

“…Survival patients in the initial phase of TAI have a higher successful outcome under endovascular repair comparative of conventional open surgical repair [1-8]. The predictors of TAI include age older than 50 years, being unrestrained, systolic blood pressure of less than 90 mmHg, thoracic injury, abdominopelvic injury with fractures of the lumbar spine and pelvis, long bone fractures, and major head injury [7].…”

“…A prompt diagnosis of traumatic TAPA through a 3-dimensional CTA of aorta and emergency repair with stent graft are mandatory to rescue the life-threatening condition. An endovascular repair is a trend with greater and greater acceptance for TAI because of lower invasivity, avoiding thoracotomy and use of heparin, lower morbidity and mortality compared with conventional open surgical repair [1-10]. …”

“…The risk of aortic rupture in traumatic aortic injury has been reported approximately 5% in the acute phase [1]. Thoracic aortic pseudoaneurysm is a rare and life-threatening complication of traumatic aortic injury with an incidence of 2%–5% [2].…”

“…The most commonly involved site is isthmus. 93%–98% of patients with traumatic aortic injury have been a definitive diagnosis by computed tomographic scan and thoracic aortic pseudoaneurysm in computed tomographic scan is a direct sign of traumatic aortic injury [1-3]. In hemodynamic unstable patients of traumatic aortic injury, an endovascular treatment with stent-graft offers a suitable alternative to open surgical intervention [1,4-8].…”