Acute Aortic Injury Research Articles

Thoracic aortic pseudoaneurysm: Inside its pathophysiology.

Our aim was to investigate pathophysiology of pseudoaneurysm of the thoracic aorta, an acute or chronic pathology, respectively, secondary to blunt thoracic trauma and aortitis, or complicating a deep penetrating aortic ulcer, intraparietal hematoma, aortic aneurysm, and even aortic graft, often with atherosclerosis as a common background. Given the relative rarity of this disease, an "inductive" retrospective method made it possible to retrieve clinical, radiological, and histopathological elements, which were mutually compared and validated through a "deductive" process of reinterpretation. We have identified three main structural constituents of this disease: a cavity, a single blood entry port, communicating with the aortic lumen, and a pseudocapsule. It is often caused by a chronic degenerative pathology of the intima and medial layers of the aorta, typically involving elastic fibers and smooth muscle cells, with possible intermediate stages of deep aortic ulcer or intraparietal hematoma. Otherwise, the acute onset may be secondary to acute aortitis or aortic injury. Today, thanks to the current angiographic tools represented by 3-D high resolution multidetector CT and MRI angiography, the diagnosis of thoracic aortic pseudoaneurysm is easier, as well as its surgical indications.

Retrospective investigation of >400 patients undergoing thoracic endovascular aortic repair with or without cerebrospinal fluid drainage.

The aim of this study was to analyse the risks and benefits of cerebrospinal fluid drainage (CSFD) placement in patients undergoing thoracic endovascular aortic repair. Between 2009 and 2020, 411 patients underwent thoracic endovascular aortic repair in 1 institution where 236 patients (57%) received a preoperative CSFD. Patient and outcome characteristics were retrospectively analysed and compared between patients with and without preoperative CSFD placement. Preoperative CSFD was performed significantly more frequently in elective patients, especially those undergoing distal stent graft extension following frozen elephant trunk-stent placement (P < 0.001). Significantly fewer CSFD was placed in patients with acute aortic injury (P < 0.001). The incidence of permanent spinal cord ischaemia (SCI) was higher in patients without preoperative CSFD [10 patients (2%) vs 1 patient (0.2%), P = 0.001]. Postoperative CSFD was placed in 3 patients (0.7%). Severe CSFD-associated complications affected 2 patients (0.5%) namely, a subdural spinal haematoma causing permanent paraplegia in one of those 2 patients. CSFS placement is associated with low procedural risk and can potentially help to prevent SCI. However, the SCI incidence is most likely also associated with other preoperative factors including the patient's haemodynamics. Hence, a general recommendation for placing a preoperative CSFD cannot be made when relying on the present evidence.

Celiac Artery Coverage During TEVAR for Dissection and Acute Aortic Injury is Not Associated with Worse Outcomes

Studies have previously identified increased morbidity and mortality with celiac artery coverage during thoracic endovascular aortic repair (TEVAR) for aneurysmal disease. This study aimed to delineate the risks associated with celiac artery coverage in all patients undergoing TEVAR for dissection, trauma, or aneurysmal disease. Using the Vascular Quality Initiative database, we identified all patients undergoing TEVAR from 2012 to 2020 and categorized them based on the underlying pathology (aneurysm, dissection, or acute/trauma). Patients were excluded if their endograft was deployed distal to aortic zone 6 or if they had any preoperative/operative celiac revascularization procedure. Univariate, regression, and Kaplan-Meier analysis were performed for all 3 groups, focusing on postoperative complications and survival. There were 8,265 patients who underwent TEVAR over the 8-year study period with 142 (1.7%) having celiac artery coverage during their index procedure. Of those patients, theceliac artery was covered during TEVAR in 1.2% of patients with dissection, 1.3% with aneurysm, and 0.7% with trauma. On unadjusted analysis, celiac artery coverage in TEVAR for aneurysmal disease was associated with increased in-hospital mortality (16% vs. 5%, P<0.001), 30-day mortality (33% vs. 23%, P=0.029), any postoperative complication (excluding death) (42% vs. 25%, P<0.001), and postoperative bowel complication (3% vs. 0.7%, P = 0.003). There were no differences in outcomes for patients treated with celiac coverage versus those without celiac coverage during TEVAR for dissection or trauma on univariate analysis. After risk adjustment, celiac artery coverage remained predictive of worse postoperative outcomes in patients with aneurysmal disease: in-hospital mortality (odds ratio [OR]=3.6, confidence interval [CI] 1.8-6.9), 30-day death (OR=1.6, CI 1.0-2.4), any postoperative complication (OR 2.2, CI 1.4-3.5), and bowel-specific postoperative complication (3.3, CI 1.0-10.8). There were no differences in patient outcomes for those treated with celiac coverage versus those without celiac coverage during TEVAR for dissection or trauma on multivariate analysis. Kaplan-Meier curves show a significant difference in overall survival based on pathology, specifically lower survival rates for patients with celiac coverage treated for aneurysmal disease. Cox regression analysis showed that celiac artery coverage for aneurysmal disease was associated with significantly increased hazard ratio affecting overall survival (hazard ratio=2.6, P<0.001), but there was no impact on survival in patients who underwent TEVAR with celiac coverage for dissection or trauma. Celiac artery coverage for patients with aneurysmal disease was correlated with a significant increase in postoperative morbidity, mortality, and lowers overall survival. However, for patients with dissection or acute/traumatic aortic pathology, celiac artery coverage does not portend worse outcomes.

Visualization of acute aortic injury with cinematic rendering.

The purpose of this study is to demonstrate the appearance of traumatic aortic injuries with the novel 3-dimensional (3D) computed tomography (CT) visualization technique known as cinematic rendering (CR). CR uses a novel lighting model to create photorealistic images with excellent anatomic detail for improved depiction of the extent of traumatic aortic injuries. Four patients with acute traumatic aortic injury identified on thoracic CT angiography were analyzed by creating standard 3D volume-rendered reconstructions and CR images on an independent 3D workstation. In this series of four patients, we present the typical patterns of aortic injury imaging findings and complications associated with traumatic aortic injury, with an emphasis on the utilization of the novel 3D technique of CR. CR can provide realistic imaging of the thoracic aortic contour with excellent spatial details. This methodology allows for an accurate assessment of aortic injury and optimal preoperative planning in patients with traumatic thoracic aortic injury.

Wrapping technique of ascending aorta in Hybrid procedure for complex aortic arch disease

Background: The hybrid procedure proved to be very suitable for Vietnamese conditions in the treatment of complex aortic diseases in the arch and on supra-renal lesion. There is a difficult situation when the ascending aorta is more dilated than can be accommodated by stent-grafts. Wrapping techique is a solution to this situation. Methods: Report on a clinical case of successful application of aortic wraping technique to treat complex aortic cross injuries at Cardiovascular and Thoracic Center, Viet Duc University Hospital. Results: A 73-year-old female patient was admitted to the hospital because of sudden chest pain. History of high blood pressure, heart failure, dyslipidemia and hypothyroidism. MSCT revealed type B aortic dissection, left hemothorax complication, the entire ascending aorta and a part of cross dilated to 50mm (maximum stent-graft size is 46mm). Poor general condition, severe and complicated acute aortic injury, if the classic surgery requires total thoracic aorta replacement – ​​the risk of death is very high, so the hybrid solution is a reasonable choice if having the solution is to solve the problem to create a landing zone for stent-graft. Hybrid surgery was started with open sternotomy, bilateral aortic - carotid bypass with Dacron prothesis 9mm, using a large artificial vessel to wrap around the ascending aorta to reduce the medium size to 38mm. Drain and close the sternum. Next is endovascular intervention – installing a stent-grafts of 42x42x200 and 42x38x150 then 38x34x150 to the diaphragm, plug for left subclavian artery. Left pleural drainage. The patient was discharged 10 days after surgery. Follow-up after 2 years for good results. Conclusion: The hybrid procedure can still be applied in the situation of ascending aorta dilatation with wrapping technique – decreasing the size of the aorta to fit the size of the stent-graft in some high-risk situations. with classic surgery.

Wrapping technique of ascending aorta in Hybrid procedure for complex aortic arch disease

Background: The hybrid procedure proved to be very suitable for Vietnamese conditions in the treatment of complex aortic diseases in the arch and on supra-renal lesion. There is a difficult situation where the ascending aorta is more dilated than can be accommodated by stent-grafts. Wrapping techique is a solution to this situation. Methods: Report on a clinical case of successful application of aortic wrap technique to treat complex aortic cross injuries at Cardiovascular and Thoracic Center, Viet Duc University Hospital. Results: A 73-year-old female patient was admitted to the hospital because of sudden chest pain. History of high blood pressure, heart failure, dyslipidemia and hypothyroidism. MSCT revealed type B aortic dissection, left hemothorax complication, the entire ascending aorta and a part of cross dilated to 50mm (maximum stent-graft size is 46mm). Poor general condition, severe and complicated acute aortic injury, if the classic surgery requires total thoracic aorta replacement – ​​the risk of death is very high, so the hybrid solution is a reasonable choice if having the solution is to solve the problem to create a landing zone for stent-graft. Hybrid surgery was started with open sternotomy, bilateral aortic - carotid bypass with Dacron prothesis 9mm, using a large artificial vessel to wrap around the ascending aorta to reduce the medium size to 38mm. Drain and close the sternum. Next is endovascular intervention – installing a stent-grafts of 42x42x200 and 42x38x150 then 38x34x150 to the diaphragm, plug for left subclavian artery. Left pleural drainage. The patient was discharged 10 days after surgery. Follow-up after 2 years for good results. Conclusion: The hybrid procedure can still be applied in the situation of ascending aorta dilatation with wrapping technique – decreasing the size of the aorta to fit the size of the stent-graft in some high-risk situations. with classic surgery.

Celiac Artery Coverage During Thoracic Endovascular Aortic Repair for Dissection and Acute Aortic Injury Is Not Associated With Worse Outcomes

Studies have previously identified increased morbidity and mortality with celiac artery coverage during thoracic endovascular aortic repair (TEVAR) for aneurysmal disease. Our study aimed to delineate the risks associated with celiac artery coverage in all patients who had undergone TEVAR for dissection, trauma, or aneurysmal disease.

Acute aortic wall injury caused by aortic cross-clamping: morphological and biomechanical study of the aorta in a swine model of three aortic surgery approaches.

BackgroundAortic cross-clamping and balloon occlusion of the aorta could lead to damage to the aorta wall.ObjectiveThe aim of this study was to investigate changes to the aorta wall related to the method used to interrupt flow (clamping or balloon) in the different techniques available for aortic surgery.MethodsExperiments were performed on 40 female pigs, weighing 25-30kg, which were randomly allocated to 4 study groups: S (n=10), no intervention (sham group); C (n=10), midline transperitoneal laparotomy for infrarenal abdominal aortic access with 60 min of cross-clamping; L (n=10), laparoscopic infrarenal abdominal aortic surgery with 60 min of cross-clamping; EV (n=10), remote proximal aortic control with transfemoral arterial insertion of aortic occlusion balloon catheter, inflated to provide continued aortic occlusion for 60min. After euthanasia, the aortas were removed and cross-sectioned to obtain histological specimens for light microscopic and morphometric analyses. The remaining longitudinal segments were stretched to rupture and mechanical parameters were determined.ResultsWe observed a reduction in the yield point of the abdominal aorta, decrease in stiffness and in failure load in the aortic cross-clamping groups (C and L) compared with the EV group.ConclusionsAortic cross-clamping during open or laparoscopic surgery can affect the mechanical properties of the aorta leading to decrease in resistance of the aorta wall, without structural changes in aorta wall histology.

Protective Effects of Ozone Oxidative Postconditioning on Long-term Injury After Renal Ischemia/Reperfusion in Rat

BackgroundRenal ischemia/reperfusion (I/R) injury can cause serious kidney damage (eg, acute aortic injury, chronic fibrosis). Some postconditioning treatments have been reported to protect from I/R effects. However, their mechanisms remain unclear. Here, we focused on potential protective effects of ozone on tubulointerstitial fibrosis after renal I/R injury in rats. MethodsAdult male rats were randomly divided into 4 groups with (1) sham-without I/R; (2) I/R-by clamping renal pedicle for 45 minutes; (3) I/R with ozone oxidative postconditioning (OzoneOP) following a 10-day reperfusion; and (4) I/R with oxygen oxidative postconditioning (OxygenOP) following a 10-day reperfusion. The kidneys were collected at 2 time points post I/R 10 days (at early phase) and 12 weeks (at late phase) and then analyzed for renal function, tissue fibrosis, and serum creatinine and urea nitrogen levels by staining and colorimetric methods. Additionally, expression levels of related fibrotic factors, such as α-smooth muscle actin, transforming growth factor β1, and phospho-Smad2, were assayed by immunochemistry staining. ResultsOzoneOP treatment downregulated the α-smooth muscle actin, transforming growth factor β1, and phospho-Smad 2 protein expression in rats subjected to I/R at 10 days and 12 weeks. Moreover, it improved renal dysfunction and attenuated the patchy tubulointerstitial fibrosis. ConclusionOurdata indicate that I/R-induced renal damage might cause severe tubulointerstitial fibrosis at the late phase, and OzoneOP treatment may inhibit this fibrotic development.

Matrix stiffness determines the phenotype of vascular smooth muscle cell in vitro and in vivo: Role of DNA methyltransferase 1

Cells perceive the physical cues such as perturbations of extracellular matrix (ECM) stiffness, and translate these stimuli into biochemical signals controlling various aspects of cell behavior, which contribute to the physiological and pathological processes of multiple organs. In this study, we tested the hypothesis that during arterial stiffening, vascular smooth muscle cells (SMCs) sense the increase of ECM stiffness, which modulates the cellular phenotype through the regulation in DNA methyltransferases 1 (DNMT1) expression. Moreover, we hypothesized that the mechanisms involve intrinsic stiffening and deficiency in contractility of vascular SMCs. Substrate stiffening was mimicked in vitro with polyacrylamide gels. A contractile-to-synthetic phenotypic transition was induced by substrate stiffening in vascular SMCs through the down-regulation of DNMT1 expression. DNMT1 repression was also observed in the tunica media of mice aortas in an acute aortic injury model and a chronic kidney failure model, as well as in the tunica intima of human carotid arteries with calcified atherosclerotic lesions. DNMT1 inhibition facilitates arterial stiffening in vivo and promotes osteogenic transdifferentiation, calcification and cellular stiffening of vascular SMCs in vitro. These effects may be attributable, at least in part, to the role of DNMT1 in regulating the promoter activities of Transgelin (SM22α) and α-smooth muscle actin (SMA) and the functional contractility of SMCs. We conclude that DNMT1 is a critical regulator that negatively regulates arterial stiffening via maintaining the contractile phenotype of vascular SMCs. This research may facilitate elucidation of the complex crosstalk between vascular SMCs and their surrounding matrix in healthy and in pathological conditions and provide new insights into the implications for potential targeting of the phenotypic regulatory mechanisms in material-related therapeutic applications.

Bindarit reduces the incidence of acute aortic dissection complicated lung injury via modulating NF-κB pathway.

The pathogenesis of acute aortic dissection (AAD) complicated acute lung injury (ALI) is not currently well defined. At present, no effective animal model has been established for AAD complicated ALI, which hinders research and development of an appropriate treatment regimen for the concurrent conditions. The aim of the present study was to evaluate the therapeutic effects of bindarit (Bnd), an indazolic derivative, on the production of monocyte chemoattractant protein (MCP)-1 in angiotensin II (AngII)-induced complicated ALI in rats. An AAD complicated ALI rat model was established using aminopropionitrile (BAPN) and AngII. The pathological features of AAD complicated ALI were assessed via biochemical and histopathological evaluations. AngII-stimulated human pulmonary microvascular endothelial cells (hPMVECs) were used to assess the effects of Bnd on MCP-1 expression. Western blot analysis was performed to analyze the expression of proteins that may be associated with the process. AAD complicated ALI was established following BAPN and AngII interference, and a massive accumulation of macrophages was observed in the lung tissues of the study rats. Bnd was able to significantly attenuate the incidence of AAD complicated ALI (P<0.05), and significantly inhibit the accumulation of macrophages (P<0.05). The overexpression of MCP-1 induced by AngII in hPMVECs was significantly inhibited by Bnd (P<0.05), which may be associated with downregulation of the classical nuclear factor-κB pathway. Bnd was able to attenuate the incidence of AAD complicated ALI, and inhibit the accumulation of macrophages in vivo. These findings provide a basis for future applications of Bnd as part of a therapeutic treatment schedule for aortic dissection complicated lung injury.

CT Angiography in the Emergency Department: Maximizing Contrast Enhancement and Image Quality While Minimizing Radiation Dose and Contrast Material Volume: Vascular/Interventional Radiology.

CT angiographic image quality and radiation dose can be optimized for each patient by applying knowledge of the principles of intravenous contrast material flow and the factors that influence contrast enhancement.

Traumatic Blunt Aortic Injuries at Unusual Locations, A Retrospective Single Institution Study

Acute aortic injuries resulting from blunt trauma are most commonly seen in the proximal descending aorta just distal to the origin of the left subclavian artery. Previous studies have shown these aortic injures can also occur at other locations 10-15% of the time. The aim of this study is to better characterize these uncommon blunt aortic injuries found at unusual locations with regard to all unique features in all aspects of their care.

CT of suspected thoracic acute aortic injury in the emergency department: is routine abdominopelvic imaging worth the additional collective radiation dose?

This study aimed to determine the incidence of non-traumatic acute aortic injury (AAI) extending from the chest into the abdomen or pelvis in emergency department (ED) patients with acute aortic syndrome (AAS), to estimate the effective dose of the abdominopelvic portion of these CT exams, and to compare the number needed to screen (NNS) with the collective population radiation dose of imaging those stations. All patients (n=238) presenting to the ED with AAS between March 2014 and June 2015 who were imaged per CT AAI protocol (noncontrast and contrast-enhanced CT angiography of the chest, abdomen, and pelvis) were retrospectively identified in this IRB-approved HIPAA-compliant study. The Stanford classification for positive cases of AAI was further subclassified based on chest, abdominal, or pelvic involvement. The dose length product (DLP) of each exam was used to estimate the dose of the abdominal and pelvic stations and the collective effective dose for the population. There were five cases of aortic dissection (AD) and two of intramural hematoma (IMH), with an AAI incidence of 2.9/100. Three cases of AAI were confined to the chest. Two cases of AAI were confined to the chest and abdomen, and two cases involved the chest, abdomen, and pelvis. There was only one case of AAI involving the ascending aorta that extended into the abdomen or pelvis. The number needed to screen to identify (a) AAI extending from the chest into the abdomen or pelvis was 59.5 and (b) Stanford A AAI extending into the abdomen or pelvis was 238. The estimated mean effective dose for the abdominopelvic stations were unenhanced abdomen 2.3mSv, unenhanced pelvis 3.3mSv, abdominal CTA 2.5mSv, and pelvic CTA 3.6mSv. The collective effective doses to the abdomen and pelvis with unenhanced CT and CTA in 59.5 patients and 238 patients were 761.6 and 3046.4mSv, respectively. While the estimated mean effective dose for imaging of the abdominopelvic stations are low, the collective effective dose should also be considered. It may be beneficial to modify or omit routine unenhanced CT and/or CTA of the abdomen/pelvis in this patient population in the absence of abdominal symptoms, and image the abdomen and pelvis in positive thoracic cases only.

Trauma cardiaco cerrado

Cardiac trauma is one of the primary causes of death amongst general population. It requires a high degree of suspicion of severe blunt trauma, deceleration mechanism and presence of indirect signs, such as ecchymosis and steering wheel or seatbelt marks in the anterior chest wall. Injuries include: cardiac concussion, heart rupture, indirect cardiac injury, such as acute coronary thrombosis, aortic injury, pericardial injury and cardiac herniation. The clinical signs and symptoms include: angina refractory to nitrates, pleuritic pain, hypotension, tachycardia, jugular venous distention that increases on inspiration, S3 gallop, pericardial rub, new murmur or crepitant rales due to pulmonary edema. The electrocardiogram is the first link in the diagnostic algorithm leading to findings such as sinus tachycardia, premature ventricular complexes, atrial fibrillation, right bundle branch block and atrioventricular block. Chest X-rays help to rule out other pulmonary or bone injuries. Troponin I has a negative predictive value of 93% for cardiac trauma; other less specific cardiac enzymes are creatine kinase and creatine kinase-MB. Echocardiogram is indicated in presence of persistent hypotension, abnormal ECG results or acute heart failure. The treatment includes initial stabilization and specific management of the injuries. Some complications may include: cardiac tamponade, myocardial contusion, acute coronary syndrome, cardiac arrhythmias and aortic injury. The prognosis of the patient depends on the vital signs at the time of arrival at the emergency department and the presence of cardiac arrest during the initial approach.

The utility of chest X-ray as a screening tool for blunt thoracic aortic injury.

The early and accurate identification of patients with blunt thoracic aortic injury (BTAI) remains a challenge. Traditionally, a portable AP chest X-ray (CXR) is utilized as the initial screening modality for BTAI, however, there is controversy surrounding its sensitivity. The purpose of this study was to assess the sensitivity of CXR as a screening modality for BTAI. After IRB approval, all adult (≥18 yo) blunt trauma patients admitted to LAC+USC (01/2011-12/2013) who underwent CXR and chest CT were retrospectively reviewed. Final radiology attending CXR readings were reviewed for mediastinal abnormalities (widened mediastinum, mediastinal to chest width ratio greater than 0.25, irregular aortic arch, blurred aortic contour, opacification of the aortopulmonary window, and apical pleural haematoma) suggestive of aortic injury. Chest CT final attending radiologist readings were utilized as the gold standard for diagnosis of BTAI. The primary outcome analyzed was CXR sensitivity. A total of 3728 patients were included in the study. The majority of patients were male (72.6%); mean age was 43 (SD 20). Median ISS was 9 (IQR 4-17) and median GCS was 15 (IQR 14-15). The most common mechanism of injury was MVC (48.0%), followed by fall (20.6%), and AVP (16.9%). The total number of CXRs demonstrating a mediastinal abnormality was 200 (5.4%). Widened mediastinum was present on 191 (5.1%) of CXRs, blurred aortic contour on 10 (0.3%), and irregular aortic arch on 4 (0.1%). An acute aortic injury confirmed by chest CT was present in 17 (0.5%) patients. Only 7 of these with CT-confirmed BTAI had a mediastinal abnormality identified on CXR, for a sensitivity of 41% (95% CI: 19-67%). The results from this study suggest that CXR alone is not a reliable screening modality for BTAI. A combination of screening CXR and careful consideration of other factors, such as mechanism of injury, will be required to effectively discriminate between those who should and should not undergo chest CT.

Multidetector Computed Tomography of Nonosseous Thoracic Trauma

the patient's immediate course (as in the setting of acute aortic injury or blunt cardiac injury). Even when not life threatening, the presence of thoracic injury may affect management. A pneumothorax, for example, may require emergent thoracostomy tube placement before surgical correction of a pelvic fracture. Chest radiography remains a frequently used screening tool owing to its low cost and portability. Multidetector computed tomography (MDCT) continues to make inroads in the evaluation of radiographic abnormalities and in the exclusion of significant injury in the setting of an appropriate mechanism (high-speed collision or high fall) in the posttrauma patient. The increase in the use of computed tomography (CT) has been driven by its ready availability at all hours, its ability to detect subtle disease missed by radiography, and its ability to change management in almost one-fifth of trauma patients. 2,3 Most often, CT is performed to evaluate abnormal findings on chest radiograph,butoccasionally MDCT maybeusedas a firstline tool. The goal of this article is to highlight the features of blunt and penetrating thoracic traumatic conditions, including aortic and cardiac injury, on MDCT images. Occasionally, these conditions may be encountered in isolation, but more often, they are seen in conjunction with other injuries (both intrathoracic and extrathoracic). Technique Unlesscontraindicated basedonallergy orrenalfailure,MDCT in the setting of trauma should be performed with the use of intravenous contrast. The potential benefit of visualizing direct signs of vascular injury or an area of blush (indicative of active extravasation or pseudoaneurysm formation) far outweighs anytheoreticalrisks.MDCTofthethoraxshouldbeperformed using a technique that allows high-quality multiplanar reconstructions (MPRs) and provides source images that allow volume-rendered images as well. At our institution, we scan using a pitch of 1 with 3-mm reconstructions at 2-mm intervals. The 33% overlap allows for high-quality MPRs and yet, 3-mm images do not result in an inordinate number of images. The balance between a manageable image burden and thin sections has become harder in the MDCT era. We only scan once in the setting of trauma. We have not found precontrast images of any help.

Thoracic endograft in traumatic aortic injury — an other job for cardiologist in University Hospital Center Zagreb

Cardiologia CROATICA Thoracic endovascular aortic repair (TEVAR) initially developed for the treatment of degenerative aneurysms of the descending thoracic aorta, has been applied to the entire spectrum of descending thoracic aortic pathology including emergent settings. Last year in our institution, three patients with an average age of 46,6 years (range 39-55) underwent emergent TEVAR for acute aortic injury during traffic accident; two in the car, and one on the motorcycle. The technical success rate was 100%. A standard Medtronic thoracic aortic stent graft VALIANT was used. There was no procedure-related complications: no stroke, spinal cord ischemia, or complications connected with vascular access. In all three cases graft was positioned bellow left subclavian artery. All three patients had polytrauma, and after successful graft implantation underwent other surgical procedures (ruptured diaphragm, subdural hematoma, multiple pelvic fractures). Fortunately all three patients overcome their complicated medical conditions. The control MSCT of aorta, before hospital discharge, has shown widely patent stent grafts with no migration and no change in the configuration. After 1 year, 8 month and 6 month of follow up, our patients confirm that TEVAR is a reliable method for the treatment of traumatic thoracic aortic injuries, even favorable in comparison with historical open surgery, with good results in the shortand medium-term follow-up.

A Simple Score Predicts Aortic Injury in Patients with Blunt Chest Trauma

Rapid identification of acute traumatic aortic injury can be challenging in multi-injured trauma patients. In a two-part retrospective study,

Emergent combined repairs for aortic injury and bowel perforation after blunt trauma

Traumatic aortic rupture is frequently associated with multi-system injuries and is often immediately fatal. Although delayed open repair or endovascular repair has been recommended for an acceptable outcome, an emergency operation is mandatory for a life-threatening condition. We present here a challenging case of survival after immediate, combined repairs for acute aortic injury and bowel perforation.