Role of conservative management in traumatic aortic injury: Comparison of long-term results of conservative, surgical, and endovascular treatment

Mosquera, Víctor X.; Marini, Milagros; López-Pérez, José; Muñiz, Javier; Herrera, José María; Cao, Ignacio; Cuenca, José

doi:10.1016/j.jtcvs.2010.10.044

Cited by 60 publications

(36 citation statements)

References 26 publications

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“…Injury can occur along the entire length of the aorta, essentially from the ascending aorta to the iliac bifurcation, although the injury typically occurs areas of aortic tethering, notably the aortic isthmus. There exist three major theories that account for the mechanism of injury (it is likely that they collectively explain the mechanism and not one explanation is correct by itself): primarily, the aortic isthmus is a transition zone from the unfixed aortic arch to the fixed descending aortathis area is predisposed to go in opposite vectors during a rapid deceleration and can lead to a tear in the intima [10,11]; secondly, weaker tensile strength exists in the tissue of the aortic isthmus making it intrinsically more vulnerable to injury [10,12]; and thirdly, a compression point between the anterior chest's osseous structures and the spine acts in a way that pinches the aorta during a deceleration trauma [10,13]. Porcine models identified an initial tear in the intima and media first from these forces causing a dissection [14].…”

Section: Introductionmentioning

confidence: 99%

Blunt thoracic aortic injury – concepts and management

Mouawad¹,

Paulisin²,

Hofmeister³

et al. 2020

J Cardiothorac Surg

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Background: Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to intracranial hemorrhage. Kinetic forces from the rapid deceleration are the impetus for the injury mechanism and are graded accordingly. Given the prevalence of trauma as a public health problem, contemporary management considerations are important. Main body: Blunt thoracic aortic injury may be fatal if not diagnosed and treated expeditiously. Endovascular options allow safe and effective management of these dangerous injuries. This paper describes the overview of blunt thoracic aortic trauma, the epidemiology, presentation, diagnosis, and treatment options with a focus on endovascular management. Conclusion: Blunt thoracic aortic injury requires a high index of suspicion based on mechanism of injury in the trauma population. Endovascular options have become the mainstay of blunt thoracic aortic injury treatment whenever feasible with satisfactory results and long-term outcomes.

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Section: Introductionmentioning

confidence: 99%

Blunt thoracic aortic injury – concepts and management

Mouawad¹,

Paulisin²,

Hofmeister³

et al. 2020

J Cardiothorac Surg

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“…Therefore, haemodynamically unstable patients may have two distinct pathophysiological processes—patients with full-thickness tear of the aorta and patients with other sources of clinically significant haemorrhage from associated injuries to the chest or abdomen 26. It is the latter group that is more likely to be seen in hospital, though patients may present without haemodynamic instability at all if major associated injuries are not present.…”

Section: Discussionmentioning

confidence: 99%

Do patients with blunt thoracic aortic injury present to hospital with unstable vital signs? A systematic review and meta-analysis

et al. 2018

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“…The in-hospital mortality rate was only 8% in this study. Mosquera et al (34) studied 66 patients with acute thoracic aortic pathology and reported higher short and long-term survival rates in the endovascular treatment group than in the surgical and conservative groups.…”

Section: Discussionmentioning

confidence: 99%

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

İslim

Salık²,

Güven³

et al. 2014

Diagn Interv Radiol

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consecutive patients (nine males, two females; age range, 26-80 years) with thoracic and abdominal aortic ruptures underwent endovascular repair in our unit. Thoracoabdominal computed tomography (CT) angiography was performed for diagnosis and follow-up. Patients were selected for endovascular repair by a cardiovascular surgeon, anesthesiologist, and interventional radiologist. All repairs were performed using commercially available stent-grafts. The patients were followed up with CT angiography before discharge, at six months, and yearly thereafter. RESULTSThree patients died by day 30. One patient died due to an unsuccessful procedure and hemodynamic instability; two patients died because of comorbidities. The other eight patients were followed for six to 24 months after the procedure. No endoleaks or late ruptures were observed during the follow-up period. The patient with iatrogenic thoracic aortic rupture developed paraplegia after the procedure. CONCLUSIONReduced mortality due to aortic rupture has been reported with the expanding use of endovascular repair. Reports of small centers are important because of the rarity of these pathologies, and because transferring patients with aortic rupture to a referral center is not usually possible.

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Role of conservative management in traumatic aortic injury: Comparison of long-term results of conservative, surgical, and endovascular treatment

Cited by 60 publications

References 26 publications

Blunt thoracic aortic injury – concepts and management

Blunt thoracic aortic injury – concepts and management

Do patients with blunt thoracic aortic injury present to hospital with unstable vital signs? A systematic review and meta-analysis

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

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