Traumatic rupture of the thoracic aorta: Ten years of delayed management

Abstract

Improvement of patient outcome with traumatic rupture of the thoracic aorta can be achieved by delaying surgical repair until after management of major associated injuries if there are no signs of impending rupture. Endovascular treatment is feasible and safe and may represent a valid alternative to open surgery in selected cases.

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

“…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).…”

“…A diagnostic pigtail catheter was placed in the ascending aorta and an angiogram was obtained to confirm the diagnosis and preoperative measurements. Brachial access was used for the diagnostic catheter at 37% of the centers; left at five (33,34,37,41) and right at three (39,40,42). A femoral approach for stent-graft delivery was preferred, although external iliac or aortic access was required in 11% of patients as a result of vessel size or delivery device length limitations (6,40,41,45).…”

“…Deployment was performed under fluoroscopic guidance. To minimize the "windsock effect" that could displace the partially deployed graft, half the authors reduced systolic blood pressure pharmacologically to 70 mm Hg (range, 50 -90 mm Hg) (33,42,45), whereas 16% administered adenosine to induce asystole (6,29,38). A confirmation digital subtraction angiogram assured exclusion of the lesion.…”

Injury to the Thoracic Aorta Following Fatal Blunt Trauma: An Autopsy Study

“…The use of endovascular devices may be a good strategy in these emergency or urgent cases, because it allows early treatment in multiply injured and high-risk patients [5,21], even if the long-term results of stenting are largely unknown and more data are required. (2) Patients with an aortic intimal tear with or without minimal periaortic bleeding (AIS 4-5).…”

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

“…Although most data are about trauma at the level of the isthmus, delayed surgery in ascending aortic ruptures also seems safe when there is no tamponade or uncontrolled aortic valve regurgitation. [8][9][10] A strict hypotensive regimen is obligatory with β-blockers and vasodilators to control systolic blood pressure and heart rate. 4 In cases with head injury where neurological monitoring is not possible, intracranial pressure monitoring is needed to control cerebral perfusion pressure.…”