Intense Activity, Emotion Can Spur Aortic Rupture

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

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Iatrogenic thoracic aortic injury in esophagectomy – a case report and literature review

Perspectives in Surgery ◽

10.33699/pis.2019.98.6.256-259 ◽

2019 ◽

Vol 98 (6) ◽

pp. 256-259

Keyword(s):

Case Report ◽

Minimally Invasive ◽

Thoracic Aorta ◽

Aortic Rupture ◽

Hypovolemic Shock ◽

Left Lung ◽

Aortic Injury ◽

Thoracoscopic Esophagectomy ◽

Neoadjuvant Radiochemotherapy ◽

Thoracic Aortic Injury

Introduction: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. Case report: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intuba- tion of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. Conclusion: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.

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Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.74 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Valentina Chiarini

Keyword(s):

Trauma Center ◽

Aortic Rupture ◽

Damage Control ◽

Aortic Injury ◽

Balloon Occlusion ◽

Traumatic Lesion ◽

Abdominal Aortic ◽

Aortic Injuries ◽

Accepted Practice ◽

Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

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A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

SAGE Open Medical Case Reports ◽

10.1177/2050313x211037784 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110377

Author(s):

Yasuhito Nakamura ◽

Kiyoshi Doi ◽

Syojiro Yamaguchi ◽

Etsuji Umeda ◽

Osamu Sakai ◽

...

Keyword(s):

Rare Case ◽

Aortic Wall ◽

Aortic Rupture ◽

Ascending Aorta ◽

Bleeding Site ◽

Penetrating Aortic Ulcer ◽

Postoperative Course ◽

Life Threatening ◽

Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

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Fatal Case of a Contained Ruptured of the Infrarenal Aorta due to Simultaneous Primary Aortocaval Fistula and Aortoenteric Fistula

Indian Journal of Surgery ◽

10.1007/s12262-021-03071-y ◽

2021 ◽

Author(s):

Abdulhakim Ibrahim ◽

Elena Marchiori ◽

Alexander Oberhuber ◽

Marco V. Usai

Keyword(s):

Psoas Abscess ◽

Aortic Rupture ◽

Fatal Case ◽

Aortoenteric Fistula ◽

Infrarenal Aorta ◽

Aortocaval Fistula ◽

Antibiotic Management ◽

Extensive Debridement ◽

Crossover Bypass ◽

Aortic Anastomosis

AbstractWe report an extremely rare case of primary aortocaval fistula with simultaneous development of an aortoenteric fistula in a 68-year-old man. The patient developed under oral anticoagulation a spontaneous intracaval aortic rupture. An emergency intervention was performed with a covering of the fistula with an aorto-uniiliac stent graft and a femoro-femoral crossover bypass. One week later, the patient was transferred to our institution with the diagnosis of a psoas abscess and a suspected concomitant aortoenteric fistula. We performed a complete explantation of the endograft and implanted it after extensive debridement an aortobiiliac bypass, made of bovine pericardium. The postoperative course was complicated, first by bleeding from the left iliac anastomosis, and then by bleeding from the proximal aortic anastomosis. The entire graft was explanted and an axillo-femoral bypass was implanted. The patient then developed a multi-organ failure and died 3 months later. If possible, an extended surgical debridement and resection of all infected tissue with in situ reconstruction is the gold standard. However, with this therapy, there is still a high risk of reinfection. Long-term antibiotic management is mandatory.

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