Endovascular Management Of Blunt Abdominal Aortic Injury

The endovascular management of blunt aortic injuries is being used more frequently in the trauma patient. Traumatic aortic injuries usually occur in the descending thoracic aorta near the origin of the left subclavian artery. Many reports in the literature demonstrate the efficacy of endovascular repair of blunt thoracic aortic injury. We report here an unusual case of abdominal aortic dissection secondary to blunt abdominal trauma following a fall. The patient also had associated intra-abdominal injuries requiring bowel resection and repair of small bowel mesenteric lacerations. He was treated with a bifurcated abdominal endograft with an excellent result after the initial operation was performed to treat the bowel injuries.

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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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Blunt Traumatic Aortic Injury: 10-Year Single-Center Experience

Aorta ◽

10.1055/s-0040-1715608 ◽

2021 ◽

Author(s):

Ahmet Can Topcu ◽

Kamile Ozeren-Topcu ◽

Ahmet Bolukcu ◽

Sinan Sahin ◽

Avni U. Seyhan ◽

...

Keyword(s):

Thoracic Aorta ◽

Subclavian Artery ◽

Open Repair ◽

Left Subclavian Artery ◽

Aortic Injury ◽

Blunt Thoracic Aortic Injury ◽

Phone Calls ◽

Primary Treatment Modality ◽

Thoracic Aortic Injury

Abstract Objective In blunt trauma patients, injury of the thoracic aorta is the second most common cause of death after head injury. In recent years, thoracic endovascular aortic repair (TEVAR) has largely replaced open repair as the primary treatment modality, and delayed repair of stable aortic injuries has been shown to improve mortality. In light of these major advancements, we present a 10-year institutional experience from a tertiary cardiovascular surgery center. Methods Records of patients who underwent endovascular or open repair of the ascending, arch or descending thoracic aorta between January 2009 and December 2018 were retrospectively analyzed. Patients without blunt traumatic etiology were excluded. Perioperative data were retrospectively collected from patient charts. Long-term follow-up was performed via data from follow-up visits and phone calls. Results A total of 1,667 patients underwent 1,740 thoracic aortic procedures (172 TEVAR and 1,568 open repair). There were 13 patients (12 males) with a diagnosis of blunt thoracic aortic injury. Mean patient age was 43.6 years (range, 16–80 years). Ten (77%) patients underwent TEVAR, two (15.4%) underwent open repair, and one (7.7%) was treated nonoperatively. Procedure-related stroke was observed in one (7.7%) case. Procedure-related paraplegia did not occur in any patients. Left subclavian artery origin was covered in seven patients. None developed arm ischemia. Hospital survivors were followed-up for an average of 60.2 months (range, 4–115 months) without any late mortality, endoleak, stent migration, arm ischemia, or reintervention. Conclusion Blunt thoracic aortic injury is a rare but highly fatal condition. TEVAR offers good early and midterm results. Left subclavian artery coverage can be performed without major complications.

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Endovascular management of a mycotic group A streptococcal abdominal aortic dissection

BJR|case reports ◽

10.1259/bjrcr.20150332 ◽

2017 ◽

Vol 3 (1) ◽

pp. 20150332

Author(s):

John Colville ◽

Manmohan Madan ◽

Khalid Bashaeb ◽

Riza Ibrahim ◽

Abysinia Sibanda

Keyword(s):

Aortic Dissection ◽

Endovascular Management ◽

Abdominal Aortic ◽

Group A ◽

Abdominal Aortic Dissection

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Occult Aortic Injury after Penetrating Abdominal Trauma

The American Surgeon ◽

10.1177/000313480707300308 ◽

2007 ◽

Vol 73 (3) ◽

pp. 239-242

Author(s):

John Sonfield ◽

Jacob Robison ◽

Stuart M. Leon

Keyword(s):

Unusual Case ◽

Primary Repair ◽

Aortic Injury ◽

Initial Attempt ◽

Penetrating Abdominal Trauma ◽

Stent Grafting ◽

Abdominal Aortic ◽

Extremity Trauma ◽

Early Imaging ◽

Aortic Trauma

Although pseudoaneurysms after penetrating extremity trauma are well described, we describe an unusual case of residual occult aortic injury after an initial attempt at repair that was recognized on postoperative imaging. Reoperation with primary resection and end-to-end repair was accomplished successfully. Because this entity is so unusual, we review strategies to avoid and recognize its occurrence. Early imaging allows early identification of aortic pseudoaneurysms should they occur, and will preclude delayed manifestation of complications, including death. Our case illustrates the utility of such postoperative scanning. Other alternatives to primary repair or interposition grafting in management of penetrating abdominal aortic trauma, such as interventional stent grafting, are discussed.

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Endograft Coverage of the Left Subclavian Artery During Repair of Traumatic Thoracic Aortic Injury May Be Associated With Significant Long-Term Morbidity

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.06.016 ◽

2016 ◽

Vol 64 (3) ◽

pp. 835-836 ◽

Cited By ~ 1

Author(s):

Michael Madigan ◽

Elizabeth Genovese ◽

Mikhail Attaar ◽

Louis Alarcon ◽

Michael Singh ◽

...

Keyword(s):

Subclavian Artery ◽

Left Subclavian Artery ◽

Aortic Injury ◽

Thoracic Aortic Injury

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Endovascular Management of Traumatic Infrarenal Abdominal Aortic Dissection

Annals of Vascular Surgery ◽

10.1007/s100169900194 ◽

1998 ◽

Vol 12 (6) ◽

pp. 515-521 ◽

Cited By ~ 28

Author(s):

Eric Picard ◽

Charles-Henri Marty-Ané ◽

Hélène Vernhet ◽

Carmine Sessa ◽

Alvian Lesnik ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Management ◽

Abdominal Aortic ◽

Abdominal Aortic Dissection

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

The American Surgeon ◽

10.1177/000313481808400725 ◽

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.

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Left subclavian artery occlusion during endovascular repair of traumatic thoracic aortic injury, cohort study

International Journal of Surgery Open ◽

10.1016/j.ijso.2019.11.002 ◽

2020 ◽

Vol 22 ◽

pp. 47-51

Author(s):

Abdullah Alhaizaey ◽

Badr Aljabri ◽

Musaad Alghamdi ◽

Ali AlAhmary ◽

Ahmad G. karmota ◽

...

Keyword(s):

Cohort Study ◽

Subclavian Artery ◽

Endovascular Repair ◽

Left Subclavian Artery ◽

Aortic Injury ◽

Artery Occlusion ◽

Subclavian Artery Occlusion ◽

Thoracic Aortic Injury

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

Vascular ◽

10.1177/1708538112474259 ◽

2013 ◽

Vol 22 (2) ◽

pp. 134-141 ◽

Cited By ~ 1

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.

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