Vias de acesso aos grandes vasos mediastinais no trauma torácico

Abstract

Trauma is the most common cause of death in the economically active population and thoracic trauma is directly or indirectly responsible for one quarter of these deaths. Lesions to the large thoracic vessels are associated with immediate or early death in the hospital setting. Patients admitted alive can be classified as stable or unstable. The access route to be elected for management of these veins will depend on this status, as well as on the anatomical particularities of the patient, which may require combined incisions for adequate access. This article provides a review and discussion of lesions to these structures as well as access routes to them.

Esternotomia parcial para tratamento de lesão iatrogênica do tronco braquiocefálico durante traqueostomia

“…In terms of symptomology, patients may have neurological deficits and severe hypotension or, more rarely, they may be asymptomatic. 3 The traditional access route to these vessels is total median sternotomy with expansion to a right anterior cervicotomy (primarily for arterial injuries). Venous injuries can be repaired or ligated without major repercussions and, although it was not necessary in the case described here, tactical ligature of the left brachiocephalic vein may be necessary to improve exposure of underlying structures.…”

“…Venous injuries can be repaired or ligated without major repercussions and, although it was not necessary in the case described here, tactical ligature of the left brachiocephalic vein may be necessary to improve exposure of underlying structures. 3 In the case of iatrogenic injuries during tracheotomy, it is common for the surgeon to become aware of an injury because of unusually voluminous bleeding. In such cases, the best course of action is to apply compression, halt the bedside procedure and transport the patient to the operating room, where the situation can be better controlled.…”

“…2 The major thoracic vessels are the thoracic segments of the aorta and the superior and inferior vena cavae, the brachiocephalic arterial trunk, the venous brachiocephalic trunks, the pulmonary veins and arteries, and the azygos vein. 3 Injuries to the major thoracic vessels account for 10% of all vascular traumas and 80% of these patients die at the scene of the traumatic event, while mortality among those who survive to hospital exceeds 20%. More than 80% of injuries to the major thoracic vessels are caused by penetrating traumas; the resulting hemorrhage may be external bleeding, bleeding contained by hematoma and mediastinal structures, cardiac tamponade, or via fistulas into adjacent structures.…”

“…More than 80% of injuries to the major thoracic vessels are caused by penetrating traumas; the resulting hemorrhage may be external bleeding, bleeding contained by hematoma and mediastinal structures, cardiac tamponade, or via fistulas into adjacent structures. 3 Hemorrhages, pneumothorax, and injuries to the trachea wall are among the most common fatal complications of tracheotomy. While venous bleeding is more common, arterial injuries with massive bleeding can also occur.…”

“…The classical approach is via a median sternotomy, which can be extended to cervicotomy. 3 This study describes an alternative, less invasive, access option for use in cases of traumatic injury to the brachiocephalic trunk.…”