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1
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Akinaga S, Maruhashi T, Oi M, Mishima T, Miyaji K, Asari Y. Blunt Thoracic and Abdominal Aortic Injury in Multiple Trauma: A Case Report. Vasc Endovascular Surg 2025; 59:416-419. [PMID: 39437127 DOI: 10.1177/15385744241296214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
BackgroundBlunt abdominal aortic injury (BAAI) is rare among traumatic aortic injuries, and further complications of blunt thoracic aortic injury (BTAI) have never been reported.Case PresentationA man in his 80s presented to our hospital following a motor vehicle accident. Pan-scan contrast-enhanced CT showed a thoracic aortic isthmus injury (Grade III), an abdominal aortic injury (Grade IV) with extravasation of contrast media at the level of the fourth lumbar vertebra. Endovascular abdominal aortic repair was performed on the same day and a thoracic endovascular aortic repair for BTAI was performed 11 days after admission. The patient had a good postoperative course and was discharged without complications.ConclusionThis report presented a rare case of BTAI complicated with BAAI. The timing of intervention for aortic injury should be determined based on urgency and other organ damage.
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MESH Headings
- Humans
- Male
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/surgery
- Wounds, Nonpenetrating/etiology
- Vascular System Injuries/diagnostic imaging
- Vascular System Injuries/surgery
- Vascular System Injuries/etiology
- Treatment Outcome
- Accidents, Traffic
- Endovascular Procedures/instrumentation
- Aorta, Thoracic/injuries
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/surgery
- Blood Vessel Prosthesis Implantation
- Aorta, Abdominal/injuries
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/surgery
- Multiple Trauma/diagnostic imaging
- Multiple Trauma/surgery
- Multiple Trauma/etiology
- Thoracic Injuries/diagnostic imaging
- Thoracic Injuries/surgery
- Thoracic Injuries/etiology
- Aged, 80 and over
- Abdominal Injuries/diagnostic imaging
- Abdominal Injuries/surgery
- Abdominal Injuries/etiology
- Aortography/methods
- Computed Tomography Angiography
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Affiliation(s)
- Seishiro Akinaga
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takaaki Maruhashi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Marina Oi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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2
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Garg I, Grist TM, Nagpal P. MR Angiography for Aortic Diseases. Cardiol Clin 2025; 43:229-250. [PMID: 40268353 DOI: 10.1016/j.ccl.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
Aortic pathologic conditions represent diverse disorders, including aortic aneurysm, acute aortic syndrome, traumatic aortic injury, and atherosclerosis. Given the nonspecific clinical features, noninvasive imaging is critical in screening, diagnosis, management, and posttherapeutic surveillance. Of the commonly used imaging modalities, including ultrasound, computed tomography, and MR imaging, the final choice often depends on a combination of factors: acuity of clinical presentation, suspected underlying diagnosis, and institutional practice. Further research is needed to identify the potential clinical role and define appropriate use criteria for advanced MR applications such as four-dimenional flow to manage patients with aortic pathologic conditions.
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Affiliation(s)
- Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University Of New Mexico, Albuquerque, NM 87131, USA
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, E3/366 Clinical Science Center 600 Highland Avenue Madison, WI 53792, USA
| | - Prashant Nagpal
- Cardiovascular and Thoracic Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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3
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Zambetti BR, Plant J, Zhang JM, Ghoreishi M, Toursavadkohi S. Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma. Ann Vasc Surg 2025; 113:35-40. [PMID: 39863276 DOI: 10.1016/j.avsg.2025.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 12/27/2024] [Accepted: 01/01/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, traumatic penetrating aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI. METHODS Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011 to 2022. Patients with blunt and penetrating injuries were compared based on preoperative characteristics, injury severity, and postoperative outcomes. RESULTS TEVAR was performed for 1,867 patients with traumatic aortic injuries, of which 1,808 (96.9%) patients had BAI and 59 (3.1%) had PAI. The majority of injuries being treated were either grade 3 (pseudoaneurysm) (55.3%) or grade 4 (transection) (16.4%). PAI patients had a higher proportion of grade 4 injuries compared to BAI (36.4% vs. 16.5%, P = 0.001). The majority of PAI were in zones 4-5 (61.1% vs. 14.2%, P < 0.001), whereas the majority of BAI were in zone 3 (66.5% vs. 16.7%, P < 0.001). Overall, the mortality rate was 8.2% (N = 154). In hospital mortality was 8.5% in the PAI group and 8.2% in the BAI group (P = 0.813). There was no significant difference in major complication rates between PAI and BAI patients. CONCLUSION PAI occurs more commonly in zones 4-5 of the thoracic aorta and often presents with higher grade aortic injury when compared to BAI. TEVAR for PAI provides excellent in-hospital survival, especially compared to historical mortality rates around 40%. An endovascular first approach may lead to improved survival for PAI.
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MESH Headings
- Humans
- Endovascular Procedures/adverse effects
- Endovascular Procedures/mortality
- Male
- Female
- Vascular System Injuries/surgery
- Vascular System Injuries/mortality
- Vascular System Injuries/diagnostic imaging
- Treatment Outcome
- Aorta, Thoracic/surgery
- Aorta, Thoracic/injuries
- Aorta, Thoracic/diagnostic imaging
- Middle Aged
- Adult
- Retrospective Studies
- Wounds, Penetrating/surgery
- Wounds, Penetrating/mortality
- Wounds, Penetrating/diagnostic imaging
- Databases, Factual
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/mortality
- Risk Factors
- Time Factors
- Postoperative Complications/mortality
- Postoperative Complications/etiology
- Aged
- United States
- Young Adult
- Wounds, Nonpenetrating/surgery
- Wounds, Nonpenetrating/mortality
- Wounds, Nonpenetrating/diagnostic imaging
- Risk Assessment
- Hospital Mortality
- Endovascular Aneurysm Repair
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Affiliation(s)
| | - Joshua Plant
- Division of Vascular Surgery, University of Maryland, Baltimore, MD
| | - Jackie M Zhang
- Division of Vascular Surgery, University of Maryland, Baltimore, MD
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4
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Goto M, Fukuda M, Hirayu N, Nabeta M, Yokosuka K, Yamashita N, Takasu O. Subacute Rare Complication in a Patient with Diffuse Idiopathic Skeletal Hyperostosis Accompanied by Minor Trauma-Induced Lumbar Fracture: A Large Abdominal Aortic Pseudoaneurysm. Spine Surg Relat Res 2025; 9:263-265. [PMID: 40223845 PMCID: PMC11983119 DOI: 10.22603/ssrr.2024-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/27/2024] [Indexed: 04/15/2025] Open
Affiliation(s)
- Masafumi Goto
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Fukuoka, Japan
- Department of Orthopaedic Surgery, Kurume University Hospital, Fukuoka, Japan
| | - Masafumi Fukuda
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Fukuoka, Japan
| | - Nobuhisa Hirayu
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Fukuoka, Japan
| | - Masakazu Nabeta
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Fukuoka, Japan
| | - Kimiaki Yokosuka
- Department of Orthopaedic Surgery, Kurume University Hospital, Fukuoka, Japan
| | - Norio Yamashita
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Fukuoka, Japan
| | - Osamu Takasu
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Fukuoka, Japan
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5
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Xie Y, Lu C, Hu J. Refractory heart failure due to acquired aortic coarctation after total arch replacement: find the right antidote! ESC Heart Fail 2025. [PMID: 40051169 DOI: 10.1002/ehf2.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 03/17/2025] Open
Abstract
A 31-year-old male presented with unexplainable symptoms of heart failure including recurrent fatigue and orthopnoea after total arch replacement for type A aortic dissection 2 months ago. Computed tomography angiography detected a severe intra-luminal stenosis, and we successfully implanted a balloon-expandable stent to dilate the stenosis. The patient with improved haemodynamics after endovascular reintervention remains stable at 2 years. The case provides a feasible endovascular therapy for heart failure caused by post-surgery aortic coarctation.
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Affiliation(s)
- Yi Xie
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guo Xue Alley 37, Chengdu, 610041, Sichuan Province, China
| | - Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guo Xue Alley 37, Chengdu, 610041, Sichuan Province, China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guo Xue Alley 37, Chengdu, 610041, Sichuan Province, China
- Department of Cardiothoracic Surgery, Guang'an Hospital of West China Hospital of Sichuan University, Guang'an, Sichuan Province, China
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6
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Wahlgren CM, Aylwin C, Davenport RA, Davidovic LB, DuBose JJ, Gaarder C, Heim C, Jongkind V, Jørgensen J, Kakkos SK, McGreevy DT, Ruffino MA, Vega de Ceniga M, Vikatmaa P, Ricco JB, Brohi K, Antoniou GA, Boyle JR, Coscas R, Dias NV, Mees BME, Trimarchi S, Twine CP, Van Herzeele I, Wanhainen A, Blair P, Civil IDS, Engelhardt M, Mitchell EL, Piffaretti G, Wipper S. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. Eur J Vasc Endovasc Surg 2025; 69:179-237. [PMID: 39809666 DOI: 10.1016/j.ejvs.2024.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 12/09/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular trauma with the aim of assisting physicians in selecting the optimal management strategy. METHODS The guidelines are based on scientific evidence completed with expert opinion. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to the ESVS evidence grading system, where the strength (class) of each recommendation is graded from I to III, and the letters A to C mark the level of evidence. RESULTS A total of 105 recommendations have been issued on the following topics: general principles for vascular trauma care and resuscitation including technical skill sets, bleeding control and restoration of perfusion, graft materials, and imaging; management of vascular trauma in the neck, thoracic aorta and thoracic outlet, abdomen, and upper and lower extremities; post-operative considerations after vascular trauma; and paediatric vascular trauma. In addition, unresolved vascular trauma issues and the patients' perspectives are discussed. CONCLUSION The ESVS clinical practice guidelines provide the most comprehensive, up to date, evidence based advice to clinicians on the management of vascular trauma.
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7
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Liese-Landolt F, Pape HC, Jukema GN. The treatment of acute traumatic aortic injuries with TEVAR: a retrospective analysis of 19 cases in a level-1 trauma center. Langenbecks Arch Surg 2025; 410:43. [PMID: 39825957 PMCID: PMC11742738 DOI: 10.1007/s00423-025-03613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 01/14/2025] [Indexed: 01/20/2025]
Abstract
INTRODUCTION Blunt traumatic aortic injury (TAI) is a critical condition and a leading cause of mortality in trauma patients, often resulting from high-speed accidents. Thoracic endovascular aortic repair (TEVAR) has developed into the preferred therapeutic approach due to its minimally invasive nature and promising outcomes. This study evaluates the safety and efficacy of TEVAR for managing TAI over a 10-year period at a Level-1 trauma center. METHODS A retrospective analysis was conducted on 19 patients with acute TAI treated with TEVAR between 2012 and 2022 at the University Hospital Zurich. Data were collected from digital records and analyzed according to the Fillinger TEVAR reporting framework. Outcomes included technical success, perioperative complications, and long-term graft durability. RESULTS The cohort had a mean age of 39 years and included patients with severe polytrauma. Technical success was achieved in 95% of cases, with no intraoperative deaths or need for open surgical conversion. Perioperative complications were minimal, and the reintervention rate was 5.3%. This study evaluates 10 years of clinical experience managing TAI with TEVAR. Long-term follow-up, with a median duration of 29 months, revealed no graft-related complications or secondary interventions. Imaging confirmed sustained graft integrity, and clinical outcomes were favorable. CONCLUSION TEVAR is a reliable and effective treatment for traumatic aortic injuries, offering excellent technical success rates and minimal perioperative and long-term complications. This study highlights TEVAR's advantages in managing polytrauma patients and its role as a minimally invasive alternative to open surgery. Additionally, the findings emphasize the need for comprehensive long-term follow-up protocols. Future research should aim to address challenges related to device durability and the integration of advanced imaging techniques to further enhance patient outcomes and broaden the applicability of TEVAR in trauma care.
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Affiliation(s)
- F Liese-Landolt
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, CH - 8091, Zurich, Switzerland.
| | - H-C Pape
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, CH - 8091, Zurich, Switzerland
| | - G N Jukema
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, CH - 8091, Zurich, Switzerland
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8
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Hua Z, Zhou B, Xue W, Zhou Z, Shan J, Xia L, Luo Y, Chai Y, Li Z. Evaluating the effectiveness of immediate vs. elective thoracic endovascular aortic repair for blunt thoracic aortic injury. Chin J Traumatol 2025; 28:22-28. [PMID: 39179447 PMCID: PMC11840310 DOI: 10.1016/j.cjtee.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/15/2024] [Accepted: 07/13/2024] [Indexed: 08/26/2024] Open
Abstract
PURPOSE To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis. METHODS This is a single-center retrospective cohort study. Patients who received TEVAR for BTAI at our institution from October 2016 to September 2023 were divided into 2 categories depending on the injury severity score (ISS) (≤ 25 vs. > 25) and when the TEVAR was performed for BTAI (within 24 h vs. after 24 h), respectively. The analysis included all patients who received TEVAR treatment after being diagnosed with BTAI through whole-body CT angiography. Patients treated with open repair and non-operative management were excluded. After propensity-score matching for various factors, outcomes during hospitalization and follow-up were compared. These factors included demographics, comorbidities, concomitant injuries, cause and location of aortic injury, Glasgow coma scale score, society for vascular surgery grading, hemoglobin concentration, creatinine concentration, shock, systolic blood pressure, and heart rate at admission. The comparison was conducted using SPSS 26 software. Continuous variables were presented as either the mean ± standard deviation or median (Q1, Q3), and were compared using either the t-test or the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 2 groups using the χ2 test or Fisher's exact test. Statistical significance was defined as a 2-sided p < 0.05. RESULTS In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores > 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS > 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) vs. 2 (4.4%), p < 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q1, Q3)) compared to the immediate group (15 (12, 15) vs. 13.5 (9, 15), p = 0.039), while the creatinine concentration (median (Q1, Q3)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) vs. 71.5 (58.3, 80.8), p = 0.012). The final sample included 52 matched patients. Complications occurred significantly less frequently in the elective group compared to the immediate group (16 (50.0%) vs. 3 (10.0%), p < 0.001). Single-factor analysis of variance showed that complications in hospitalized patients were significantly associated with immediate TEVAR as the sole independent risk factor (odds ratio: 9.000, 95% confidence interval: 2.266-35.752, p = 0.002). CONCLUSION In this propensity-score matched analysis of patients undergoing TEVAR for BTAI, elective TEVAR was significantly associated with a lower risk of complication rates. In this study using propensity-score matching, patients who underwent elective TEVAR for BTAI had lower complication rates than immediate TEVAR.
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Affiliation(s)
- Zhaohui Hua
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Baoning Zhou
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wenhao Xue
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhibin Zhou
- Department of Vascular Surgery, Nanchang University Second Affiliated Hospital, Nanchang, 330006, China
| | - Jintao Shan
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lei Xia
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yunpeng Luo
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yiming Chai
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhen Li
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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9
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Zambetti BR, Nelson AC, Hosseinpour H, Anand T, Colosimo C, Spencer AL, Stewart C, Bhogadi SK, Hejazi O, Joseph B, Magnotti LJ. The optimal management of blunt aortic injury in the young. Am J Surg 2024; 237:115943. [PMID: 39236378 DOI: 10.1016/j.amjsurg.2024.115943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset. METHODS Patients (1-19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1-9] and adolescents [ages 10-19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI. RESULTS Adolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 %, p = 0.057) and significantly reduced mortality (2.1 vs 14.4 %, p < 0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059-0.324, p < 0.0001). CONCLUSIONS BAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.
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Affiliation(s)
| | - Adam C Nelson
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Tanya Anand
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Christina Colosimo
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Audery L Spencer
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Collin Stewart
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Sai K Bhogadi
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Omar Hejazi
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Bellal Joseph
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA
| | - Louis J Magnotti
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA.
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10
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Galan D, Caban KM, Singerman L, Braga TA, Paes FM, Katz DS, Munera F. Trauma and 'Whole' Body Computed Tomography: Role, Protocols, Appropriateness, and Evidence to Support its Use and When. Radiol Clin North Am 2024; 62:1063-1076. [PMID: 39393850 DOI: 10.1016/j.rcl.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
Imaging plays a crucial role in the immediate evaluation of the trauma patient, particularly using multi-detector computed tomography (CT), and especially in moderately to severely injured trauma patients. There are specific areas of relative consensus, while other aspects of whole-body computed tomography (WB-CT) use remain controversial and are subject to opinion/debate based on the current literature. Even a few hours of a delayed diagnosis may result in a detrimental outcome for the patient. One must utilize all the tools available to enhance the interpretation of images. It is also important to recognize imaging pitfalls and artifacts to avoid unnecessary intervention.
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Affiliation(s)
- Daniela Galan
- Department of Radiology, Jackson Memorial Hospital, University of Miami-Miller School of Medicine, 1611 Northwest 12th Avenue, West Wing 279, Miami, FL 33136, USA.
| | - Kim M Caban
- Department of Radiology, Jackson Memorial Hospital, University of Miami-Miller School of Medicine, 1611 Northwest 12th Avenue, West Wing 279, Miami, FL 33136, USA
| | - Leandro Singerman
- Department of Radiology, Jackson Memorial Hospital, University of Miami-Miller School of Medicine, 1611 Northwest 12th Avenue, West Wing 279, Miami, FL 33136, USA
| | - Thiago A Braga
- Department of Radiology, Jackson Memorial Hospital, University of Miami-Miller School of Medicine, 1611 Northwest 12th Avenue, West Wing 279, Miami, FL 33136, USA
| | - Fabio M Paes
- Department of Radiology, Jackson Memorial Hospital, University of Miami-Miller School of Medicine, 1611 Northwest 12th Avenue, West Wing 279, Miami, FL 33136, USA
| | - Douglas S Katz
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Felipe Munera
- Department of Radiology, Jackson Memorial Hospital, University of Miami-Miller School of Medicine, 1611 Northwest 12th Avenue, West Wing 279, Miami, FL 33136, USA
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11
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Choi Y, Jakob R, Ehret AE, von Bohemer L, Cesarovic N, Falk V, Emmert MY, Mazza E, Giampietro C. Stretch-induced damage in endothelial monolayers. BIOMATERIALS ADVANCES 2024; 163:213938. [PMID: 38959650 DOI: 10.1016/j.bioadv.2024.213938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
Endothelial cells are constantly exposed to mechanical stimuli, of which mechanical stretch has shown various beneficial or deleterious effects depending on whether loads are within physiological or pathological levels, respectively. Vascular properties change with age, and on a cell-scale, senescence elicits changes in endothelial cell mechanical properties that together can impair its response to stretch. Here, high-rate uniaxial stretch experiments were performed to quantify and compare the stretch-induced damage of monolayers consisting of young, senescent, and aged endothelial populations. The aged and senescent phenotypes were more fragile to stretch-induced damage. Prominent damage was detected by immunofluorescence and scanning electron microscopy as intercellular and intracellular void formation. Damage increased proportionally to the applied level of deformation and, for the aged and senescent phenotype, induced significant detachment of cells at lower levels of stretch compared to the young counterpart. Based on the phenotypic difference in cell-substrate adhesion of senescent cells indicating more mature focal adhesions, a discrete network model of endothelial cells being stretched was developed. The model showed that the more affine deformation of senescent cells increased their intracellular energy, thus enhancing the tendency for cellular damage and impending detachment. Next to quantifying for the first-time critical levels of endothelial stretch, the present results indicate that young cells are more resilient to deformation and that the fragility of senescent cells may be associated with their stronger adhesion to the substrate.
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Affiliation(s)
- Young Choi
- ETH Zürich, Dep. of Mechanical and Process Engineering, Zürich, Switzerland
| | - Raphael Jakob
- ETH Zürich, Dep. of Mechanical and Process Engineering, Zürich, Switzerland
| | - Alexander E Ehret
- ETH Zürich, Dep. of Mechanical and Process Engineering, Zürich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - Lisa von Bohemer
- University of Zurich, Institute of Regenerative Medicine, Schlieren, Switzerland
| | - Nikola Cesarovic
- ETH Zürich, Dep. of Health Sciences and Technology, Zürich, Switzerland; Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Volkmar Falk
- ETH Zürich, Dep. of Health Sciences and Technology, Zürich, Switzerland; Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maximilian Y Emmert
- University of Zurich, Institute of Regenerative Medicine, Schlieren, Switzerland; Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Edoardo Mazza
- ETH Zürich, Dep. of Mechanical and Process Engineering, Zürich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland.
| | - Costanza Giampietro
- ETH Zürich, Dep. of Mechanical and Process Engineering, Zürich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland.
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12
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Chopko TC, Khan FW, Pochettino A. Bull attack causing complex blunt thoracic aortic injury requiring total arch replacement. JTCVS Tech 2024; 26:16-20. [PMID: 39156532 PMCID: PMC11329201 DOI: 10.1016/j.xjtc.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 08/20/2024] Open
Affiliation(s)
| | - Fazal W. Khan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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13
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Aizawa H, Yamauchi H, Ando M, Ono M. Posttraumatic aortic regurgitation and root pseudoaneurysm following blunt chest trauma: a case report. Surg Case Rep 2024; 10:180. [PMID: 39083244 PMCID: PMC11291823 DOI: 10.1186/s40792-024-01963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The simultaneous diagnosis of severe aortic regurgitation and aortic root pseudoaneurysm resulting from traffic injury is extremely rare. This report presents the case of a patient with Marfan syndrome who experienced aortic root pseudoaneurysm and subacute severe aortic regurgitation following a traffic accident. CASE PRESENTATION A 64-year-old woman was diagnosed with Marfan syndrome 16 years ago and is undergoing ongoing follow-up at an outpatient clinic. Eight years previously, the patient underwent total arch replacement combined with J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan) deployment for acute type A dissection. Five months before presentation, the patient suffered a left rib fracture in a traffic accident and received conservative management at a local hospital. The patient presented to the emergency room with worsening shortness of breath and orthopnea. Echocardiography revealed severe aortic regurgitation and moderate tricuspid regurgitation. Computed tomography revealed new-onset pseudoaneurysm at the aortic root. Surgical repair was successfully performed using a modified Bentall procedure with a bioprosthetic valve and tricuspid annuloplasty. Intraoperative findings revealed pseudoaneurysm with perforation of the right sinus of Valsalva. Although the left and right aortic valve leaflets were normal, the noncoronary leaflet exhibited a ruptured fibrous strand of a cusp fenestration, resulting in acute aortic regurgitation. CONCLUSIONS This case report highlights the rare occurrence of aortic root pseudoaneurysm and subacute aortic regurgitation following a traffic accident. In cases of blunt chest trauma, particularly in patients with Marfan syndrome, frequent examination is crucial to assess the possibility of posttraumatic aortic regurgitation and aortic injury.
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Affiliation(s)
- Hiroaki Aizawa
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Haruo Yamauchi
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Masahiko Ando
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Minoru Ono
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
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14
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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15
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Wippel D, Lutz M, Kluckner M, Gruber L, Loizides A, Fischer J, Gizewski ER, Enzmann FK, Wipper S. Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents. J Clin Med 2024; 13:3315. [PMID: 38893026 PMCID: PMC11172595 DOI: 10.3390/jcm13113315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.
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Affiliation(s)
- David Wippel
- Department of Vascular Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.W.); (M.K.); (J.F.); (S.W.)
| | - Maximilian Lutz
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.G.); (A.L.); (E.R.G.)
| | - Michaela Kluckner
- Department of Vascular Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.W.); (M.K.); (J.F.); (S.W.)
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.G.); (A.L.); (E.R.G.)
| | - Alexander Loizides
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.G.); (A.L.); (E.R.G.)
| | - Jennifer Fischer
- Department of Vascular Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.W.); (M.K.); (J.F.); (S.W.)
| | - Elke R. Gizewski
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.G.); (A.L.); (E.R.G.)
| | - Florian K. Enzmann
- Department of Vascular Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.W.); (M.K.); (J.F.); (S.W.)
| | - Sabine Wipper
- Department of Vascular Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.W.); (M.K.); (J.F.); (S.W.)
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16
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Hsu TA, Huang JF, Kuo LW, Cheng CT, Kuo YC, Liao CH, Hsieh CH, Fu CY. Does Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury Increase the Probability of Delayed Intra-abdominal Hemorrhage in Patients With Concomitant Blunt Abdominal Trauma? J Endovasc Ther 2024; 31:428-437. [PMID: 36214460 DOI: 10.1177/15266028221128200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Most blunt thoracic aortic injuries (BTAIs) may be treated using thoracic endovascular aortic repair (TEVAR), and most blunt abdominal traumas (BATs) are managed conservatively. We hypothesized that severe trauma that needs TEVAR may increase the risk of delayed intra-abdominal hemorrhage in patients with concomitant BTAI and BAT because of the potential hemorrhagic shock, disseminated intravascular coagulopathy, blood loss, consequent need for blood transfusion, and procedure-associated heparinization. MATERIALS AND METHODS From 2015 to 2019, blunt trauma patients with concomitant severe chest trauma and abdominal trauma who could be managed conservatively were studied. The probability of delayed intra-abdominal hemorrhage was compared between patients with concomitant BTAI who received or did not undergo TEVAR. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and multivariate logistic regression (MLR) were used to eliminate discrepancies between these 2 groups. RESULTS Among the 341 studied patients, there were 26 patients with BTAI, and 19 of them underwent TEVAR. Delayed intra-abdominal hemorrhage was observed in 4 patients (21.1%, 4/19) who underwent TEVAR. Both PSM and IPTW showed that patients who underwent TEVAR for concomitant BTAI had a greater delayed need for blood transfusions and a larger proportion of delayed intra-abdominal hemorrhage than patients who did not undergo the procedure. The MLR analysis showed that TEVAR for BTAI was an independent risk factor for delayed intra-abdominal hemorrhage (odds ratio: 10.534, 95%, p<0.001). CONCLUSION An increased probability of delayed intra-abdominal hemorrhage in patients with BAT (who could be managed conservatively) was observed in patients who underwent TEVAR for concomitant BTAI. CLINICAL IMPACT More attention should be give in patients with high grade aortic injuries and concomitant abdominal trauma.
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Affiliation(s)
- Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Jen-Fu Huang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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17
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Golestani S, Dubose JJ, Efird J, Teixeira PG, Cardenas TC, Trust MD, Ali S, Aydelotte J, Bradford J, Brown CV. Nonoperative Management for Low-Grade Blunt Thoracic Aortic Injury. J Am Coll Surg 2024; 238:1099-1104. [PMID: 38407302 DOI: 10.1097/xcs.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) is the standard of care for the treatment of blunt thoracic aortic injury (BTAI) requiring intervention. Data suggest that low-grade BTAI (grade I [intimal tears] or grade II [intramural hematoma]) will resolve spontaneously if treated with nonoperative management (NOM) alone. There has been no comparison specifically between the use of NOM vs TEVAR for low-grade BTAI. We hypothesize that these low-grade injuries can be safely managed with NOM alone. STUDY DESIGN Retrospective analysis of all patients with a low-grade BTAI in the Aortic Trauma Foundation Registry from 2016 to 2021 was performed. The study population was 1 primary outcome was mortality. Secondary outcomes included complications, ICU length of stay, and ventilator days. RESULTS A total of 880 patients with BTAI were enrolled. Of the 269 patients with low-grade BTAI, 218 (81%) were treated with NOM alone (81% grade I, 19% grade II), whereas 51 (19%) underwent a TEVAR (20% grade I, 80% grade II). There was no difference in demographic or mechanism of injury in patients with low-grade BTAI who underwent NOM vs TEVAR. There was a difference in mortality between NOM alone and TEVAR (8% vs 18%, p = 0.009). Aortic-related mortality was 0.5% in the NOM group and 4% in the TEVAR group (p = 0.06). Hospital and ICU length of stay and ventilator days were not different between the 2 groups. CONCLUSIONS NOM alone is safe and appropriate management for low-grade BTAI, with lower mortality and decreased rates of complication when compared with routine initial TEVAR.
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Affiliation(s)
- Simin Golestani
- From the Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, TX
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18
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Garg I, Siembida JM, Hedgire S, Priya S, Nagpal P. Computed Tomography Angiography for Aortic Diseases. Radiol Clin North Am 2024; 62:509-525. [PMID: 38553183 DOI: 10.1016/j.rcl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aortic pathologies encompass a heterogeneous group of disorders, including acute aortic syndrome, traumatic aortic injury , aneurysm, aortitis, and atherosclerosis. The clinical manifestations of these disorders can be varied and non-specific, ranging from acute presentations in the emergency department to chronic incidental findings in an outpatient setting. Given the non-specific nature of their clinical presentations, the reliance on non-invasive imaging for screening, definitive diagnosis, therapeutic strategy planning, and post-intervention surveillance has become paramount. Commonly used imaging modalities include ultrasound, computed tomography (CT), and MR imaging. Among these modalities, computed tomography angiography (CTA) has emerged as a first-line imaging modality owing to its excellent anatomic detail, widespread availability, established imaging protocols, evidence-proven indications, and rapid acquisition time.
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Affiliation(s)
- Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jakub M Siembida
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarv Priya
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
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19
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Deng Z, Zhong Y, Zou L, Bi G, Chen J, Dai X, Hu J, Xiong G, Deng L. Endovascular Repair Blunt Thoracic Aortic Injury in Adolescent: A Case Series. J Endovasc Ther 2024:15266028241245907. [PMID: 38590278 DOI: 10.1177/15266028241245907] [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: 04/10/2024]
Abstract
BACKGROUND Blunt traumatic aortic injury (BTAI) is a rare occurrence in adolescents, yet it is associated with a high mortality rate necessitating immediate treatment. Although endovascular repair has become the preferred treatment for such injuries in adults, its effectiveness in adolescents remains uncertain. CASE SUMMARY Blunt traumatic aortic injury typically presents with concomitant injuries to other organs and carries a high perioperative mortality rate with operative repair (OR). In this report, we describe the treatment of 3 clinical cases of BTAI in adolescents using thoracic endovascular aortic repair (TEVAR). These cases contribute pertinent evidence supporting the efficacy of intravascular repair for BTAI. CONCLUSION Operative repair (OR) remains the gold standard for treating BTAI in adolescents. Nevertheless, TEVAR therapy presents a viable alternative for patients with multiple injuries in whom anticoagulation is contraindicated. Further long-term observation is necessary to assess the lasting effects of TEVAR therapy. CLINICAL IMPACT This study has provided insights into endovascular repair for adolescent BTAT, offering clinicians significant reference material for choosing treatment strategies for adolescent BTAT. The study aims to demonstrate the safety and effectiveness of endovascular repair treatments in a series of clinical cases involving adolescent BTAI.
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Affiliation(s)
- Zhihe Deng
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Yaoyang Zhong
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Liping Zou
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Guoshan Bi
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Jie Chen
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Xianpeng Dai
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Jun Hu
- Department of Cardiac Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Guozuo Xiong
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
| | - Liming Deng
- Department of Vascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Hunan Province Thrombotic Disease Prevention and Therapy Clinical Medical Research Center, Hengyang, China
- Hunan Provincial Key Clinical Specialty, Hengyang, China
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20
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AlQurashi HE, Alzahrani HA, Bafaraj MO, Bosaeed M, Almasabi M, Banhidarah A. Endovascular Repair in Blunt Thoracic Aortic Injury: A 10-Year Single Center Experience. Cureus 2024; 16:e55327. [PMID: 38559515 PMCID: PMC10981867 DOI: 10.7759/cureus.55327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Life-threatening blunt thoracic aortic injury (BTAI) typically occurs alongside multiple other traumatic injuries. Symptoms of BTAI can range from being asymptomatic in the case of intimal tears to becoming catastrophic in the case of uncontained aortic ruptures. The aim of this research was to examine the clinical outcomes for those who underwent thoracic endovascular aortic repair (TEVAR) in hospital settings. Methods: A cross-sectional retrospective study was conducted using patient data that were extracted from Al-Noor Specialist Hospital, Makkah, Saudi Arabia, for the duration between January 2011 and December 2021. This study included data from all patients aged 18 and up who had been diagnosed with BTAI and had undergone TEVAR. The BTAI diagnoses were confirmed using CT scans. Logistic regression was utilized to identify predictors of patients' health status improvement and length of stay. RESULTS A total of 80 patients were involved. Around 50.0% (n=40) of the patients had grade 3 thoracic aortic injuries. The median duration of stay was 14.00 days (Interquartile range 21.00). Only one patient developed post-procedure complications (1.3%). Almost one-third (31.3%; n=25) of the patients required subclavian coverage. One patient developed intraoperative endoleak (1.3%). One patient developed an access site complication (1.3%). The mortality rate within 30 days of the operation was 1.3%. The vast majority of the patients (92.5%; n=74) showed improvement upon discharge from the hospital. The baseline patient characteristics and length of hospitalization had no effect on the improvement of patient status upon discharge or their length of stay (p>0.05). CONCLUSION Patients with BTAI have shown an excellent success rate with TEVAR and a low complication rate. Predictors of procedure success and length of stay need to be identified; however, this can't be done without larger-scale investigations. This can aid in the development of preventative measures that improve clinical outcomes for the patients.
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Affiliation(s)
| | | | | | - Mohammed Bosaeed
- Vascular and Endovascular Surgery, Alnoor Specialist Hospital, Makkah, SAU
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21
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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22
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Hartung B, Schäuble A, Peldschus S, Schüssler M, Meyer HL. The Documentation of Injuries Caused by Traffic Accidents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:27-36. [PMID: 38055024 PMCID: PMC10916764 DOI: 10.3238/arztebl.m2023.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Persons injured in traffic accidents may have injuries of characteristic types that are of significance for the complex reconstruction of the accident and whose medicolegally sound clinical documentation is highly important. This is of particular relevance for the approximately 55 000 persons who are severely injured in traffic accidents in Germany each year. Gaps in documentation are often disadvantageous for the injured persons. METHODS This review is based on pertinent publications retrieved by a selective literature review, with additional consideration of relevant textbooks in traffic medicine and legal medicine, as well as the guidelines of the AWMF (Association of the Scientific Medical Societies in Germany). RESULTS Injuries in traffic accidents typically differ depending on the mode of participation of the injured person in traffic. They must be examined with a view toward the sequence of events of the accident and documented in medicolegally sound fashion. In particular, because of the different mechanical forces involved, it is important to document the seat that the injured person occupied in the automobile, the nature of the collision (pedestrian vs. automobile; bicycle, e-bike, e-scooter, and motorcycle accidents), and the protective devices that were in use. CONCLUSION The precise documentation of injuries and examination findings, with critical consideration of their plausibility in relation to the sequence of events of the accident as far as it is known, is an important duty of the physician. This documentation serves as the basis for further judicial steps leading to compensation when legally appropriate.
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Affiliation(s)
- Benno Hartung
- Institute of Forensic Medicine, Essen University Hospital, Essen, Germany
| | | | - Steffen Peldschus
- Institute of Forensic Medicine, Biomechanics and Accident Analysis, LMU Munich, Munich, Germany
| | - Maximilian Schüssler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Heinz-Lothar Meyer
- Clinic for Trauma, Hand and Reconstructive Surgery Essen University Hospital, Essen, Germany
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23
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Gang Q, Lun Y, Pang L, Li X, Hou B, Xin S, Zhang J. Traumatic Aortic Dissection as a Unique Clinical Entity: A Single-Center Retrospective Study. J Clin Med 2023; 12:7535. [PMID: 38137605 PMCID: PMC10744057 DOI: 10.3390/jcm12247535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical characteristics, treatment approaches, and outcomes of the Stanford Type B traumatic aortic dissection (TAD) with non-traumatic aortic dissection (NTAD), and assess better management for TAD. METHODS We retrospectively analyzed patients who underwent thoracic endovascular aortic repair for Stanford type B aortic dissection at The First Hospital of China Medical University between 2014 and 2022. The patients were divided into TAD and NTAD groups based on whether they had a history of acute trauma. This study ultimately included 65 patients with TAD and 288 with NTAD. We assessed and compared the baseline characteristics, laboratory indicators, imaging features, surgical procedures, and follow-up results between the groups. RESULTS The TAD group was younger compared to the NTAD group (50.00 [IQR40.00-59.00] vs. 55.00 [IQR 47.00-61.00] years, p = 0.020). A lower percentage of the TAD group had a history of hypertension (20% vs. 71.18%, p < 0.001). The length of aortic dissection was shorter in the TAD group compared to the NTAD group (30.00 [IQR 22.00-40.00] vs. 344.00 [IQR 237.25-400.00] mm, p < 0.001). All patients with TAD underwent TEVAR following the same strategy as NTAD. The mean preoperative duration was 7.00 (IQR 2.00-14.00) days in the TAD group and 11.00 (IQR 8.00-15.00) days in the NTAD group (p < 0.001). TAD showed fewer complications after TEVAR in mid-to-long-term follow-up. CONCLUSIONS TAD is distinct from NTAD. TAD typically presents with more localized lesions than NTAD, and the patients experience a shorter preoperative duration and a better mid-to-long-term outcome.
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Affiliation(s)
| | | | | | | | | | | | - Jian Zhang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; (Q.G.); (Y.L.); (L.P.); (X.L.); (B.H.); (S.X.)
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24
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Wang H, Shu C, Wang T, He H, Li X, Li Q, Peng Y, Wang L, Sun L. Zone 2/3 lesion and emergency repair as potential mortality predictors of TEVAR for thoracic aortic pseudoaneurysm. J Cardiothorac Surg 2023; 18:299. [PMID: 37880709 PMCID: PMC10599020 DOI: 10.1186/s13019-023-02345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/09/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Thoracic aortic pseudoaneurysm (TAP) is an uncommon but life-threatening condition. The present study aimed to investigate the early and midterm clinical outcome of TAP patients following TEVAR and identify potential mortality predictors. METHODS We retrospectively reviewed a series of 37 eligible patients with TAP admitted to our hospital from July 2010 to July 2020. We explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. RESULTS There were 29 men and 12 women, with the mean age as 59.5 ± 13.0 years (range 30-82). The mean follow-up period was 30.7 ± 28.3 months (range 1-89). For early outcome (≤ 30 days), mortality happened in 3 (8.1%) zone 3 TAP patients versus 0 in zone 4 (p = 0.028); postoperative acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm outcome, survival at 3 months, 1 year and 5 years was 88.8%, 75.9% and 68.3%, which showed significant difference between zone 2/3 versus zone 4 group (56.3% vs. 72.9%, p = 0.013) and emergent versus elective TEVAR group (0.0% versus 80.1%, p = 0.049). Previous stent grafting or esophageal foreign body with Aortoesophageal fistula (AEF), and systemic vasculitis, as etiologies, resulted in encouraging immediate outcome but worse midterm prognosis. CONCLUSION TAP lesions at zone 2/3 and emergent TEVAR predict worse midterm outcomes compared to zone 4 lesions and elective TEVAR. The outcomes are also mainly restricted by the etiology of the TAP.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China.
- Department of Vascular Surgery, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Yuan Peng
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Likun Sun
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
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25
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Obeid JM, Martinez C, Gaibi-Rodriguez A, Kanade R, Arrillaga A, Leslie C, Fasanya C, Rovensky M, Carter TI. Double jeopardy: Successful management of a traumatic ascending aortic pseudoaneurysm with concurrent subdural hematoma. Trauma Case Rep 2023; 47:100918. [PMID: 37663378 PMCID: PMC10474223 DOI: 10.1016/j.tcr.2023.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/05/2023] Open
Abstract
We present the case of a 59-year-old male who sustained an ascending aortic injury and a subdural hematoma after a head on collision. After undergoing emergent craniotomy for evacuation of the subdural hematoma, he was maintained with strict blood pressure control. Once able to be safely anticoagulated, he underwent replacement of the ascending aorta. This exceedingly rare case was managed by a multidisciplinary team approach that led to an optimal outcome given his disastrous multi-traumatic injuries.
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Affiliation(s)
- Joseph M. Obeid
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, United States of America
| | - Camilo Martinez
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, United States of America
| | - Ashla Gaibi-Rodriguez
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, United States of America
| | - Rahul Kanade
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, United States of America
| | - Abenamar Arrillaga
- Department of Trauma Surgery, Good Samaritan Hospital, West Islip, NY, United States of America
| | - Cynthia Leslie
- Department of Trauma Surgery, Good Samaritan Hospital, West Islip, NY, United States of America
| | - Charles Fasanya
- Department of Trauma Surgery, Good Samaritan Hospital, West Islip, NY, United States of America
| | - Maksim Rovensky
- Department of Cardiothoracic Surgery, St. Francis Hospital, Roslyn, NY, United States of America
| | - Timothy I. Carter
- Department of Cardiothoracic Surgery, St. Francis Hospital, Roslyn, NY, United States of America
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26
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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27
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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: 0.5] [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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28
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Abstract
Aortic pathologic conditions represent diverse disorders, including aortic aneurysm, acute aortic syndrome, traumatic aortic injury, and atherosclerosis. Given the nonspecific clinical features, noninvasive imaging is critical in screening, diagnosis, management, and posttherapeutic surveillance. Of the commonly used imaging modalities, including ultrasound, computed tomography, and MR imaging, the final choice often depends on a combination of factors: acuity of clinical presentation, suspected underlying diagnosis, and institutional practice. Further research is needed to identify the potential clinical role and define appropriate use criteria for advanced MR applications such as four-dimenional flow to manage patients with aortic pathologic conditions.
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Affiliation(s)
- Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University Of New Mexico, Albuquerque, NM 87131, USA
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, E3/366 Clinical Science Center 600 Highland Avenue Madison, WI 53792, USA
| | - Prashant Nagpal
- Cardiovascular and Thoracic Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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29
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Li Z, Pei M, Zhang J, Liu N, Wang J, Zou D. A study to characterize the mechanical properties and material constitution of adult descending thoracic aorta based on uniaxial tensile test and digital image correlation. Front Bioeng Biotechnol 2023; 11:1178199. [PMID: 37388776 PMCID: PMC10306407 DOI: 10.3389/fbioe.2023.1178199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
The mechanical properties and material constitution of the aorta are important in forensic science and clinical medicine. Existing studies on the material constitution of the aorta do not satisfy the practical requirements of forensic and clinical medicine, as the reported failure stress and failure strain values for human aortic materials have a high dispersion. In this study, descending thoracic aortas were obtained from 50 cadavers (dead within 24 h) free of thoracic aortic disease, aged from 27 to 86 years old, which were divided into six age groups. The descending thoracic aorta was divided into proximal and distal segments. A customized 4-mm cutter was used to punch a circumferential and an axial dog-bone-shaped specimen from each segment; the aortic ostia and calcification were avoided. Instron 8,874 and digital image correlation were used to perform a uniaxial tensile test on each sample. Four samples from each descending thoracic aorta produced ideal stress-strain curves. All parameter-fitting regressions from the selected mathematical model converged, and the best-fit parameters of each sample were obtained. The elastic modulus of collagen fiber, failure stress, and the strain showed a decreasing trend with age, while the elastic modulus of elastic fiber showed an increasing trend with age. The elastic modulus of collagen fiber, failure stress, and strain of circumferential tensile were all greater than those for axial tensile. There was no statistical difference in model parameters and physiological moduli between the proximal and distal segments. The failure stress and strain in the proximal circumferential, distal circumferential, and distal axial tensile were all greater for the male group than for the female group. Finally, the Fung-type hyperelastic constitutive equations were fitted for the different segments in different age groups.
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Affiliation(s)
- Zhengdong Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Ming Pei
- Institute of Forensic Science, Xuzhou Public Security Bureau, Xuzhou, Jiangsu, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Ningguo Liu
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Jinming Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
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Liu C, Song Y, Yuan Y, Chen J, Hu Y. Delayed Repair of Aortic Dissection in a Trauma Patient With Occult Esophageal Rupture. ANNALS OF THORACIC SURGERY SHORT REPORTS 2023; 1:259-262. [PMID: 39790320 PMCID: PMC11708684 DOI: 10.1016/j.atssr.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 01/12/2025]
Abstract
Aortic dissection and esophageal rupture are life-threatening conditions in trauma patients. The combination complicates treatment. Here, we report a case of traumatic aortic dissection with occult esophageal rupture that was treated successfully with a staged operative strategy: primary esophageal repair followed by delayed aortic arch and aortic valve repair.
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Affiliation(s)
- Chang Liu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Song
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Ye Yuan
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianming Chen
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yijie Hu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
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Zambetti BR, Patel DD, Stuber JD, Zickler WP, Hosseinpour H, Anand T, Nelson AC, Stewart C, Joseph B, Magnotti LJ. Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury. J Am Coll Surg 2023; 236:753-759. [PMID: 36728440 DOI: 10.1097/xcs.0000000000000540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset. STUDY DESIGN Patients undergoing operative repair for IAI were identified from the Trauma Quality Improvement Program database during a 5-year timespan, ending in 2019. Age, sex, race, severity of injury, severity of shock, type of iliac repair (open or endovascular), mechanism, morbidity and mortality were recorded. Patients with IAI were stratified by both type of repair and mechanism and compared. Multivariable logistic regression analysis was used to identify independent predictors of mortality. RESULTS Operative IAI was identified in 507 patients. Of these injuries, 309 (61%) were penetrating and 346 (68.2%) involved the external iliac artery. The majority of patients were male (82%) with a median age and ISS of 31 and 20, respectively. Endovascular repair was performed in 31% of cases. For patients with penetrating injuries, the type of repair impacted neither morbidity nor mortality. For blunt-injured patients, endovascular repair was associated with lower morbidity (29.3% vs 41.3%; p = 0.082) and significantly reduced mortality (14.6% vs 26.7%; p = 0.037) compared with the open-repair approach. Multivariable logistic regression identified endovascular repair as the only modifiable risk factor associated with decreased mortality (odds ratio 0.34; 95% CI 0.15 to 0.79; p = 0.0116). CONCLUSIONS Traumatic IAI causes significant morbidity and mortality. Endovascular repair was identified as the only modifiable predictor of decreased mortality in blunt-injured patients with traumatic IAI. Therefore, for select patients with blunt IAIs, an endovascular repair should be the preferred approach.
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Affiliation(s)
- Benjamin R Zambetti
- From the Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD (Zambetti)
| | - Devanshi D Patel
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN (Patel, Stuber)
| | - Jacqueline D Stuber
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN (Patel, Stuber)
| | - William P Zickler
- Division of Vascular Surgery, Mount Sinai Hospital, New York, NY (Zickler)
| | - Hamidreza Hosseinpour
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Tanya Anand
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Adam C Nelson
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Collin Stewart
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Bellal Joseph
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Louis J Magnotti
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
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Matsuo A, Matsuyama S, Kurisu K, Ueno Y, Oishi Y, Shiose A. Endovascular Aortic Repair for Thoracic Aortic Compression Resulting From Chance Fracture of the Thoracic Spine. Tex Heart Inst J 2023; 50:491653. [PMID: 36944119 PMCID: PMC10178656 DOI: 10.14503/thij-22-7891] [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: 03/23/2023]
Abstract
Blunt aortic injury is a serious condition with a high mortality rate. Although rare, blunt aortic injury associated with spinal fracture has also been reported, and appropriate management of aortic disease is key to a good outcome. This report is a case of a 78-year-old man who was found to have a transverse fracture (Chance fracture) in the ninth thoracic vertebra, with a sharp bone fragment compressing the thoracic aorta. Early spinal surgery was needed; however, there was concern about the possibility of bleeding from the aorta and surrounding small arteries associated with the bone fragment during spinal surgery. Therefore, thoracic endovascular aortic repair was performed before spinal surgery. The next day after thoracic endovascular aortic repair, posterior spinal instrumentation was performed, and the postoperative course was uneventful. Because aortic injury associated with vertebral fracture can lead to massive bleeding and spinal cord injury, endovascular repair before spinal surgery is reasonable.
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Affiliation(s)
- Akinobu Matsuo
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Sho Matsuyama
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Kazuhiro Kurisu
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Yasutaka Ueno
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyusyu University Hospital, Fukuoka, Fukuoka Prefecture, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyusyu University Hospital, Fukuoka, Fukuoka Prefecture, Japan
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Blunt thoracic aortic injury: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg 2023; 94:113-116. [PMID: 35999667 DOI: 10.1097/ta.0000000000003759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sun J, Ren K, Zhang L, Xue C, Duan W, Liu J, Cong R. Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis. J Cardiothorac Surg 2022; 17:335. [PMID: 36564841 PMCID: PMC9783465 DOI: 10.1186/s13019-022-02094-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Approximately 80% of patients with blunt thoracic aortic injury (BTAI) die before reaching the hospital. Most people who survive the initial injury eventually die without appropriate treatment. This study analyzed and reported the treatment strategy of a single center for BTAI in the last 10 years and the early and middle clinical results. METHODS This retrospective study included patients diagnosed with BTAI at Xijing Hospital from 2013 to 2022. All inpatients with BTAI aged ≥ 18 years were included in this study. The clinical data, imaging findings, and follow-up results were retrospectively collected and analyzed. The Kaplan-Meier curve and multivariate logistic regression were used to compare survivors and nonsurvivors. RESULTS A total of 72 patients (57% men) were diagnosed with BTAI, with a mean age of 54.2 ± 9.1 years. The injury severity score was 24.3 ± 18, with Grade I BTAI1 (1.4%), Grade II 17 (23.6%), Grade III 52 (72.2%), and Grade IV 2 (2.8%) aortic injuries. Traffic accidents were the main cause of BTAI in 32 patients (44.4%). Most patients had trauma, 37 had rib fractures (51.4%), Sixty patients (83.3%) underwent thoracic endovascular aortic repair (TEVAR) surgery, eight (11.1%) underwent conservative treatment, and only four (5.6%) underwent open surgery. The overall hospitalization mortality was 12.5%. In multivariate logistic regression, elevated creatinine levels (P = 0.041) and high Glasgow coma scale (GCS) score (P = 0.004) were the predictors of hospital mortality. The median follow-up period was 57 (28-87) months. During the follow-up period, all-cause mortality was 5.6% and no aortic-related deaths were reported. Three patients (4.2%) needed secondary surgery and two of them underwent endovascular repair. CONCLUSION Although TEVAR surgery may be associated with intra- or postoperative dissection rupture or serious complications in the treatment of Grade III BTAI, the incidence rate was only 8.9%. Nevertheless, TEVAR surgery remains a safe and feasible approach for the treatment of Grade II or III BTAI, and surgical treatment should be considered first,. A high GCS score and elevated creatinine levels in the emergency department were closely associated with hospital mortality. Younger patients need long-term follow-up after TEVAR.
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Affiliation(s)
- Jingwei Sun
- grid.508540.c0000 0004 4914 235XXi’an Medical University, Xi’an, China ,grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
| | - Kai Ren
- grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
| | - Liyun Zhang
- grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
| | - Chao Xue
- grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
| | - Weixun Duan
- grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China ,grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
| | - Jincheng Liu
- grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China ,grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
| | - Ren Cong
- grid.233520.50000 0004 1761 4404Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 Shaanxi China
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Inaba Y, Iida Y, Oka H, Miki T, Hachiya T, Shimizu H. Blunt traumatic aortic injury to the brachiocephalic and left carotid arteries. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2022; 1:11. [PMID: 39516899 PMCID: PMC11533455 DOI: 10.1186/s44215-022-00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2024]
Abstract
BACKGROUND Blunt traumatic aortic injury (BTAI) is a life-threatening pathology that most commonly occurs after traffic accidents or a fall from a considerable height. We report a rare case of traumatic double transection which included the brachiocephalic artery (BCA) and left carotid artery (LCA) following a motorcycle accident. CASE PRESENTATION A 52-year-old man was brought to our emergency room for blunt trauma. Urgent computed tomography (CT) indicated BCA and LCA transection. Two weeks after the BTAI, CT indicated an increase in the size of the BCA pseudoaneurysm, a newly developed LCA pseudoaneurysm, and a spread of hematoma. An emergency partial aortic arch replacement including BCA and LCA reconstruction was performed 17 days after the BTAI. The postoperative course was good, and he was discharged 12 days later. CONCLUSIONS An open aortic repair appeared to be more suited in the present case because the aortic injury occurred in a branched lesion of the aortic arch. It was thought that complete stent graft coverage of the transection lesion would be difficult. Although coexisting multiple system injuries complicate aortic repair, there was a rapid enlargement of the BCA and LCA pseudoaneurysms. Therefore, strict management is needed even in the case of cervical artery injury.
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Affiliation(s)
- Yu Inaba
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi tsurumiku, Yokohama City, Kanagawa, 230-8765, Japan.
| | - Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi tsurumiku, Yokohama City, Kanagawa, 230-8765, Japan
| | - Hidetoshi Oka
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi tsurumiku, Yokohama City, Kanagawa, 230-8765, Japan
| | - Takahisa Miki
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi tsurumiku, Yokohama City, Kanagawa, 230-8765, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi tsurumiku, Yokohama City, Kanagawa, 230-8765, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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Wu HY, Sun JT, Hsieh CC, Chu SE, Chiang WC, Ma MHM, Huang CY. A Man With Severe Chest Pain after a Motor Vehicle Crash. Ann Emerg Med 2022; 80:86-94. [PMID: 35717118 DOI: 10.1016/j.annemergmed.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Hsin-Yi Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Chieh Hsieh
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Sheng-En Chu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Jinadasa SP, Mueller AL, Apffel A, Cave B, DuBose JJ, Scalea TM, Kundi R. Close surveillance imaging is unnecessary for patients with grade I blunt thoracic aortic injury. Am J Surg 2022; 224:1324-1328. [PMID: 35728986 DOI: 10.1016/j.amjsurg.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND No evidence-based recommendations exist for imaging surveillance of grade I blunt thoracic aortic injuries (BTAI). We aimed to evaluate the natural history of these injuries to provide guidance for follow-up imaging. METHODS Patients that presented to our trauma center from 2008 to 2021 with grade I BTAI were retrospectively evaluated. CT angiography images were assessed for initial injury grade and subsequent stability, improvement, worsening, or resolution. RESULTS Of 83 patients who had grade I injuries and repeat imaging, 57.8% had complete resolution, 20.5% had improvement, and 18.1% had stability of their injury. Only seven patients (8.4%) demonstrated worsening of their injury. Six patients had eventual resolution and one underwent endovascular repair that would not have been performed under current practice patterns. CONCLUSIONS Since grade I injuries do not worsen to require later surgical intervention, early surveillance imaging is not necessary and further imaging may not be necessary at all.
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Affiliation(s)
- Sayuri P Jinadasa
- R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA.
| | - Ariel L Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Annie Apffel
- University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA.
| | - Brandon Cave
- University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA.
| | - Joseph J DuBose
- R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA.
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA.
| | - Rishi Kundi
- R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA.
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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: 1] [Impact Index Per Article: 0.3] [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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Mandigers TJ, Bissacco D, Domanin M, D’Alessio I, Tolva VS, Piffaretti G, van Herwaarden JA, Trimarchi S. Cardiac and aortic modifications after endovascular repair for blunt thoracic aortic injury: a systematic review. Eur J Vasc Endovasc Surg 2022; 64:176-187. [DOI: 10.1016/j.ejvs.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022]
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Evans CCD, Li W, Yacob M, Brogly S. Longer-term rates of survival and reintervention after thoracic endovascular aortic repair (TEVAR) for blunt aortic injury: a retrospective population-based cohort study from Ontario, Canada. Trauma Surg Acute Care Open 2022; 7:e000856. [PMID: 35402731 PMCID: PMC8948392 DOI: 10.1136/tsaco-2021-000856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/02/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Blunt aortic injury (BAI) is associated with a high rate of mortality. Thoracic endovascular aortic repair (TEVAR) has emerged as the preferred treatment option for patients with BAI. In this study, we compare the longer-term outcomes of patients receiving TEVAR with other treatment options for BAI. Methods We conducted a retrospective cohort study using administrative health data on patients with BAI in Ontario, Canada between 2009 and 2020. Patients with BAI and who survived at least 24 hours after hospital admission were identified using diagnostic codes. We classified patients as having received TEVAR, open surgical, hybrid repair, or medical management as their initial treatment approach based on procedure codes. The primary outcome was survival to maximum follow-up. Secondary outcomes included aorta-related mortality or aortic reintervention. Cox's proportional hazards models were used to estimate the effect of TEVAR on survival. Results 427 patients with BAI were followed for a median of 3 years (IQR: 1-6 years), with 348 patients (81.5%) surviving. Survival to maximum follow-up did not differ between treatment groups: TEVAR: 79%, surgical repair: 63.6%, hybrid repair: 85.7%, medical management: 83.3% (p=0.10). In adjusted analyses, TEVAR was not associated with improved survival compared with surgical repair (HR: 0.6, 95% CI: 0.3 to 1.6), hybrid repair (HR: 1.4, 95% CI: 0.5 to 3.6), or medical management (HR: 1.5, 95% CI: 0.8 to 2.6). Aortic reinterventions were required in only 2.6% of surviving patients but were significantly more common in the TEVAR group (p<0.01). Conclusions The longer-term survival from BAI appears highly favorable with low rates of reintervention and death in the years after injury, regardless of the initial treatment approach. Level of evidence IV, Therapeutic study.
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Affiliation(s)
- Christopher C D Evans
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada,Institute of Clinical and Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wenbin Li
- Institute of Clinical and Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michael Yacob
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Susan Brogly
- Institute of Clinical and Evaluative Sciences, Queen's University, Kingston, Ontario, Canada,Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Shibahashi K, Matsunaga H, Ishida T, Sugiyama K, Hamabe Y. A new screening model for quantitative risk assessment of blunt thoracic aortic injury. Eur J Trauma Emerg Surg 2022; 48:4607-4614. [DOI: 10.1007/s00068-022-01925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
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Delayed Endovascular Repair With Procedural Anticoagulation: A Safe Strategy for Blunt Aortic Injury. Ann Vasc Surg 2022; 84:195-200. [PMID: 35247536 DOI: 10.1016/j.avsg.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blunt aortic injury (BAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma. The purposes of this study were to identify predictors of mortality for BAI and to examine the impact of procedural heparinization during thoracic endovascular aortic repair (TEVAR) on neurologic outcomes in patients with BAI/TBI. METHODS Patients with BAI were identified over an 8 year period. Age, gender, severity of injury and shock, time to TEVAR, morbidity, and mortality were recorded and compared. Multivariable logistic regression (MLR) was performed to determine independent predictors of mortality. Youden's index determined optimal time to TEVAR. RESULTS A total of 129 patients were identified. The majority (74%) were male with a median age and injury severity score (ISS) of 40 years and 29, respectively. Of these, 26 (20%) had a concomitant TBI. Patients with BAI/TBI had higher injury burden at presentation (ISS 37 vs. 29, P = 0.002; Glasgow Coma Scale [GCS] 6 vs. 15, P < 0.0001), underwent fewer TEVAR procedures (31 vs. 53%, P = 0.039), and suffered increased mortality (39 vs. 16%, P = 0.009). All TEVARs had procedural anticoagulation, including patients with TBI, without change in neurologic function. The optimal time to TEVAR was 14.8 hr. Mortality increased in TEVAR patients before 14.8 hr (8.7 vs. 0%, P = 0.210). MLR identified TEVAR as the only modifiable factor that reduced mortality (odds ratio 0.11; 95% confidence interval 0.03-0.45, P = 0.002). CONCLUSIONS TEVAR use was identified as the only modifiable predictor of reduced mortality in patients with BAI. Delayed TEVAR with the use of procedural heparin provides a safe option regardless of TBI with improved survival and no difference in discharge neurologic function.
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Boutin L, Caballero MJ, Guarrigue D, Hammad E, Rennuit I, Delhaye N, Neuschwander A, Meyer A, Bitot V, Mathais Q, Boutonnet M, Julia P, Olaf M, Duranteau J, Hamada SR. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. Eur J Vasc Endovasc Surg 2022; 63:401-409. [PMID: 35144894 DOI: 10.1016/j.ejvs.2021.09.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal. The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European country. METHODS This was a multicentre, retrospective study using prospectively collected data from the French National Trauma Registry and the National Uniform Hospital Discharge Database from 10 trauma centres in France. The primary endpoint was the prevalence of BTAI. The secondary endpoints focused chronologically on injury characteristics, management, and patient outcomes. RESULTS 209 patients were included with a mean age of 43 ± 19 years and 168 (80%) were men. The calculated prevalence of BTAI at hospital admission was 1% (162/15 094) (BTAI admissions/all trauma). The time to diagnosis increased with the severity of aortic injury and the clinical severity of the patients (grade 1: 94 [74, 143] minutes to grade 4: 154 [112, 202] minutes, p = .020). This delay seemed to be associated with the intensity of the required resuscitation. Sixty seven patients (32%) received no surgical treatment. Among those treated, 130 (92%) received endovascular treatment, 14 (10%) open surgery (two were combined), and 123 (85%) were treated within the first 24 hours. Overall mortality was 20% and the attributed cause of death was haemorrhagic shock (69%). Mortality was increased according to aortic injury severity, from 6% for grade 1 to 65% for grade 4 (p < .001). Twenty-six (18.3%) patients treated by endovascular aortic repair had complications. CONCLUSION BTAI prevalence at hospital admission was low but occurred in severe high velocity trauma patients and in those with a high clinical suspicion of severe haemorrhage. The association of shock with high grade aortic injury and increasing time to diagnosis suggests a need to optimise early resuscitation to minimise the time to treatment. Endovascular treatment has been established as the reference treatment, accounting for more than 90% of interventional treatment options for BTAI.
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Affiliation(s)
- Louis Boutin
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France; Department of Anaesthesiology and Critical Care, Hôpital Saint-Louis, APHP, DMU Parabol, FHU PROMICE, Université de Paris, France; INSERM, UMR 942, MASCOT, Cardiovascular Marker in Stress Condition, Paris, France
| | - Marie-Josée Caballero
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France
| | - Delphine Guarrigue
- Department of Anaesthesiology and Critical Care, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuelle Hammad
- Department of Anaesthesiology and Critical Care, Hôpital Nord, APHM, Marseille, France
| | - Isabelle Rennuit
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, APHP, Université de Paris, Clichy, France
| | - Nathalie Delhaye
- Department of Anaesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, APHP, Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Arthur Neuschwander
- Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Alain Meyer
- Department of Anaesthesiology and Critical Care, Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France
| | - Valérie Bitot
- Department of Anaesthesiology and Critical Care, Hôpital Henri Mondor, APHP, Créteil, France
| | - Quentin Mathais
- Department of Anaesthesiology and Critical Care, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Mathieu Boutonnet
- Department of Anaesthesiology and Critical Care, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Pierre Julia
- Departement of Vascular Surgery, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Mercier Olaf
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Jacques Duranteau
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France
| | - Sophie R Hamada
- Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, APHP, Université Paris Saclay, Kremlin Bicêtre, France; Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France; CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France.
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Lee J, Ye J, Lee J, Kim S, Choi H, Kim Y, Yoon S, Sul Y, Choi J. Observational management of Grade II or higher blunt traumatic thoracic aortic injury: 15 years of experience at a single suburban institution. Int J Crit Illn Inj Sci 2022; 12:101-105. [PMID: 35845121 PMCID: PMC9285127 DOI: 10.4103/ijciis.ijciis_89_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/08/2021] [Accepted: 01/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background: We aimed to investigate the outcomes after delayed management of ≥ Grade II blunt traumatic thoracic aortic injury (BTAI). Methods: Between January 2005 and December 2019, we retrospectively reviewed the medical records of 21 patients with ≥ Grade II thoracic aortic injury resulting from blunt trauma. Twelve patients underwent observation for the injury, whereas nine patients were transferred immediately after the diagnosis. Patients were divided into a nonoperative management group (n = 7) and delayed repair group (n = 5) based on whether they underwent thoracic endovascular aneurysm repair or surgery. Results: The most common dissection type was DeBakey classification IIIa (n = 9). Five patients underwent delayed surgery (including aneurysm repair), with observation periods ranging from 1 day to 36 months. The delayed repair group exhibited higher injury severity scores than the nonoperative management group (n = 7). The nonoperative management group was followed-up with blood pressure management without a change in status for a period ranging from 3 to 96 months. Conclusions: Our findings indicated that conservative management may be appropriate for select patients with Grade II/III BTAI, especially those exhibiting hemodynamic stability with anti-impulse therapy and minimally sized pseudoaneurysms. However, further studies are required to identify the risk factors for injury progression and long-term outcomes.
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45
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Yeh CH, Li JY. Traumatic blunt aortic injury: experience in one hospital. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_232_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ono S, Tateishi R, Shioya M, Itoda Y, Tsukioka Y, Nakahara Y, Kanemura T. Atypical presentation of isolated traumatic ascending aortic dissection with cardiac tamponade. SAGE Open Med Case Rep 2021; 9:2050313X211060683. [PMID: 34925840 PMCID: PMC8673863 DOI: 10.1177/2050313x211060683] [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: 08/02/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
Blunt traumatic aortic injury is a rare but life-threatening condition, usually following high-energy trauma. We present the case of a 79-year-old man who was transferred to a hospital complaining of nausea after being struck on the chest. Computed tomography led to diagnosis of ascending aortic dissection with cardiac tamponade. Emergent ascending aortic replacement was performed successfully and he was discharged home on postoperative day 24 without any complications. The key to early diagnosis of blunt traumatic aortic injury is careful and detailed history-taking. If trauma patients complain of unexplained symptoms, the threshold for conducting computed tomography should be lowered to avoid misdiagnosis or therapeutic delay.
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Affiliation(s)
- Shunya Ono
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
| | - Retsu Tateishi
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
| | - Masato Shioya
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
| | - Yoshihumi Itoda
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
| | - Yusuke Tsukioka
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
| | - Yoshinori Nakahara
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
| | - Takeyuki Kanemura
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, Japan
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Vascular Reconstruction for Traumatic Injuries. Adv Surg 2021; 55:251-271. [PMID: 34389095 DOI: 10.1016/j.yasu.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brown SR, Still SA, Eudailey KW, Beck AW, Gunn AJ. Acute traumatic injury of the aorta: presentation, diagnosis, and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1193. [PMID: 34430634 PMCID: PMC8350653 DOI: 10.21037/atm-20-3172] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
Despite advances in detection and treatment, acute traumatic aortic injury (ATAI) is associated with high rates of morbidity and mortality. Both physical and hemodynamic forces have been postulated as mechanisms of aortic injury during a traumatic event. For patients who survive the initial injury, rapid detection is critical for diagnosis and procedural planning, which requires a thorough knowledge of both its clinical presentation and the available diagnostic imaging modalities. Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can each have a role in the diagnosis of ATAI. After stabilization of the patient, the management of ATAI is guided by the severity of injury. Appropriately selected patients with low grade injuries may be managed non-operatively. When treatment is required, there are both open surgical and endovascular options. In current practice, endovascular approaches with stent-graft placement are preferred due to their high clinical success and low rates of complications. Complications from endograft placement can include: endoleak, endograft collapse, infection, endograft failure, and endograft migration. Open surgical repair is now reserved for patients with unfavorable anatomy for endovascular therapies. This review provides a comprehensive overview of ATAI including its epidemiology and demographics, mechanisms of injury, clinical and radiographic diagnosis, treatment options, and post-therapeutic follow-up.
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Affiliation(s)
- S Rodes Brown
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sasha A Still
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew J Gunn
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Pathology of the Aorta and Aorta as Homograft. J Cardiovasc Dev Dis 2021; 8:jcdd8070076. [PMID: 34209632 PMCID: PMC8304113 DOI: 10.3390/jcdd8070076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022] Open
Abstract
The aorta is not a rigid tube, it is an “organ” with lamellar units, consisting of elastic fibers, extracellular matrix and smooth muscle cells in between as parenchyma. Several diseases may occur in the natural history of the aorta, requiring replacement of both semilunar cusps and ascending aorta. They may be congenital defects, such as bicuspid aortic valve and isthmal coarctation with aortopathy; genetically determined, such as Marfan and William syndromes; degenerative diseases, such as atherosclerosis and medial necrosis with aortic dilatation, valve incompetence and dissecting aneurysm; inflammatory diseases such as Takayasu arteritis, syphilis, giant cell and IgM4 aortitis; neoplasms; and trauma. Aortic homografts from cadavers, including both the sinus portion with semilunar cusps and the tubular portion, are surgically employed to replace a native sick ascending aorta. However, the antigenicity of allograft cells, in the lamellar units and interstitial cells in the cusps, is maintained. Thus, an immune reaction may occur, limiting durability. After proper decellularization and 6 months’ implantation in sheep, endogenous cell repopulation was shown to occur in both the valve and aortic wall, including the endothelium, without evidence of inflammation and structural deterioration/calcification in the mid-term. The allograft was transformed into an autograft.
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Retrospective study of thoracic endovascular aortic repair as a first-line treatment for traumatic blunt thoracic aortic injury. Gen Thorac Cardiovasc Surg 2021; 70:16-23. [PMID: 34137003 DOI: 10.1007/s11748-021-01661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI). METHODS Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines. Initial treatment was categorized into four groups: nonoperative management (NOM), open aortic repair (OAR), TEVAR, or emergency room thoracotomy/cardiopulmonary resuscitation (ERT/CPR). RESULTS The patients' mean age and ISS were 56.7 ± 20.9 years and 48.3 ± 20.4, respectively. Type III or IV aortic injury were diagnosed in 82 patients. The breakdown of initial treatments was as follows: NOM for 28 patients, OAR for four, TEVAR for 47, and ERT/CPR for 25. The overall early mortality rate was 32.7%. Logistic regression analysis confirmed ISS > 50 and shock on admission as risk factors for early mortality. The cumulative survival rate of all patients was 61.2% at 5 years after treatment. After initial treatment, eight patients receiving TEVAR required OAR. The cumulative rate of freedom from reintervention using TEVAR at 5 years was higher in approved devices than in custom-made devices (96.0 vs. 56.3%, p = 0.011). CONCLUSIONS Using TEVAR as an initial treatment for patients with BTAI is a reasonable approach. Patients with severe multiple traumas and shock on admission had poor early outcomes, and those treated with custom-made devices required significant rates of reintervention.
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