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Pauka D, Poór VS, Maróti P, Told R, Tóth D, Tornóczky T, Molnár TF, Simon G. Biomechanical study on the effect of atherosclerosis on the vulnerability of thoracic aorta, and it's role in the development of traumatic aorta injury. PLoS One 2023; 18:e0287652. [PMID: 37683010 PMCID: PMC10491303 DOI: 10.1371/journal.pone.0287652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/12/2023] [Indexed: 09/10/2023] Open
Abstract
Traumatic aorta injury (TAI) is the second most common traumatic cause of death preceded only by head injuries, being responsible for 5% to 30% of all mortalities in high-speed deceleration injuries. Multiple external factors might play a role such as impact speed, impact direction, occupant location, and presence or lack of restraining safety mechanism. Apart from these external factors, also human biological factors can influence its development. Based on the data of scientific literature, age clearly plays a role in suffering TAI, but the role of atherosclerosis-as a disease affecting the structure of the aorta-is unknown. Biomechanical properties of tissue samples of 104 aorta specimens removed during the autopsy from the posterior (Group 'A') and lateral wall (Group 'B') of descending aorta were analyzed. Specimens were examined by a Zwick/Roell Z5.0 biaxial tester. The Young's modulus (E (MPa)) was calculated using a linear regression procedure where the base of the elongation was the parallel length of the sample, the achieved maximal force (Fmax (N)), the elongation at the time of Fmax (Lmax (mm)), the force at the beginning of rupture (Fbreak (N)), the elongation at the time of Fbreak (Lbreak (mm)) were registered. Specimens were categorized based on macroscopic and microscopic appearance. In the posterior (A) samples the difference between Lbreak (p<0.001) and Lmax (p<0.001) was significant between the macroscopic group. Lbreak (p = 0.009) and Lmax (p = 0.003) showed similar pattern in the lateral (B) samples. Comparing the histological groups by the measured parameters (Fmax, Lmax, Fbreak, Lbreak) showed a significant difference in the means (p<0.001, p = 0.003, p<0.001 respectively). The study demonstrated that atherosclerosis decreases the resistance of the aorta. The rupture occurs at lower force (Fmax and Fbreak), and at shorter elongation (Lmax and Lbreak) in case of the presence of atherosclerosis. This effect is most substantial if calcification is present: the resistance of aorta affected by calcification is only two-thirds on average compared to aorta affected by the early phase of atherosclerosis. This phenomenon can be clearly explained by the weakening structure of the tunica intima.
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Affiliation(s)
- Dénes Pauka
- Department of Forensic Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Viktor Soma Poór
- Department of Forensic Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Maróti
- 3D Printing & Visualisation Centre, University of Pécs, Pécs, Hungary
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Roland Told
- 3D Printing & Visualisation Centre, University of Pécs, Pécs, Hungary
| | - Dénes Tóth
- Department of Forensic Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Tornóczky
- Department of Pathology, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás F. Molnár
- Department of Surgery, Petz A University Teaching Hospital, Győr, Hungary
- Medical Skills Education and Innovation Centre, Operational Medicine Group, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Simon
- Department of Forensic Medicine, Medical School, University of Pécs, Pécs, Hungary
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Fang XX, Wu XH, Chen XF. Blunt aortic injury–traumatic aortic isthmus pseudoaneurysm with right iliac artery dissection aneurysm: A case report. World J Clin Cases 2022; 10:4998-5004. [PMID: 35801016 PMCID: PMC9198877 DOI: 10.12998/wjcc.v10.i15.4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/19/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Blunt aortic injury is a special type of aortic disease. Due to its low incidence, high prehospital mortality and high probability of leakage diagnosis, the timely identification of patients with blunt aortic injury who survive the initial injury has always been a clinical challenge.
CASE SUMMARY We report a case of traumatic aortic pseudoaneurysm with right iliac artery dissection aneurysm that was diagnosed 3 mo after a traffic accident. The patient is a 76-year-old male who was knocked down by a fast-moving four-wheel motor vehicle while crossing the road (the damage mechanism was side impact). He received chest, cranial computed tomography (CT) and whole abdomen enhanced CT in the local hospital. The images suggested subarachnoid hemorrhage, right frontoparietal scalp hematoma, fracture of the right clavicle and second rib, lump-shaped mediastinal shadow outside the anterior descending thoracic aorta (mediastinal hematoma), mesenteric vascular injury with hematoma formation, pelvic fracture, and subluxation of the left sacroiliac joint. After the pelvic fracture was fixed with an external stent, he was sent to our hospital for further treatment. In our hospital, he successfully underwent partial resection of the small intestine and CT-guided screw internal fixation of the left sacroiliac joint and returned to the local hospital for rehabilitation treatment. However, since the accident, the patient has been suffering from mild chest pain, which has not aroused the attention of clinicians. During rehabilitation, his chest pain gradually worsened, and the thoracic aorta computed tomography angiography performed in the local hospital showed a pseudoaneurysm in the initial descending segment of the aortic arch. After transfer to our hospital, a dissecting aneurysm of the right external iliac artery was incidentally found in the preoperative evaluation. Finally, endovascular stent graft repair was performed, and he was discharged on the 10th day after the operation. No obvious endo-leak was found after 4 years of follow-up.
CONCLUSION We highlight that emergency trauma centers should consider the possibility of aortic injury in patients with severe motor vehicle crashes and repeat the examination when necessary to avoid missed diagnoses.
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Affiliation(s)
- Xiao-Xin Fang
- Department of Cardiology, Taizhou Hospital of Zhejiang Province (Taizhou Hospital, Zhejiang University School of Medicine), Linhai 317000, Zhejiang Province, China
| | - Xin-Hui Wu
- Department of Orthopedics, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xiao-Feng Chen
- Department of Cardiology, Taizhou Hospital of Zhejiang Province (Taizhou Hospital, Zhejiang University School of Medicine), Linhai 317000, Zhejiang Province, China
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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3
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Dahal R, Acharya Y, Tyroch AH, Mukherjee D. Blunt Thoracic Aortic Injury and Contemporary Management Strategy. Angiology 2022; 73:497-507. [DOI: 10.1177/00033197211052131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
- Ranjan Dahal
- Division of Cardiovascular Medicine, Texas Tech HSC, Paul Foster School of Medicine, El Paso, TX, USA
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Alan H. Tyroch
- Department of Surgery, Texas Tech HSC, Paul Foster School of Medicine, El Paso, TX, USA
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine, Texas Tech HSC, Paul Foster School of Medicine, El Paso, TX, USA
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Tension Hemothorax in Aortic Rupture: A Case Report. MEDICINA-LITHUANIA 2021; 57:medicina57080790. [PMID: 34440997 PMCID: PMC8400638 DOI: 10.3390/medicina57080790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.
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5
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Alarhayem AQ, Rasmussen TE, Farivar B, Lim S, Braverman M, Hardy D, Jenkins DJ, Eastridge BJ, Cestero RF. Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era. J Vasc Surg 2020; 73:896-902. [PMID: 32682070 DOI: 10.1016/j.jvs.2020.05.079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) is the preferred operative treatment of blunt thoracic aortic injuries (BTAIs). Its use is associated with improved outcomes compared with open surgical repair and nonoperative management. However, the optimal time from injury to repair is unknown and remains a subject of debate across different societal practice guidelines. The purpose of this study was to evaluate national trends in the management of BTAI, with a specific focus on the impact of timing of repair on outcomes. METHODS Using the National Trauma Data Bank, we identified adult patients with BTAI between 2012 and 2017. Patients with prehospital or emergency department cardiac arrest or incomplete data sets were excluded from analysis. Patients were classified according to timing of repair: group 1, <24 hours; and group 2, ≥24 hours. The primary outcome evaluated was in-hospital mortality; secondary outcomes included overall hospital and intensive care unit length of stay. Multivariable logistic regression was performed to identify independent predictors of mortality. RESULTS The analysis was completed for 2821 patients who underwent TEVAR for BTAI with known operative times. The overall mortality in the patient cohort was 8.4% (238/2821); 75% of patients undergoing TEVAR were repaired within 24 hours. Mortality was more than twofold greater in group 1 compared with group 2 (9.8% [207/2118] vs 4.4% [31/703]; P = .001). This mortality benefit persisted across injury severity groups and was independent of the presence of serious extrathoracic injuries. Logistic regression analysis, adjusting for age ≥65 years, Glasgow Coma Scale score ≤8, systolic blood pressure ≤90 mm Hg at admission, and serious extrathoracic injuries, showed a higher adjusted mortality in group 1 (odds ratio, 2.54; 95% confidence interval, 1.66-3.91; P = .001). CONCLUSIONS The majority of patients with BTAI undergo endovascular repair within 24 hours of injury. Patients undergoing delayed repair have improved survival compared with those repaired within the first 24 hours of injury in spite of similar injury patterns and severity. In patients with BTAIs without signs of imminent rupture, delaying endovascular repair beyond 24 hours after injury should be considered.
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Affiliation(s)
| | - Todd E Rasmussen
- Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Md.
| | - Behzad Farivar
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sungho Lim
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Max Braverman
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - David Hardy
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Donald J Jenkins
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Brian J Eastridge
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Ramon F Cestero
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
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6
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Kenel-Pierre S, Ramos Duran E, Abi-Chaker A, Melendez F, Alghamdi H, Bornak A, Lopez AJ, Rey J. The role of heparin in endovascular repair of blunt thoracic aortic injury. J Vasc Surg 2019; 70:1809-1815. [DOI: 10.1016/j.jvs.2019.01.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/31/2019] [Indexed: 10/26/2022]
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7
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Son SA, Jung H, Cho JY, Oh TH, Do YW, Lim KH, Kim GJ. Mid-term outcomes of endovascular repair for traumatic thoracic aortic injury: a single-center experience. Eur J Trauma Emerg Surg 2019; 45:965-972. [PMID: 31183525 DOI: 10.1007/s00068-019-01166-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury (TTAI) reports short-term benefits. However, long-term durability and the need of reintervention remain unclear. Here, we determined mid-term outcome of TEVAR for TTAI and investigated the influence of the length of proximal landing zone on aorta. METHODS Between October 2009 and February 2018, 69 patients diagnosed TTAI and 42 included patients underwent TEVAR. Patients were divided into two groups by the length of proximal landing zone; ≤ 20 mm and > 20 mm. The primary endpoint was success and survival rate, and the secondary endpoint was the increase of aorta size and the need of reintervention. RESULTS The mean follow-up period was 47.9 ± 29.6 months and 100% success rate. No endoleaks or additional reinterventions during the follow-up period. The cumulative survival of all-cause death was 90.5 ± 2.3%, 85.7 ± 4.1% and 61.7 ± 8.4% at 1, 5 and 7 years, respectively. There was no statistically significant difference in the increase of aorta size due to the length of the proximal landing zone (p = 0.65). CONCLUSION In selective TTAI patients for TEVAR, the length of proximal landing zone did not considerably influence the aorta size or needed further reintervention.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Kyoung Hoon Lim
- Trauma Center, Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea.
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8
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Mhamdi S, Nakhli M, Chelly M, Chouchene A, Chaouch A, Naija W, Said R. Postendovascular thoracic aortic repair subclavian steal syndrome revealed by severe headache. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S. Mhamdi
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - M.S. Nakhli
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - M. Chelly
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - A. Chouchene
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - A. Chaouch
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - W. Naija
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - R. Said
- Faculty of Medicine Ibn El Jazzar, University Of Sousse, Tunisia
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9
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Surveillance Recommendations after Thoracic Endovascular Aortic Repair Should Be Based on Initial Indication for Repair. Ann Vasc Surg 2019; 57:51-59. [DOI: 10.1016/j.avsg.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/22/2018] [Accepted: 11/08/2018] [Indexed: 11/22/2022]
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10
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Trlica J, Kučerová Š, Kočová E, Kočí J, Habal P, Raupach J, Guňka I, Nechvátal L, Páral J, Šimek J, Šmejkal K, Frank M, Dědek T. Deceleration thoracic aortic ruptures in trauma center level I areas: a 6-year retrospective study. Eur J Trauma Emerg Surg 2019; 45:943-949. [PMID: 30617603 DOI: 10.1007/s00068-018-01063-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.
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Affiliation(s)
- Jan Trlica
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic. .,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic.
| | - Štěpánka Kučerová
- Institute of Forensic Medicine, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Eva Kočová
- Department of Radiology, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jaromír Kočí
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Petr Habal
- Department of Cardiac Surgery, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Igor Guňka
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Lukáš Nechvátal
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jiří Páral
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jan Šimek
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czech Republic
| | - Karel Šmejkal
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czech Republic
| | - Martin Frank
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Dědek
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
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Skripochnik E, Novikov D, Bilfinger TJ, Loh SA. Short-term results of left subclavian artery salvage in blunt thoracic aortic injury with short proximal landing zones. J Vasc Surg 2018; 68:985-990. [DOI: 10.1016/j.jvs.2018.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/20/2018] [Indexed: 10/16/2022]
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12
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Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: A Report of Three Cases in Which Surgeries Were Performed at Different Timings. Case Rep Surg 2018; 2018:7061509. [PMID: 30159195 PMCID: PMC6109575 DOI: 10.1155/2018/7061509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/14/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Blunt thoracic aortic injury (BTAI) is a critical condition. Thoracic endovascular aortic repair (TEVAR) is considered a surgical treatment for BTAI. Reports reveal that some patients benefit from conservative and delayed operation rather than emergency operative therapy. Here, we present three BTAI cases that were treated with TEVAR using different timings. Case Presentation Case 1 involved a 49-year-old man injured in a car accident and who went into shock. After stabilization with Advanced Trauma Life Support in the emergency room, TEVAR was performed immediately. Case 2 involved a 69-year-old man who was injured after falling. His hemodynamic status was stable and enhanced computed tomography revealed intraluminal hematoma. He underwent TEVAR 15 days after the injury occurred, following conservative therapy. Case 3 involved a 60-year-old man who was injured in a car accident and presented BTAI with subarachnoid hemorrhage and diaphragm tear. A pseudoaneurysm was observed in the distal aortic arch. After open abdominal exploration, diaphragm repair, and observation for subarachnoid hemorrhage, TEVAR was performed 8 hours after arrival. All three patients survived. Conclusions We treated BTAI successfully. We suggest that TEVAR is useful for BTAI. The timing of the operation and therapeutic option, including conservative therapy, should be decided for each patient.
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Buczkowski P, Puslecki M, Stefaniak S, Juszkat R, Kulesza J, Perek B, Misterski M, Urbanowicz T, Ligowski M, Zabicki B, Dabrowski M, Szarpak L, Jemielity M. Post-traumatic acute thoracic aortic injury (TAI)-a single center experience. J Thorac Dis 2017; 9:4477-4485. [PMID: 29268517 DOI: 10.21037/jtd.2017.10.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background We assess the effectiveness and our experience in emergency thoracic endovascular aortic repair (TEVAR) in patients with post-traumatic acute thoracic aortic injury (TAI) and associated multiorgan trauma. TAI is a life-threatening condition. It usually results from a sudden deceleration caused by vehicle accident, a fall or some other misfortune. Techniques of endovascular aortic repair have become promising methods to treat emergent TAI. Methods Since 2007, 114 patients with thoracic aorta pathologies have been treated by TEVAR. Our study involved 15 (incl. 14 men) of them (13%) who underwent stent graft implantation for post-traumatic either aortic rupture or pseudoaneurysm. The procedural access was limited to small skin incision in one groin and percutaneous puncture of the contralateral femoral artery. We evaluated technical success, early and long-term mortality, complication rate of procedure and throughout clinical and instrumental follow-up. Results Technical success rate was 100%. All patients survived the endovascular interventions. No additional procedures or conversions to open surgery were necessary. After the operation, none of the patients had symptoms of stroke or spinal cord ischemia (SCI). No serious stent-graft-related adverse events such as endoleak, infection or migration were noted during follow-up period that ranged from 6 to 108 months. Conclusions In our department, techniques of TEVAR with stentgraft implantation have become methods of choice in treatment of traumatic TAIs since they have enabled to minimize operational risk, particularly in unstable multitrauma patients in severe clinical status. TEVAR for TAI performed in emergency settings provide favorable long-term results.
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Affiliation(s)
- Piotr Buczkowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Puslecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Robert Juszkat
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Kulesza
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Ligowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartosz Zabicki
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Dabrowski
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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14
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Jovanovic M, Radojkovic M, Djordjevic P, Rancic D, Jovanovic N, Rancic Z. Recycling and Reinforcing Intimomedial Flap of the Infrarenal Aorta Using Anterior Longitudinal Ligament in Patients With Acute Trauma With Bowel Injuries. Vasc Endovascular Surg 2017; 51:501-505. [PMID: 28764607 DOI: 10.1177/1538574417722930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present a patient with blunt abdominal trauma with severe acute right limb ischemia and clinical signs of diffuse peritonitis. Computed tomography angiography showed circumferential dissection of the infrarenal aorta with occlusion of the right common iliac artery. We opted for simultaneous abdomen exploration and open repair of injured aorta. Critical weakening of the aortic wall with imminent rupture was identified intraoperatively. Aortotomy cranially from bifurcation showed circumferential intimomedial dissection. The fixation of fragile intimomedial flap of aortic dissection was achieved with reinforcement using an anterior longitudinal ligament. The long aortoiliac arteriotomy was repaired using a great saphenous vein patch. Patient had uneventful postoperative course and was discharged after 7 days. In patients with abdominal polytrauma with peritonitis, and no available endovascular tools, open surgery for circumferential aortic dissection is possible and successful. Described reinforcement of the posterior aortic wall to the anterior longitudinal ligament should be added to the armamentarium of aortic injury treatment.
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Affiliation(s)
- Milan Jovanovic
- 1 Medical Faculty of Niš, Niš, Serbia.,2 Vascular Surgery Clinic, Clinical Centre of Niš, Niš, Serbia
| | - Milan Radojkovic
- 1 Medical Faculty of Niš, Niš, Serbia.,3 General Surgery Clinic, Clinical Centre of Niš, Niš, Serbia
| | | | - Dejan Rancic
- 1 Medical Faculty of Niš, Niš, Serbia.,4 Otorhinolaryngology Clinic, Clinical Centre of Niš, Niš, Serbia
| | | | - Zoran Rancic
- 5 Clinic for Heart and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
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15
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Mytsyk M, Grapow MTR, Shahinian J, Maurer M, Gurke L, Eckstein FS. Case report: Open replacement of incomplete semi-circular traumatic ruptures of the ascending and descending aorta. J Cardiothorac Surg 2016; 11:110. [PMID: 27422556 PMCID: PMC4947277 DOI: 10.1186/s13019-016-0485-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 05/24/2016] [Indexed: 11/15/2022] Open
Abstract
An incomplete traumatic rupture of the ascending aorta is a rare but life-threatening condition. Hence, the assessment of the extent of the injury prior to therapy is crucial. We report a case of a 50-year-old male with traumatic aortic rupture who underwent emergency surgery after the evaluation of computed tomography scan (CT-scan). The surgical treatment involved replacement of the ascending aorta and stent implantation in descending aorta due to its covered rupture.
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Affiliation(s)
- Miroslawa Mytsyk
- Division of Cardiac Surgerz, University Hospital of Basel, Basel, Switzerland.
| | - Martin T R Grapow
- Division of Cardiac Surgerz, University Hospital of Basel, Basel, Switzerland
| | - Jasmin Shahinian
- Division of Cardiac Surgerz, University Hospital of Basel, Basel, Switzerland
| | - Markus Maurer
- Department of Anesthesia, University Hospital of Basel, Basel, Switzerland
| | - Lorenz Gurke
- Division of Vascular Surgery, University Hospital of Basel, Basel, Switzerland
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16
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Lee CH, Huang JK, Yang TF. Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital. J Thorac Dis 2016; 8:1149-54. [PMID: 27293831 DOI: 10.21037/jtd.2016.04.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition. This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. METHODS In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan. RESULTS The median age of the patients was 49±22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights. The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively. CONCLUSIONS Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.
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Affiliation(s)
- Chih-Hsien Lee
- 1 Department of Cardiac Surgery, Tungs' Taichung Metro-Harbor Hospital, Taichung, Taiwan ; 2 Department of Biological Science and Technology, National Chiao-Tung University, Hsin-Chu, Taiwan ; 3 Department of Surgery, National Defense Medical Center, 4 Graduate Institute of Medical Informatics and Cardiology, Taipei Medical University, Hsin-Chu, Taiwan
| | - Jau-Kang Huang
- 1 Department of Cardiac Surgery, Tungs' Taichung Metro-Harbor Hospital, Taichung, Taiwan ; 2 Department of Biological Science and Technology, National Chiao-Tung University, Hsin-Chu, Taiwan ; 3 Department of Surgery, National Defense Medical Center, 4 Graduate Institute of Medical Informatics and Cardiology, Taipei Medical University, Hsin-Chu, Taiwan
| | - Ten-Fang Yang
- 1 Department of Cardiac Surgery, Tungs' Taichung Metro-Harbor Hospital, Taichung, Taiwan ; 2 Department of Biological Science and Technology, National Chiao-Tung University, Hsin-Chu, Taiwan ; 3 Department of Surgery, National Defense Medical Center, 4 Graduate Institute of Medical Informatics and Cardiology, Taipei Medical University, Hsin-Chu, Taiwan
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17
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Mitchell J, Bogar L, Burton N. Cardiothoracic surgical emergencies in the intensive care unit. Crit Care Clin 2015; 30:499-525. [PMID: 24996607 DOI: 10.1016/j.ccc.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with cardiothoracic surgical emergencies are frequently admitted to the ICU, either prior to operative intervention or after surgery. Recognition and appropriate timing of operative intervention are key factors in improving outcomes. A collaborative team approach with the cardiothoracic service is imperative in managing this patient population.
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Affiliation(s)
- Jessica Mitchell
- Department of Critical Care Medicine, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103, USA.
| | - Linda Bogar
- Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA; Cardiac Vascular & Thoracic Surgery Associates, Inova Fairfax Hospital, 2921 Telestar Court, Falls Church, VA 22042, USA
| | - Nelson Burton
- Cardiac Vascular & Thoracic Surgery Associates, Inova Fairfax Hospital, 2921 Telestar Court, Falls Church, VA 22042, USA
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18
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Belov IV, Komarov RN, Frolov KB, Salagaev GI. [Surgical treatment of patient with thoracoabdominal aorta rupture and large false aneurysm]. Khirurgiia (Mosk) 2015:63-64. [PMID: 25909555 DOI: 10.17116/hirurgia2015163-64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iu V Belov
- Klinika aortal'noĭ i serdechno-sosudistoĭ khirurgii Pervogo Moskovskogo gosudarstvennogo meditsinskogo universiteta im. I.M. Sechenova
| | - R N Komarov
- Klinika aortal'noĭ i serdechno-sosudistoĭ khirurgii Pervogo Moskovskogo gosudarstvennogo meditsinskogo universiteta im. I.M. Sechenova
| | - K B Frolov
- Klinika aortal'noĭ i serdechno-sosudistoĭ khirurgii Pervogo Moskovskogo gosudarstvennogo meditsinskogo universiteta im. I.M. Sechenova
| | - G I Salagaev
- Klinika aortal'noĭ i serdechno-sosudistoĭ khirurgii Pervogo Moskovskogo gosudarstvennogo meditsinskogo universiteta im. I.M. Sechenova
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19
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He S, Chen X, Zhou X, Hu Q, Ananda S, Zhu S. Sudden death due to traumatic ascending aortic pseudoaneurysms ruptured into the esophagus: 2 case reports. Medicine (Baltimore) 2015; 94:e716. [PMID: 25881850 PMCID: PMC4602502 DOI: 10.1097/md.0000000000000716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We present 2 rare cases of patients with uncontrolled hemorrhagic shock induced by traumatic ascending aortic pseudoaneurysm rupture into the esophagus. Two men were presented to the hospital after traffic accidents. Their chest radiograph showed no obvious signs of aortic damage or aortic pseudoaneurysms but only a small amount of high-density shadow in the mediastinum and no specific clinical signs besides chest tightness or chest tenderness. The first case was misdiagnosed as pulmonary contusion and pleural effusion, and the second case was misdiagnosed as mediastinal lesions in the mediastina. They were given symptomatic and supportive treatment. Unfortunately, they died suddenly after >1 month of traumatic accident. At autopsy, ascending aortic pseudoaneurysms that broke into the esophagus and multiple organ hematocele were detected by gross examination. In histopathological examination, inflammatory cells and proliferated fibrous connective tissue were detected in the ascending aortic pseudoaneurysms, and the pathological gastrointestinal bleeding was not seen. The drugs and poisons were not found on toxicological analysis. The 2 patients died as a result of hemorrhagic shock from traumatic ascending aortic pseudoaneurysm rupture into the esophagus. We suggest that thoracic surgeon should be aware of the possibility of aortic injury after chest trauma to reduce misdiagnosis and prevent similar accidents.
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Affiliation(s)
- Shixia He
- From the Department of Forensic Medicine (SH, XC, XZ, QH, SZ), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; and Ministry of Health and Quality of Life (SA), Mauritius
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20
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Oberhuber A, Schabhasian D, Kohlschmitt R, Rottbauer W, Orend KH, Rasche V. The bird beak configuration has no adverse effect in a magnetic resonance functional analysis of thoracic stent grafts after traumatic aortic transection. J Vasc Surg 2014; 61:365-73. [PMID: 25449004 DOI: 10.1016/j.jvs.2014.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study used magnetic resonance imaging (MRI) to analyze functional long-term outcome after endovascular repair of blunt aortic injury. METHODS This prospective study enrolled 27 of 53 patients who were treated between 1999 and 2008. Patients underwent functional multidimensional contrast-enhanced MRI with flow analysis or compliance measurements of the aorta, or both. Ten patients were treated with the Medtronic Valiant (Medtronic World Medical, Sunrise, Fla), 14 patients received a Gore TAG (W. L. Gore & Associates, Flagstaff, Ariz), and two received a C (conformable)-TAG (W. L. Gore & Associates) stent graft. For several patients, repetitive measurements over time could be done. Median follow-up was 3.92 ± 2.7 years. The MRI parameters were: three-dimensional flow: echo time/repetition time = 3.1/5.3 ms, Δx(pixel density) = 2.5 × 2.5 × 3 mm(3); respiratory navigator, α = 15°, venc(encoding velocity) = 200 cm/s along anterior-posterior, right-left, and foot-head direction, 40 cardiac phases. Cine: echo time/repetition time = 1.7/3.4 ms, Δx(pixel density) = 1.2 × 1.2 × 6 mm(3), breathhold, α = 60°, 40 cardiac phases. RESULTS The flow analysis showed flow acceleration at the proximal end of the stent graft, with higher values in patients with a nonoptimal alignment of the stent graft. No differences were found between different devices (median acceleration was 75.99 ± 37.98 cm/s for Gore and 71.59 ± 17.22 cm/s for Medtronic). The values were stable during follow-up. In the compliance analysis, the part of the aorta covered with the stent graft showed nearly no expansion, whereas the ascending and descending aorta showed normal expansion. This behavior did not change over the time. At the proximal end of the stent graft, a slight compression could be noted (-0.5 ± 0.14 mm), except in those patients with a C-TAG device from Gore. CONCLUSIONS Functional analysis showed no adverse long-term outcome of the bird beak configuration of stent grafts in the aortic arch after endovascular repair after blunt aortic injury.
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Affiliation(s)
- Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University of Düsseldorf, Düsseldorf, Germany.
| | - David Schabhasian
- Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | - Robert Kohlschmitt
- Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | | | - Karl-Heinz Orend
- Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | - Volker Rasche
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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21
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Martinelli O, Malaj A, Gossetti B, Bertoletti G, Bresadola L, Irace L. Outcomes in the emergency endovascular repair of blunt thoracic aortic injuries. J Vasc Surg 2013; 58:832-5. [DOI: 10.1016/j.jvs.2013.02.243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 02/22/2013] [Accepted: 02/23/2013] [Indexed: 10/26/2022]
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22
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Di Marco L, Pacini D, Di Bartolomeo R. Acute Traumatic Thoracic Aortic Injury: Considerations and Reflections on the Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:117-22. [PMID: 26798683 DOI: 10.12945/j.aorta.2013.12-009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/13/2013] [Indexed: 12/14/2022]
Abstract
Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compared with early open repair. Despite developments in operative techniques, there still remains considerable operative mortality and morbidity associated with a surgical approach even if delayed. Endovascular stent grafts for the thoracic aorta represents an alternative to the conventional approach for traumatic aortic rupture. Because of the lower invasivity avoiding thoracotomy and use of heparin, endovascular repair can be applied in acute patients without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. However, despite the good deal of convincing evidence for endovascular treatment for thoracic aortic diseases and for traumatic aortic injuries as a valid and efficacious alternative to surgery, several reports show a variety of late complications of thoracic endografts especially for first-generation stent-grafts. In light of this, is the endovascular treatment really safe, efficacious and free from complications in the long term? This manuscript aims to offer a moment of reflection on this important chapter of aortic pathology.
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Affiliation(s)
- Luca Di Marco
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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23
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Li PS, Tsai CL, Lin TC, Hung SW, Hu SY. Endovascular treatment for traumatic thoracic aortic pseudoaneurysm: a case report. J Cardiothorac Surg 2013; 8:36. [PMID: 23452982 PMCID: PMC3639143 DOI: 10.1186/1749-8090-8-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
Cases of an endovascular treatment for traumatic aortic injury are extremely rare. A prompt diagnosis of traumatic thoracic aortic pseudoaneurysm through a 3-dimensional computed tomographic angiography of aorta and emergency repair are mandatory to rescue the life-threatening condition. An endovascular treatment is a trend for traumatic aortic injury because of lower invasivity, morbidity and mortality. We reported a rare case of traumatic aortic injury with thoracic aortic pseudoaneurysm definitively diagnosed by the reconstructional computed tomographic angiography of aorta and successfully treated with endovascular stent-graft.
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Affiliation(s)
- Po-Sung Li
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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24
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Muradi A, Yamaguchi M, Idoguchi K, Nomura Y, Okada T, Okita Y, Sugimoto K. Iliac leg and abdominal aortic cuff stent-graft for blunt thoracic aortic injury in young patient. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:825-8. [PMID: 23445792 DOI: 10.5761/atcs.cr.12.02120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thoracic endovascular aortic repair for blunt thoracic aortic injury in young adults with small aortic diameter often encounters high difficulty. We report, to our knowledge, the first case of successful treatment using combination of iliac leg and abdominal aortic cuff stent-graft.
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Affiliation(s)
- Akhmadu Muradi
- Center for Endovascular Therapy, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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25
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Martí de Gracia M, Artigas Martín JM, Soto JA. Evaluation of thoracic vascular trauma with multidetector computed tomography. Semin Roentgenol 2012; 47:342-51. [PMID: 22929693 DOI: 10.1053/j.ro.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Milagros Martí de Gracia
- Emergency Radiology Unit from Department of Radiology, La Paz University Hospital, Madrid, Spain.
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26
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Coppi G, Tshomba Y, Psacharopulo D, Marone EM, Chiesa R. Aberrant right subclavian artery in blunt aortic injury: implication for treatment and review of the literature. Ann Vasc Surg 2012; 26:861.e1-6. [PMID: 22794343 DOI: 10.1016/j.avsg.2012.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/17/2012] [Indexed: 11/18/2022]
Abstract
Blunt aortic injury (BAI) involving an aberrant right subclavian artery (ARSA) is uncommon. The presence of an ARSA entails several treatment issues, in particular regarding the risk of perioperative posterior cerebral stroke. We report the case of a man with an ARSA who suffered from BAI. An initial conservative treatment with delayed open repair was chosen. A review of the published literature with discussion of the case is presented. The presence of an ARSA in patients with BAI can be considered a poor anatomy for endovascular repair, and suitable patients may benefit from delayed open repair.
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Affiliation(s)
- Giovanni Coppi
- Vascular Surgery-Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Milano, Italy.
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27
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Ikeda A, Sato F, Tokunaga C, Enomoto Y, Kanemoto S, Matsushita S, Hiramatsu Y, Sakakibara Y. Surgical repair for rupture of a chronic traumatic thoracic aneurysm 14 years after injury: report of a case. Surg Today 2011; 42:191-4. [PMID: 22068669 DOI: 10.1007/s00595-011-0001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/06/2011] [Indexed: 11/24/2022]
Abstract
Traumatic thoracic aortic injury is a lethal condition. Because its mortality rate is extremely high in the acute phase, these patients rarely survive long enough for a chronic aneurysm to develop. We herein report a case of surgical repair for a ruptured chronic traumatic thoracic aneurysm. A 32-year-old man, who had been involved in a traffic accident 14 years earlier, was diagnosed with a rupture of a chronic traumatic thoracic aneurysm. Preoperative computed tomography showed that the ruptured aneurysm arose from the aortic isthmus and was accompanied by multiple daughter lesions. He underwent an aorta graft replacement with reconstruction of the left subclavian artery using both a median sternotomy and a left thoracotomy. The surgery was successful and the postoperative course was uneventful. Chronic traumatic thoracic aneurysm is usually a single lesion, and cases with daughter aneurysms have rarely been reported. We include a review of the previous literature and also discuss the etiology of this condition.
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Affiliation(s)
- Akihiko Ikeda
- Department of Cardiovascular Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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28
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Traumatische Aortenruptur. Notf Rett Med 2011. [DOI: 10.1007/s10049-011-1523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Clouse WD. Endovascular repair of thoracic aortic injury: current thoughts and technical considerations. Semin Intervent Radiol 2011; 27:55-67. [PMID: 21359015 DOI: 10.1055/s-0030-1247889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thoracic aortic traumatic injury is a highly morbid event. Mortality and paraplegia rates after emergent open repair remain high. Now, however, thoracic aortic endografting for trauma (TAET) is commonly used. It is appealing due to reduction of operative stress for the multiply injured trauma victim. This minimizing of stress and risk is secondary to avoidance of thoracotomy, single-lung ventilation, aortic cross-clamping, and the more complex anesthetic techniques required. Early and midterm results from TAET delineate improved outcomes, yet access and aortic constraints continue to challenge TAET. Questions regarding longer-term durability of endografts in younger patients remain unanswered. Broader application of TAET within endovascular programs is challenged by appropriate imaging, operating suite inventories, and the logistics and personnel required for TAET. Currently developed thoracic endograft devices are not ideal for TAET due to platform size and graft diameter. This is changing, however, as new modifications have been developed and trials are ongoing. In light of these collective factors, the management paradigm for traumatic aortic injury is beginning to favor TAET.
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30
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Forbes TL, Harris JR, Lawlor DK, DeRose G. Aortic dilatation after endovascular repair of blunt traumatic thoracic aortic injuries. J Vasc Surg 2010; 52:45-8. [DOI: 10.1016/j.jvs.2010.01.094] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/28/2010] [Accepted: 01/29/2010] [Indexed: 11/26/2022]
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Abstract
Although the long-term durability of stent grafts is still a concern, stent-graft treatment is already the best option in a large number of patients with descending thoracic aortic diseases who are poor candidates for surgical repair, or in an acute setting. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.
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Affiliation(s)
- Rossella Fattori
- Cardiovascular Radiology Unit-Cardiovascular Department (pad 21), University Hospital S. Orsola, Via Massarenti 9, 40128 Bologna, Italy.
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32
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Ehrlich MP, Rousseau H, Heijman R, Piquet P, Beregi JP, Nienaber CA, Sodeck G, Fattori R. Early Outcome of Endovascular Treatment of Acute Traumatic Aortic Injuries: The Talent Thoracic Retrospective Registry. Ann Thorac Surg 2009; 88:1258-63. [DOI: 10.1016/j.athoracsur.2009.06.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 06/06/2009] [Accepted: 06/10/2009] [Indexed: 12/01/2022]
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33
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Reply to the Editor. J Thorac Cardiovasc Surg 2009. [DOI: 10.1016/j.jtcvs.2009.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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