Atypical profile of aortic injury associated with blunt trauma in the metropolitan area of Japan

BackgroundAortic injury caused by blunt trauma is a critical medical condition that requires extraordinary caution in the treatment. It is often caused by direct hit and high-speed deceleration in motor vehicle accidents. We reviewed and analysed the cases of aortic injury that referred to our institution located in the midst of the metropolitan area of Tokyo, Japan.MethodsWe retrospectively reviewed the blunt trauma cases transferred to Tokyo Medical and Dental University Hospital in the past 10 years. All cases with aortic injury were analyzed regardless of the AIS scores. Results: Between 2007 and 2017, a total of 3500 blunt trauma cases were transferred. Nineteen cases showed aortic injuries associated with blunt trauma (Age: 63.5±15.6 y.o.; 15 males). Thirteen patients were injured by fall, four patients were senior pedestrians hit by cars, one was injured while riding a motor bike, and one was hit by a train. A total of 11 cases presented a cardiopulmonary arrest on arrival; 8 severe aortic injuries, 1 cardiac rupture; and 2 multiple injuries. Eight cases were alive on arrival; 3 Stanford type A aortic dissections, 3 Stanford type B aortic dissections, and 2 aortic ruptures. Two cases of Stanford type A dissection underwent emergency repairs, whereas all 3 type B dissections went on a good course with conservative treatment.ConclusionsAortic injury caused by blunt trauma seems to be rare in a metropolitan area in Japan. In addition, the leading cause in our cases was fall, which might be a rare cause of aortic injuries in the other countries. Our observation might be a manifestation of population aging.

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Closing the gap between type A and type B aortic dissections

Current Opinion in Cardiology ◽

10.1097/hco.0000000000000666 ◽

2019 ◽

Vol 34 (6) ◽

pp. 621-626

Author(s):

Davide Carino ◽

Manuel Castellà ◽

Eduard Quintana

Keyword(s):

Type A ◽

Type B ◽

Closing The Gap ◽

Aortic Dissections

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Near Side Lateral Impacts and Aortic Injury: A Parametric Study

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-54019 ◽

2011 ◽

Author(s):

Aditya Belwadi ◽

King H. Yang

Keyword(s):

Head Injury ◽

Cause Of Death ◽

High Speed ◽

Motor Vehicle ◽

Flail Chest ◽

The United States ◽

Aortic Injury ◽

Blunt Injury ◽

Traumatic Rupture ◽

Sternal Fracture

Traumatic rupture of the aorta (TRA) remains the second most common cause of death associated with motor vehicle crashes after brain injury. On an average, nearly 8,000 people die annually in the United States due to blunt injury to the aorta. It is observed that more than 80% of occupants who suffer an aortic injury die at the scene due to exsanguination into the chest cavity. TRA and blunt aortic injury (BAI) are leading causes of death in high-speed blunt impact trauma. More specific injuries that fall under these classifications include myocardial contusion (MC), traumatic aortic disruption (TAD), sternal fracture (SF), flail chest (FC) and tracheobronchial disruption (TBD) (Swan et al. 2001). Smith and Chang (1986) reported on 387 cases of blunt traumatic death in vehicular crashes and found that aortic injury was second only to head injury as the leading cause of death. Burkhart et al. (2001) reviewed 242 autopsy cases with fatal BAI and concluded that in most cases aortic injury was accompanied by head injury, rib fractures and/or hepatic trauma.

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Chyloperitoneum after Blunt Abdominal Injury

The American Surgeon ◽

10.1177/000313480707300816 ◽

2007 ◽

Vol 73 (8) ◽

pp. 811-813 ◽

Cited By ~ 3

Author(s):

James M. Haan ◽

Stephanie Montgomery ◽

Timothy J. Novosel ◽

Deborah M. Stein ◽

Thomas M. Scalea

Keyword(s):

Blunt Trauma ◽

Fibrin Sealant ◽

High Speed ◽

Motor Vehicle ◽

Vena Cava ◽

Retrospective Chart Review ◽

Operative Management ◽

Medium Chain Triglycerides ◽

Moderate Amount ◽

Medium Chain

The objective of this study was to evaluate incidence of chylous injury in blunt trauma using a retrospective chart review. We present two patients who sustained chyle duct injury after blunt trauma. The first patient is a pedestrian struck by car. Abdominal CT scan revealed duodenal thickening and a moderate amount of paraduodenal fluid, which prompted surgical exploration. At laparotomy, the patient was found to have a disruption of his lymphatics at the level of the inferior vena cava (IVC) without duodenal injury treated with hemoclips, fibrin sealant and elemental gastrojejunal feeds. The second patient was involved in a high speed motor vehicle collision (MVC) resulting in transection of the mesentery of the transverse colon. Disrupted lacteals were treated intra-operatively with hemoclips and fibrin sealant decreasing the lymph leak. In both cases, the leak completely resolved with use of tube feedings with medium chain triglycerides. On literature review, six prior patients with spontaneous chylous retroperitoneum were described undergoing similar operative management. Chylous leakage due to blunt trauma is a rare finding. Mechanism of injury includes hyperextension or flexion resulting in stretching and shearing of the tethered lymphatics. Open ligation or clipping of the injured ducts seems effective. Tube feeds with medium chain triglycerides may enhance efficacy of operative treatment.

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The use of pyloric exclusion for treating duodenal trauma: case series

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600009 ◽

2008 ◽

Vol 126 (6) ◽

pp. 337-341 ◽

Cited By ~ 14

Author(s):

Gustavo Pereira Fraga ◽

Guilherme Biazotto ◽

José Benedito Bortoto ◽

Nelson Adami Andreollo ◽

Mario Mantovani

Keyword(s):

Blunt Trauma ◽

Motor Vehicle ◽

Primary Repair ◽

Hypovolemic Shock ◽

Case Series ◽

Gunshot Wounds ◽

University Hospital ◽

Morbidity Rate ◽

Cross Sectional ◽

Pyloric Exclusion

CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients). CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

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Current status of the management and outcomes of acute aortic dissection in Japan: Analyses of nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination data

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619872847 ◽

2019 ◽

Vol 9 (3_suppl) ◽

pp. S21-S31 ◽

Cited By ~ 6

Author(s):

Tetsuo Yamaguchi ◽

Michikazu Nakai ◽

Yoko Sumita ◽

Yoshihiro Miyamoto ◽

Hitoshi Matsuda ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Vascular Diseases ◽

Type A ◽

Primary Diagnosis ◽

Current Status ◽

Type B ◽

Japanese Yen ◽

Aortic Dissections ◽

Autumn And Winter

Background: Despite recent advances in the diagnosis and management, the mortality of acute aortic dissection remains high. This study aims to clarify the current status of the management and outcome of acute aortic dissection in Japan. Methods: A total of 18,348 patients with acute aortic dissection (type A: 10,131, type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012–March 2015 were studied. Characteristics, clinical presentation, management, and in-hospital outcomes were analyzed. Results: Seasonal onset variation (autumn- and winter-dominant) was found in both types. More than 90% of patients underwent computed tomography for primary diagnosis. The overall in-hospital mortality of types A and B was 24.3% and 4.5%, respectively. The mortality in type A patients managed surgically was significantly lower than in those not receiving surgery (11.8% (799/6788) vs 49.7% (1663/3343); p<0.001). The number of cases managed endovascularly in type B increased 2.2-fold during the period, and although not statistically significant, the mortality gradually decreased (5.2% to 4.1%, p=0.49). Type A showed significantly longer length of hospitalization (median 28 days) and more than five times higher medical costs (6.26 million Japanese yen) than those in type B. The mean Barthel index at discharge was favorable in both type A (89.0±22.6) and type B (92.6±19.0). More than two-thirds of type A patients and nearly 90% of type B patients were directly discharged home. Conclusions: This nationwide study elucidated the clinical features and outcomes in contemporary patients with acute aortic dissections in real-world clinical practice in Japan.

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Endovascular Approaches and Perioperative Considerations in Acute Aortic Dissection

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253211425424 ◽

2011 ◽

Vol 15 (4) ◽

pp. 141-162

Author(s):

Omid Jazaeri ◽

Rajan Gupta ◽

Paul J. Rochon ◽

T. Brett Reece

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type B ◽

Secondary Complications ◽

Acute Setting ◽

Anesthetic Considerations ◽

Aortic Dissections ◽

Difficult Situations ◽

Management Issues

Aortic dissections remain complicated management issues both in the acute setting and in the chronic setting. Acute problems revolve around malperfusion syndromes or rupture, whereas chronic issues progress from the development of aneurysms in the residual dissected aorta. Endovascular approaches to dealing with these difficult situations are being used more frequently to treat acute issues in type B dissections and prevent secondary complications in type A dissections that may require significant intervention in the future. This article discusses the endovascular approaches employed in the care of acute dissections with particular attention toward the anesthetic considerations involved in these challenging cases.

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Aortic dissection in Siriraj patients: Computed tomography findings

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v19i3.10 ◽

2017 ◽

Vol 19 (3) ◽

pp. 5-25

Author(s):

Krisdee Prabhasavat ◽

Sukrit Sorotpinya ◽

Jitladda Wasinrat ◽

Somchai Chairoongruang

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Outer Wall ◽

Type B ◽

Computed Tomographic ◽

Wall Calcification ◽

Acute Dissection ◽

Aortic Dissections

Background: CTA has replaced angiography in both diagnosis and evaluation of aortic dissection. Most findings are associated with true and false lumens which account for the most important information in both diagnosis and management. Objective: To describe computed tomographic (CT) findings including types based on Stanford classification, true and false lumens, acute and chronic aortic dissections, relation to origins of aortic branches, complications and other related findings. Methods: Computed tomographic angiography (CTA) scans of one hundred and twenty patients with aortic dissection during 2007 to 2016 were retrospectively reviewed. The findings indicating types, true and false lumens, acute and chronic, origination of aortic branches, complication and other related findings are categorized. Result: Most true lumens were smaller, having outer wall calcification. Most false lumens were larger, showing beak sign, cobweb sign, and intraluminal thrombi. However, the larger lumens could be true lumens as well as the smaller lumen could be a false lumen and outer wall calcification could be seen in a false lumen. The larger true lumens and the smaller false lumens with outer wall calcifications were more often found in chronic aortic dissection than acute aortic dissection. Both acute and chronic aortic dissections were more Stanford type B than type A. Complications included rupture, hemopericardium, hemothorax, hemomediastinum and distal organ infarction, which were more frequent in acute dissection. Intrathoracic complications were more commonly caused by type A acute dissection. Renal infarction was the most common complication in type B acute aortic dissection. Conclusion: Most CT fi ndings of aortic dissection in this study were typical. Atypical fi ndings were also found in both acute and chronic aortic dissections. Outer wall calcifi cations of false lumens in acute aortic dissection were found in 2 cases.

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Blunt Thoracic Aortic Injury and Contemporary Management Strategy

Angiology ◽

10.1177/00033197211052131 ◽

2022 ◽

pp. 000331972110521

Author(s):

Ranjan Dahal ◽

Yogesh Acharya ◽

Alan H. Tyroch ◽

Debabrata Mukherjee

Keyword(s):

Motor Vehicle ◽

Management Strategies ◽

Aortic Injury ◽

Medical Attention ◽

High Morbidity ◽

Thoracic Aortic Injury ◽

Aortic Injuries ◽

Diagnostic Modalities ◽

Contemporary Management ◽

Enhanced Computed Tomography

Thoracic aortic injury (TAI) is a leading cause of death in blunt chest trauma. Motor vehicle collisions are the commonest cause, and most patients die before receiving medical attention. Survivors who make it to the hospital also typically have other debilitating injuries with high morbidity. It is imperative to understand the nature of these injuries and implement current management strategies to improve patient outcomes. A literature review on contemporary management strategies on blunt thoracic aortic injuries was performed to evaluate the available evidence using online databases (PubMed and Google Scholar). We found that there has been an improved survival owing to the current advancement in diagnostic modalities, the use of contrast-enhanced computed tomography angiography, and contemporary management techniques with an endovascular approach. However, careful assessment of patients and a multidisciplinary effort are necessary to establish an accurate diagnosis. Minimal aortic injuries (intimal tear and aortic hematoma) can be managed medically with careful monitoring of disease progression with imaging. Endovascular approaches and delayed intervention are key strategies for optimal management of high-grade TAI.

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Isolated Chyle Duct Injury in Blunt Trauma

The American Surgeon ◽

10.1177/000313480607200203 ◽

2006 ◽

Vol 72 (2) ◽

pp. 116-117

Author(s):

Sharmila Dissanaike ◽

John A. Griswold ◽

Ari Halldorsson ◽

Eldo E. Frezza

Keyword(s):

Blunt Trauma ◽

High Speed ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Chyle Leak ◽

Cisterna Chyli ◽

Vehicle Accident ◽

Isolated Injury ◽

The Right ◽

Gallbladder Fossa

We present a case of a patient sustaining an isolated injury to the right main branch of the cysterna chyli due to a high-speed motor vehicle accident. A 42-year-old man presented after a high-speed collision. CT revealed a collection of hypodense fluid in the gallbladder fossa, which was the clue to take him to the OR. We proceeded to laparoscopic exploration, and based on the milky white color of the fluid, identified a chyle leak. In an open fashion, the retroperitoneum was explored and the injury was identified as disruption of the right lumbar branch entering the cisterna chyli, and this was ligated with silk ties. Chyle duct injury secondary to blunt trauma is a rare finding. The use of CT imaging can identify this injury. Laparoscopy can confirm the injury. Open ligation of the injured duct is the best treatment.

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