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Thanh VT, Bang HT, Hai PVH, Phuong DD, Cuong LT, Vy TT. Traumatic rupture of the thoracic aorta: A life-threatening emergency and the role of endovascular repair. Radiol Case Rep 2023; 18:1605-1609. [PMID: 36852290 PMCID: PMC9958258 DOI: 10.1016/j.radcr.2023.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/16/2023] Open
Abstract
Traumatic rupture of the thoracic aorta is a rare condition, with a high mortality rate. Over the last 2 decades, strategies for managing aortic injury caused by blunt chest trauma have changed substantially, resulting in significantly improved outcomes. The recent development of endovascular repair offers a less invasive alternative to conventional open repair, particularly in patients with multiple injuries. Here, we report the case of a 31-year-old man who was referred to our emergency department with blunt chest trauma following a motorcycle-truck collision. Computed tomography confirmed acute traumatic rupture of the thoracic aorta, and the patient was successfully treated with endovascular repair.
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Affiliation(s)
- Vu Tri Thanh
- Thu Duc City Hospital, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy, 215 Hong Bang St, District 5, Ho Chi Minh City, 72714 Vietnam
- Department of Health Organization and Management, Faculty of Public Health, University of Medicine and Pharmacy, 217 Hong Bang Street, District 5, Ho Chi Minh City, 72714 Vietnam
| | - Phan Vu Hong Hai
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy, 217 Hong Bang Street, District 5, Ho Chi Minh City, 72714 Vietnam
| | - Dao Duy Phuong
- Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy, 215 Hong Bang St, District 5, Ho Chi Minh City, 72714 Vietnam
| | - Lam Thao Cuong
- Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy, 215 Hong Bang St, District 5, Ho Chi Minh City, 72714 Vietnam
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy, 217 Hong Bang Street, District 5, Ho Chi Minh City, 72714 Vietnam
| | - Tran Thanh Vy
- Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy, 215 Hong Bang St, District 5, Ho Chi Minh City, 72714 Vietnam
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy, 217 Hong Bang Street, District 5, Ho Chi Minh City, 72714 Vietnam
- Corresponding author.
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Creating Interactive Three-Dimensional Applications to Visualise Novel Stent Grafts That Aid in the Treatment of Aortic Aneurysms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1356:1-29. [PMID: 35146615 DOI: 10.1007/978-3-030-87779-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Three-Dimensional (3D) medical animations incorporated into applications are highly beneficial for clinical outreach and medical communication purposes that work towards educating the clinician and patient. Aortic aneurysms are a clinically important area to communicate with multiple audiences about various treatment options; both abdominal and thoracic aortic aneurysms were selected to create 3D animations and applications to educate medical professionals and patients regarding treatment options. Fenestrated endovascular aortic repair (FEVAR) and thoracic endovascular aortic repair (TEVAR) are both tried and tested minimally invasive surgical methods for treating thoracic aortic aneurysms respectively. The Terumo Aortic Custom Relay Proximal Scalloped stent graft and Fenestrated Anaconda stent graft were both designed specifically for these procedures; however, it can be difficult to visually communicate to clinicians and patients in a straightforward way how these devices work. Therefore, we have developed two interactive applications that use 3D visualisation techniques to demonstrate how these aortic devices function and are implemented. The objective of these applications is to engage both clinicians and patients, therefore demonstrating that the addition of anatomically accurate 3D visualisations within an interactive interface would have a positive impact on public engagement while also ensuring that clinicians will have the best possible understanding of the potential uses of both devices, enabling them to exploit their key features to effectively broaden the treatable patient population.Detailed anatomical modelling and animation was used to generate realistic and accurate rendered videos showcasing both products. These videos were integrated into an interactive application within a modern, professional graphic interface that allowed the user to explore all aspects of the stent device. The resulting applications were broken down into three modules: deployment, clinical performance and features. Following application development, these applications were evaluated by professionals in the field. Overall, positive feedback was received regarding the user-friendly nature of the applications and highly effective animations to showcase the products. The clinical applications and feature modules were particularly successful, while the deployment modules had a neutral response. Biomedical applications such as these show great potential for communicating the key features of medical devices and promoting discussion between clinicians and patients; further testing would need to be conducted on a larger group of participants in order to validate the learning effectiveness of the applications.
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Cassidy S, Allouni K, Day C, Wells D, Pherwani A, Ablett D. Blunt Thoracic Aortic Injury and Acute Trauma: The Effect on Aortic Diameter and the Consequences for Stent-graft Sizing. Ann Vasc Surg 2020; 72:563-570. [PMID: 33227478 DOI: 10.1016/j.avsg.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Blunt thoracic aortic injury (BTAI) is associated with a high mortality and large trauma burden. Trauma and resuscitation after injury affect cardiovascular status, which may in turn affect aortic diameter. Measurement of aortic diameter is necessary to guide stent-graft sizing as part of BTAI management. Inaccurate measurement may lead to stent-graft complications. This pilot study aimed to assess the effect of acute major trauma on stent-graft sizing and stent-graft complications, in the context of BTAI and to assess whether any effect could be predicted. METHODS Patients who were admitted to a UK major trauma center between January 2007 and December 2017, and were diagnosed with BTAI, were identified. The thoracic aortic diameter was measured at six points on initial and surveillance computed tomography imaging. Data on patient demographics, admission heart rate, mean arterial pressure (MAP), and serum lactate were gathered. RESULTS Thirty-two patients were identified. Twenty met inclusion criteria. Of these, 12 were managed operatively and eight nonoperatively. The mean age was 40, the mean injury severity score was 43, and 85% were male. A mean increase in diameter between initial trauma scan and surveillance scan was noted throughout the thoracic aorta (P < 0.05). Stent-graft oversizing relative to aortic diameter changed significantly from initial trauma imaging to surveillance imaging (P < 0.05). Admission heart rate, MAP, and serum lactate were not predictive of the percentage change in aortic diameter. There were no complications at surveillance imaging (mean 45 days) or during medium term follow-up (mean 532 days). CONCLUSIONS Aortic diameter is affected by BTAI, acute major trauma, and resuscitation in a significant and variable manner. Measurements of the aorta in a patient with BTAI in the acute trauma setting should be viewed with uncertainty. A lack of complications in the short term is suggestive of a wide tolerance range regarding stent-graft sizing, but long-term results are unknown.
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Affiliation(s)
- Samuel Cassidy
- Keele University Medical School, Stoke-on-Trent, Staffordshire, UK.
| | - Kader Allouni
- Department of Interventional Radiology, Royal Stoke Unviersity Hospital, Stoke-on-Trent, Staffordshire, UK
| | - Christopher Day
- Department of Interventional Radiology, Royal Stoke Unviersity Hospital, Stoke-on-Trent, Staffordshire, UK
| | - David Wells
- Department of Interventional Radiology, Royal Stoke Unviersity Hospital, Stoke-on-Trent, Staffordshire, UK
| | - Arun Pherwani
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
| | - Daniel Ablett
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
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Carter R, Wee IJY, Petrie K, Syn N, Choong AM. Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review. Vascular 2018; 27:204-212. [PMID: 30522411 DOI: 10.1177/1708538118812548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Whilst the management of blunt traumatic thoracic aortic injury has seen a paradigm shift to an 'endovascular first' approach, the limitations of thoracic endovascular aortic repair remain. An inadequate proximal landing zone limits the use of thoracic aortic stent grafts and in an emergent polytrauma setting, aortic arch debranching via open surgery may not be practical or feasible. A wholly endovascular approach to debranching utilising 'off-the-shelf' stents and parallel graft techniques may represent a possible solution. Hence, we sought to perform a systematic review investigating the use of chimney graft techniques alongside thoracic aortic stenting in blunt traumatic thoracic aortic injury. METHODS We performed the systematic review in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on Medline (PubMed), Web of Science and Scopus to identify articles describing the use of chimney grafts in traumatic aortic transection (PROSPERO: CRD42017082549). RESULTS The systematic search revealed 172 papers, of which 88 duplicates were removed resulting in 84 papers to screen. Based on title, abstract and full text review, six articles were included for final analysis. There were nine patients in total with an average age of 41 (three females, five males, one unspecified), all with significant polytrauma, secondary to the mechanism of injury. A variety of stents were used between centres, with techniques showing a predominance to stenting of the left subclavian artery (77%, n = 7). The technical success rate was 82%, with two (18%) cases of type 1 endoleaks, of which one resolved spontaneously. CONCLUSIONS Despite the encouraging results, this by no means provides for a firm conclusion given the small sample size. Patients should still be judiciously selected on a case-by-case basis when employing the chimney graft technique. Larger cohort studies are needed to establish these findings.
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Affiliation(s)
- Rebeca Carter
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,2 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ian Jun Yan Wee
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kyle Petrie
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,2 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicholas Syn
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Mtl Choong
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,4 Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore.,5 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,6 Division of Vascular Surgery, National University Heart Centre, Singapore, Singapore
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Fogleman L, Caffery T, Gruner J, Tatum D. Thoracic aortic transection resulting in a type B dissection following blunt trauma. BMJ Case Rep 2017; 2017:bcr-2016-218766. [PMID: 29170169 DOI: 10.1136/bcr-2016-218766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old man sustained an acute grade III aortic injury resulting in a type B aortic dissection in the setting of severe traumatic brain injury, cervical spine injury and multiple orthopaedic injuries following a motorcycle crash. The patient underwent an emergent thoracic endovascular aortic repair, complicated by a thoracic pseudoaneurysm rupture and ongoing exsanguination from a persistent type 1 endoleak. Additional stent grafts were required to gain control of the endoleak. The patient ultimately progressed to brain death post procedure in the intensive care unit. This case reviews treatment considerations in the context of a blunt thoracic aortic transection and distal dissection with concomitant polytrauma.
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Affiliation(s)
- Lance Fogleman
- Emergency Medicine, LSU Health Baton Rouge, Baton Rouge, Louisiana, USA
| | - Terrell Caffery
- Emergency Medicine, LSU Health Baton Rouge, Baton Rouge, Louisiana, USA
| | - Jeffrey Gruner
- Trauma Specialist Program, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Danielle Tatum
- Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
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Double-valve intervention with staged hybrid repair for post-traumatic aortic incompetence and aortic rupture. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shan JG, Zhai XM, Liu JD, Yang WG, Xue S. Thoracic Endovascular Aortic Repair for Traumatic Thoracic Aortic Injury: A Single-Center Initial Experience. Ann Vasc Surg 2016; 32:104-10. [PMID: 26802306 DOI: 10.1016/j.avsg.2015.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several publications have documented the technical feasibility and efficacy of stent grafting for aortic injuries. We report short- and mid-term results of thoracic endovascular repair with covered stent grafts for type B blunt thoracic aortic injury. METHODS We performed a retrospective review of patients who had sustained blunt thoracic aortic injuries. From January 2010 to March 2014, 13 patients (12 men and 1 woman) were admitted and treated in our department for type B thoracic aortic injury. The patients' ages ranged from 19 to 62 years. Traffic accidents were responsible for 10 of the 13 blunt thoracic aortic injuries, and the remainder was caused by blunt trauma from falls. Medical records were examined to identify the clinical outcomes of the procedures, and follow-up computed tomography scans were reviewed to document the efficacy of thoracic endovascular aortic repair. RESULTS Endovascular stent grafting was technically successful in all cases, and no paraplegia or stroke-like events were reported. No major cardiac, neurologic, or peripheral vascular complications were observed during early or late follow-up. None of the patients died from procedure-related complications. CONCLUSIONS Our single-center experience demonstrates the feasibility of performing endovascular repair for type B blunt aortic injury. As experience with endovascular surgery accumulates, this method of treatment promises to become the first-choice option for repairing this type of aortic injury, with less associated morbidity and mortality relative to conventional surgical repair.
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Affiliation(s)
- Jiang-Gui Shan
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xin-Ming Zhai
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ji-Dong Liu
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wen-Gang Yang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Song Xue
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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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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Jang MO, Kim JH, Oh SK, Lee MG, Park KH, Sim DS, Hong YJ, Ahn Y, Jeong MH. Endovascular stent in traumatic thoracic aortic dissection. Korean Circ J 2012; 42:341-4. [PMID: 22701500 PMCID: PMC3369966 DOI: 10.4070/kcj.2012.42.5.341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/02/2011] [Accepted: 09/01/2011] [Indexed: 11/11/2022] Open
Abstract
Traumatic thoracic aortic injury is typically fatal. However, recent improvements in pre-hospital care and diagnostic modalities have resulted in an increased number of patients with traumatic aortic injury arriving alive at the hospital. Also, the morbidity and mortality associated with endovascular repair are significantly lower than with conventional open surgery in traumatic thoracic aorta injury. We experienced two cases of successful management of traumatic thoracic aortic dissection with endovascular stents caused by traffic accidents.
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Affiliation(s)
- Mi Ok Jang
- The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Lamarche Y, Berger FH, Nicolaou S, Bilawich AM, Louis L, Inacio JR, Janusz MT, Evans D. Vancouver simplified grading system with computed tomographic angiography for blunt aortic injury. J Thorac Cardiovasc Surg 2011; 144:347-54, 354.e1. [PMID: 22070925 DOI: 10.1016/j.jtcvs.2011.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 09/15/2011] [Accepted: 10/04/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Delineation of blunt aortic injury by computed tomographic angiography guides management of this potentially fatal injury. Two existing grading systems are problematic to apply and not linked to outcomes. A simplified computed tomographic angiography-based grading system, linked to clinical outcomes, was developed, and feasibility and reliability were evaluated. METHODS Retrospective review was performed of all blunt aortic injury cases presenting to a single provincial quaternary referral center designated for blunt aortic injury management between 2001 and 2009. Management, associated injuries, hospital survival, and cause of death were determined. Initial computed tomographic angiography was reviewed, and injuries were graded according to the new Vancouver simplified grading system by 2 study authors. Three additional trauma radiologists then graded the aortic injuries with the 2 existing systems and the simplified system. Interrater reliability was determined. RESULTS Forty-eight patients were identified. Two had minimal aortic injury (grade I), 7 had an intimal flap larger than 1 cm (grade II), 32 had traumatic pseudoaneurysm (grade III), 6 had active contrast extravasation (grade IV), and 1 could not be rated. Survivals were 100%, 90%, and 33% for grades I and II, III, and IV, respectively. Of grade III injuries, 14% were medically managed, 68% repaired endovascularly, and 18% repaired with open surgery. Interrater correlation was best with the simplified score, with only 0.5% of cases unable to be classified. CONCLUSIONS The Vancouver simplified blunt aortic injury grading system is easy to use and correlates with clinical outcomes. Prospective external validation is required.
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Affiliation(s)
- Yoan Lamarche
- Division of Cardiothoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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