Blunt Thoracic Aortic Injury and Contemporary Management Strategy

Angiology ◽  
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.

Improving Surveillance of Traumatic Thoracic Aortic Injuries Repaired with Thoracic Endovascular Graft Placement

2018 ◽  
Vol 84 (7) ◽  
pp. 1129-1132
Author(s):  
Nathan A. Ludwig ◽  
Neal Bhutiani ◽  
Paul L. Linsky ◽  
Amit J. Dwivedi ◽  
Matthew C. Bozeman
Keyword(s):  
Injury Severity ◽  
Vascular Complications ◽  
Aortic Injury ◽  
Late Complications ◽  
Thoracic Aortic Injury ◽  
University Of Louisville ◽  
Long Term Follow Up ◽  
Aortic Injuries

The optimal follow-up protocol for patients undergoing thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury remains unclear. The objective of this study was to assess follow-up patterns in such patients and present an approach to improve long-term follow-up in this cohort. The University of Louisville Trauma Registry was queried for patients who underwent TEVAR for traumatic thoracic aortic injuries between 2006 and 2016. Demographic, injury-specific, perioperative, and outcome measures were recorded for each patient. Follow-up evaluation and duration of follow-up were captured. Follow-up imaging was reviewed for any evidence of vascular complications. A total of 56 patients underwent TEVAR for traumatic thoracic aortic injury. Median age was 48 (range 18–86). Injury mechanism was largely blunt trauma (55 (98%)). Median injury severity score was 34 (range 17–43). Median length of stay was 12.5 days (range 1–40 days), and 51 patients (91%) survived to discharge. Of these, 30 (54%) made at least one follow-up appointment, and 21 of those 30 (70%) received a follow-up CT scan. Median time to last follow-up was one month (range 0–48 months), with 12 patients (21%) having follow-up beyond two months. No patients demonstrated any evidence of vascular complications on imaging at last follow-up. Despite the increased use of TEVAR to treat traumatic aortic injuries, limited follow-up data exist to predict the long-term outcomes of such interventions. Development of statewide or regional databases may help better track outcomes and identify late complications.

Trauma to the Thoracic Aorta

2018 ◽  
Author(s):  
Thurston M. Bauer ◽  
Mark A. Farber
Keyword(s):  
20Th Century ◽  
Endovascular Repair ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
The United States ◽  
High Energy ◽  
Aortic Injury ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Aortic Transection

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries. This review contains 13 figures, 8 tables, 1 video and 56 references. Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection

Trend of management of traumatic thoracic aortic injuries in a single center

Vascular ◽  
2013 ◽  
Vol 22 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Bibombe P Mwipatayi ◽  
Arwen Boyle ◽  
Michael Collin ◽  
Jean-Louis Papineau ◽  
Vikram Vijayan
Keyword(s):  
Endovascular Repair ◽  
Paradigm Shift ◽  
Injury Severity ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Aortic Injuries ◽  
The Mean ◽  
Aortic Trauma

The purpose of this study was to review the shift in the trend of management and mid-term outcomes of all patients who sustain thoracic aortic injury. A Retrospective analysis was performed of all patients sustaining blunt thoracic aortic trauma admitted to our unit. Forty-seven patients were presented with injury to the thoracic aorta following blunt chest injury. Ten patients underwent open surgical repair of their thoracic aortic injury. The mean age ± SD (range) was 29.4 ± 7.9 years (18–41) with a mean Injury Severity Score (ISS) of 41 ± 14.7 (25–75). Fifteen patients underwent thoracic endovascular repair for blunt aortic transections with a mean age of 35.1 ± 14.5 years (17–65), mean ISS of 40.8 ± 13.9 (20–75) and an average length of hospital stay of 25.6 ± 14.5 days (3–77). The mean aortic diameter proximal to the aortic injury was 23.46 ± 3.02 mm (19–28) with a mean aortic angulation of 58.46° ± 17.73 (44–80°). The mean oversizing was 24.4 ± 5.4% (17–32%). At our institution, there has been a paradigm shift in the emergent repair of blunt thoracic aortic injury from open surgery to endovascular repair. Oversizing of the stent-graft did not translate to a poorer outcome.

scholarly journals Traumatic Thoracic Aorta Injuries: Outcomes up to 15 years Post Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Varun J Sharma
Keyword(s):  
Endovascular Repair ◽  
Motor Vehicle ◽  
Common Mechanism ◽  
High Morbidity ◽  
Type I ◽  
Graft Thrombosis ◽  
Hand Ischemia ◽  
Aortic Injuries ◽  
Type I Endoleak

Background Aortic injuries are one of the leading causes of death following trauma, with a 75% pre-hospital and 50% in-hospital mortality. Endovascular repair is technically easier with fewer complications, but unproven in the long term. Methods Retrospective analysis of patients who underwent endovascular repair of thoracic aortic injuries from 2001-2018 at Liverpool Hospital. Primary endpoint was death, secondary endpoints were re-interventions, hand ischemia, access vessel repair, cardiopulmonary, neurological and ischemic complications. Results 24 patients, 10 female, most common mechanism was motor-vehicle injuries (75%) in Zone 3 (71%). Deployment was proximal (n=11), on (n=2) or distal (n=11) to the Left Subclavian Artery (LSCA). Average follow up 5.4 years ±5.1 years (Range 0.1-15.2 years), with 2 deaths. At <90 days, complications were hand ischemia (n=4, n=1 needing intervention), access vessel endarterectomy (n=1) and conversion to open bypass (n=1).  At >90 days, complications were hand ischemia needing intervention (n=1), bird-beaking (n=2) and minor graft thrombosis (n=1). Type I endoleak was the only statistically significant predictor of reintervention (RR 21.00, p=0.002) and hand ischemia (RR 4.7, p=0.02). Survival free from any complication in Zone 2 was 50% at less than 5 years; Zone 3 was 58.8% at 5 years, 42.9%at 10 and 15 years; Zone 4 was 100% at 5 years. Conclusions Endovascular repair for thoracic aortic injuries has low levels of mortality and morbidity. The LSCA can be covered without arm ischemia, and Type I endoleak carries high morbidity. At up to 15 years follow up, graft complications remain low. 

Trauma to the Thoracic Aorta

2018 ◽  
Author(s):  
Thurston M. Bauer ◽  
Mark A. Farber
Keyword(s):  
20Th Century ◽  
Endovascular Repair ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
The United States ◽  
High Energy ◽  
Aortic Injury ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Aortic Transection

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries. This review contains 13 figures, 8 tables, 1 video and 56 references. Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection

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

2019 ◽  
Vol 4 (1) ◽  
pp. e000342
Author(s):  
Shusuke Mori ◽  
Tomohiko Ai ◽  
Yasuhiro Otomo
Keyword(s):  
Blunt Trauma ◽  
Metropolitan Area ◽  
High Speed ◽  
Motor Vehicle ◽  
Type A ◽  
Aortic Injury ◽  
University Hospital ◽  
Type B ◽  
Aortic Injuries ◽  
Aortic Dissections

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.

scholarly journals Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Konstantinos Lagios ◽  
Georgios Karaolanis ◽  
Theodossios Perdikides ◽  
Theodoros Bazinas ◽  
Nikolaos Kouris ◽  
...  
Keyword(s):  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Aortic Injury ◽  
Time Interval ◽  
Spinal Cord Blood Flow ◽  
Pseudoaneurysm Formation ◽  
Hematoma Formation ◽  
Thoracic Aortic Injury ◽  
Aortic Injuries ◽  
Aortic Trauma

Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved.

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