The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta

Cook, Judy; Salerno, Christopher T.; Krishnadasan, Baiya; Nicholls, Stephen C.; Meissner, Mark H.; Karmy‐Jones, Riyad

doi:10.1016/j.jtcvs.2005.10.030

Cited by 91 publications

(78 citation statements)

References 37 publications

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“…Although endovascular repair of TAI using abdominal aortic components has been reported, we have generally limited the endovascular approach at our institution to patients who met sizing criteria for off-label use of thoracic devices. [12][13][14] (We made one exception in the case of a pediatric patient with an enlarging pseudoaneurysm who was not a candidate for open repair.…”

Section: Discussionmentioning

confidence: 99%

Blunt traumatic aortic injury: Initial experience with endovascular repair

Azizzadeh

Keyhani

Miller

et al. 2009

Journal of Vascular Surgery

356

262

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Section: Discussionmentioning

confidence: 99%

Blunt traumatic aortic injury: Initial experience with endovascular repair

Azizzadeh

Keyhani

Miller

et al. 2009

Journal of Vascular Surgery

356

262

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“…Patients diagnosed by emergent thoracotomy or who died in the emergency department before intervention were excluded or categorized separately (6,30,33,36,37,39,41).…”

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

“…Despite a decrease in the incidence of motor vehicle crash injuries (1,2), most trauma centers report an increased number of patients with BTAI (3)(4)(5)(6)(7). This may be a result of a decrease in prehospitalization mortality rates from 90% to 63% associated with the implementation of automobile safety measures and improved in-field management and transport (8,9).…”

mentioning

confidence: 99%

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Hoffer

Forauer

Silas

et al. 2008

Journal of Vascular and Interventional Radiology

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“…Postmortem incelemelerde ise her dört boşluğun da eşit oranda etkilendiği bildirilmiştir (8,9). Torasik aort yaralanması olan hastalarda künt kalp yaralanması insidansı %3.6 ile %63 arasındadır (10,11). Torasik aort yaralanması olan hastalarda künt kalp yaralanması sıklığı, torasik aort yaralanması olmayan travmalı hastalara göre daha yüksektir (12).…”

Section: Künt Kalp Yaralanmalarıunclassified

Cardiac Trauma

Özkaynak¹,

Gümüş²,

Polat³

et al. 2014

JAREM

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ÖZETKalp ve büyük damar yaralanmaları künt, penetran veya iatrojenik nedenlere bağlı olabilir. Travmaya bağlı ölümlerin yaklaşık %25'i toraks yaralanmalarına bağlıdır. Künt yaralanmaların en sık nedeni yüksek enerjili trafik kazalarıdır. Bu hastaların %5'i müdahale şansı bulabilmektedir. Künt travma hikayesi olan hastalar, semptomatik olsun veya olmasın, miyokard enfarktüsü geçirmiş veya geçirmekteymiş gibi çok yakından takip edilmelidir. Künt travmaya bağlı perikardiyal ve epikardiyal kanama, miyokard kontuzyonu ve nihayetinde miyokardda laserasyon oluşur. Ventrikül ve atrial rüptür, atriyoventriküler septumda, ventriküler septumda rüptür, papiller adalelerde rüptüre bağlı mitral veya triküspid kapaklarda akut yetmezlik, koroner arterlerde fistüli-zasyon, laserasyon ve/veya tromboz, pulmoner venlerde rüptür gözlenebilir. Penetran yaralanmalar kesici delici alet ve ateşli silah ile yaralanmalara, iatrojenik, tanısal veya tedavi amaçlı girişimlere bağlı, oluşabilir. Kalp yaralanmalarında, hastanın travma bölgesinden müdahale edileceği merkeze en hızlı şekilde sevk edilmesi bu hastalar için hayatta kalımı etkileyen en önemli faktördür. Belirgin şok ve/veya tamponad bulgusu olan hastalarda ileri tetkik beklenmeden, ameliyathaneye alınarak müdahaleye başlanmalı, gerekirse sıvı yollarının yerleştirilmesi beklenmeden cerrahi girişime başlanmalıdır. Basit yaralanmalar, primer olarak onarılabilirse de çok büyük miyokard hasarlanmasında veya intrakardiyak yaralanmalarda (valvül hasarı, septal defekt oluşumu, eşlik eden ve koroner arter bypass gerektiren durumlar, vb.) kardiyopulmoner bypass altında onarım gerekebilir. Hemodinamisi stabil olan hastalarda ise ilk 48 ile 72 saat çok yakın takip şarttır. (JAREM 2014; 2: 45-8) Anahtar Sözcükler: Kardiyak travma, kardiyak yaralanma, künt travma, penetran yaralanma ABSTRACT Advances in cardiac surgery over the past decades have enabled more efficient, complex and successful repairs of cardiac injuries. Cardiac injuries may be caused by blunt, penetrating or iatrogenic trauma. 25% of the trauma related deaths are caused by chest trauma. The lethal nature of this injury is due to the high concentration of major vascular and visceral structures within the mediastinum. The most common cause of blunt cardiac injury is high impact motor vehicle accidents. Other sources of blunt cardiac trauma are falls from heights, crush injuries and athletic injuries. Only 5% of these patients would receive medical intervention. Blunt trauma causes pericardial and epicardial hemorrhage and myocardial contusion. Myocardial contusion may range in severity from minor subepicardial hematoma to larger extravasations including the full thickness of the myocardium. Larger contusions lead to necrosis which may heal by scarring or may lead to lethal rupture of the myocardium. Rupture in the ventricles, atria, atrioventricular septum and pulmonary veins can be seen. Rupture in papillary muscles may lead to acute mitral or tricuspid failure. Fistulization, laceration and thrombosis in the coronary arteries...

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The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta

Abstract: The improved outcome over the decade since the initial experience reflects both a reduced severity of injury attributable to restraint systems and a more flexible approach to the acute management, which can modify the effect of associated injuries.

Cited by 91 publications

References 37 publications

Blunt traumatic aortic injury: Initial experience with endovascular repair

Blunt traumatic aortic injury: Initial experience with endovascular repair

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Cardiac Trauma

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