Blunt Aortic Trauma Research Articles

A Case Report of Blunt Aortic Trauma in a Difficult Anatomic Location with Emergent Intraoperating Room Extracorporeal Membrane Oxygenation

A Case Report of Blunt Aortic Trauma in a Difficult Anatomic Location with Emergent Intraoperating Room Extracorporeal Membrane Oxygenation

Postoperative complications of endovascular blunt thoracic aortic injury repair

BackgroundThoracic endovascular aortic repair (TEVAR) has become the standard of care for thoracic aortic aneurysms and increasingly for blunt thoracic aortic injury (BTAI). Postoperative complications, including spinal cord ischemia and...

Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair

The prevalence of a bovine aortic arch configuration is higher in patients treated for thoracic aortic aneurysms and type B dissection; its prevalence in aortic isthmic trauma has not been described. A case control study was performed comparing consecutive patients treated at our institution for acute isthmic aortic transection after blunt trauma between 2002 and 2019 and a control group of consecutive sex-matched individuals undergoing imaging for nonaortic disease. Imaging and clinical findings were reviewed. Subjects were divided into bovine and nonbovine groups and prevalence was compared. The length of the aortic segment between the left subclavian artery (LSA) and the next proximal great vessel was measured in the control population and a comparison was performed between bovine and nonbovine aortic arch subjects. Thirty-three consecutive (30 male) patients were reviewed, 66 individuals (60 male) were included in the control group. A higher incidence of bovine arch in trauma patients was found: 57.6% vs. 34.8% (P=0.007). The median (range, mm) and mean (SD) distance between the bovine trunk and the LSA were 13mm (2-27) and 12.4mm (5.9), respectively, compared with 5mm (1-27) and 7.8mm (6.1) between the left common carotid and LSA in nonbovine aortic arches (P<0.005). A higher incidence of bovine arch in patients reaching out for surgical treatment for traumatic isthmic aortic transection was found in our population. Clinical interpretation of this finding can lead to several alternatives. Confirmation with larger series and data on prevalence of this anatomic variation in nonsurvivors is needed to provide a better understanding of this finding.

Isolated Abdominal Injury of Blunt Aortic Trauma: Two Case Reports and Review of the Literature

Background: Injury to the abdominal aorta as part of a blunt injury is a rare event and is normally associated with other abdominal injuries. The management of these injuries can be non-operative, open repair or endovascular repair.Methods: We present two cases of blunt abdominal aortic injury (BAAI) in which the aorta was the only abdominal injury. This is followed by a review of the current literature.Results: Both these cases were treated endovascularly with good results. Conclusions: BAAIs are rare and can occur in isolation, i.e. without any accompanying abdominal injuries. Despite historically being treated mostly by open repair, endovascular repair offers many advantages and can be safely managed.

Endovascular treatment of blunt thoracic aortic injuries

A new era has begun in the last two decades with the advent of endovascular methods in the therapy of blunt thoracic aorta injuries. Our experiences with the endovascular interventions of blunt aortic trauma in the Cardiovascular Center of Semmelweis University are summarised here. We included those patients who underwent endovascular intervention due to blunt aortic trauma in a university hospital between 1998 and 2014. The statistical analysis was performed with the use of Excel. 41 patients were selected from our database. There were 34 males, the average age was 47 years (±17 years). Among the 41 patients 15 underwent an acute procedure (12 ruptures) and 26 patients received delayed treatment (in 4 cases due to growing of the pseudoaneurysm). There was only one early postoperative death. Late mortality was 22.5% and 7.5% was related to the aortic injury. Our late mortality and complication rates were similar to other studies, which reinforces international experiences. In the cases when delayed treatment is feasible, the patient can be stabilized and the CTA images can be analyzed for precise stentgraft planning. The treatment of blunt thoracic aorta injured patients should take place in specialized centers capable of such endovascular interventions.

PC170. Management Challenges in Patients With Blunt Abdominal Aortic Injuries

Blunt abdominal aortic injuries (BAAI) are rare, accounting for only 5% of all blunt aortic traumas. We reviewed the incidence, management, and outcomes of patients with BAAI at a Level I urban trauma center over a 10-year period. Through our trauma registry, we retrospectively reviewed all patients who presented with BAAI to a Level I urban trauma center from 2004 to 2014. Medical records and autopsy data were used to analyze the severity and location of aortic trauma, associated injuries, treatment methods, and outcomes. We identified 38 total patients with blunt aortic injuries. Blunt thoracic aortic trauma accounted for 85% of the injuries. BAAI were identified in 6 patients (15%). The median age of BAAI patients was 41 years (range, 29-82 years). Motor vehicle collision was the etiology in 4 patients and pedestrian struck in 2 patients. Median injury severity score (ISS) was 66.5 (range, 34-75). There were 5 injuries of the infrarenal aorta (2 intimal tears, 1 dissection, 1 pseudoaneurysm, 1 free rupture) and 1 free rupture at the level of the left renal artery. All patients sustained additional spine or other bony fractures. There were 11 associated solid organ and bowel injuries in 4 patients. In-hospital mortality was 50%, which included both free ruptures and one case of infrarenal aortic dissection in the setting of brain death. Laparotomy and repair of an aortic tear at the level of the left renal artery was performed on one free aortic rupture, with a hospital course complicated by multiple organ resections, intra-abdominal sepsis, and death secondary to aortic rupture 8 days after initial repair. The patient with the infrarenal aortic pseudoaneurysm was treated with aortic stent graft cuffs, with survival to discharge after a course complicated by respiratory failure from lung injuries. Two patients with intimal tears were managed nonoperatively to discharge. Two of the survivors were found to be isolated blunt abdominal aortic traumas, without concomitant intra-abdominal injuries, while the third survivor sustained additional blunt gastric, small bowel, and colon injuries. In contrast, both free aortic ruptures were associated with multiple solid organ and bowel injuries. BAAIs are rare events with high mortality rates. Management decisions are challenging and must be made in the setting of complex injuries across multiple systems.

Review of a 10-year single center experience in treatment of thoracoabdominal aortic trauma

Objective To review the case data and treatment methods in a single center so as to search for rational treatments for thoracoabdominal aortic trauma. Methods This retrospective analysis was performed for 34 cases (28 males and 6 females) sustaining thoracoabdominal aortic trauma treated from October 2002 to February 2013. The mean age was 41 years (range, 11-60 years). Causes of injury included traffic crashes in 14 cases, high falls in 7, stab wound in 3, abdominal crash injury in 3, aorticoesophageal fistula caused by a fish bone in 3, interventional therapy-induced aortic dissection in 2, abdominal aortic injury caused by the dropped ventricular septal defect occluder in 1, and accidental aortic injury in spinal operation in 1. There were 23 cases of thoracic aortic trauma (6 sharp and 17 blunt) and 11 cases of abdominal aortic trauma (4 sharp and 7 blunt). Preoperative imaging findings, treatment methods and follow-up data were studied. Results Personal treatment was produced based on the mechanism of injury and imaging findings. Of sharp thoracic aortic trauma, 2 cases were treated non-operatively but both died, and four cases had endovascular repair (one progressed, two cured, and one died). All the four cases of sharp abdominal aortic trauma had open surgery (three cured and one severely complicated). Of thoracic aortic trauma, four cases were treated non-operatively (three cured and one died), twelve cases had endovascular repair (11 cured and one died), and one case had open surgery and cured. Six cases of blunt abdominal aortic trauma were treated non-operatively and one had open surgery. Conclusions Treatment of aortic trauma should be based on injury condition, injury site, and occurrence of aortic rupture or impending of aortic rupture. Endovascular repair has a high success rate and good clinical outcome in treatment of thoracoabdominal aortic trauma. Key words: Aorta; Wounds and injures; Endovascular repair

Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma.

Blunt traumatic aortic injury (BTAI) is the second most common cause of death in trauma patients. Eighty percent of patients with BTAI will die before reaching a trauma center. The issues of how to diagnose, treat, and manage BTAI were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the practice management guidelines on this topic published in 2000. Since that time, there have been advances in the management of BTAI. As a result, the EAST guidelines committee decided to develop updated guidelines for this topic using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework recently adopted by EAST. A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding BTAI from 1998 to 2013. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included imaging to diagnose BTAI, type of operative repair, and timing of operative repair. Sixty articles were identified. Of these, 51 articles were selected to construct the guidelines. There have been changes in practice since the publication of the previous guidelines in 2000. Computed tomography of the chest with intravenous contrast is strongly recommended to diagnose clinically significant BTAI. Endovascular repair is strongly recommended for patients without contraindications. Delayed repair of BTAI is suggested, with the stipulation that effective blood pressure control must be used in these patients.

Validating Common Carotid Artery Stenosis by Duplex Ultrasound With Carotid Angiogram or Computed Tomographic Angiography Scan

Objectives: Endovascular aortic repair has revolutionized the management of blunt aortic trauma. However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients. Methods: Weretrospectively reviewedall blunt traumatic aortic injuries at an academic Level I trauma center over a tenyear period (2001-2010). Images were reviewed by a radiologist and graded according to SVS guidelines (Grade I-IV). Demographics, injury severity, and outcomes were recorded. Results: We identified214patientswithblunt injuries to the thoracic or abdominal aorta. 115 were deemed operative injuries at presentation and were excluded from analysis. The remaining 99 were observed. On presentation, 54 had minimal (Grade I or II) injury. Of these, 43 had follow-up imaging at a mean of 102 days postinjury and constitute our study cohort. Mean age was 39 years and mean length of stay was 16 days. Forty-one patients (95%) had Grade I injury (intimal flap) and two patients had Grade II injury (medial hematoma). Forty (93%) were thoracic aortic injuries and the remaining were abdominal. On follow-up imaging, 23 of 43 (54%) had complete resolution of injury, 18 (42%) had no change in aortic injury, and two (5%) had progression (enlargement) of injury. Of the 2 patients with progression, one progressed fromGrade I to Grade II and one progressed from Grade I to Grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention. No patients were operated on or died from a grade I or II aortic injury. Conclusions: Injury progression in Grade I-II blunt aortic injury is rare (w5%) and did not cause death in our study cohort. Since progression to Grade III injury is possible, follow-up with repeat aortic imaging is reasonable.

Unusual blunt aortic trauma injury

Unusual blunt aortic trauma injury

Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil. A case series

OBJECTIVE:The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years.METHODS:Twenty‐eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty‐six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma.RESULTS:Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow‐up for the overall group was 33.6 months, with 48.7 months (range 8‐83 months) for the OR group, and 29.8 months (range 2‐91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8‐48 h, median 20 h) for the OR group and 30.3 hours (range 2‐240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay.CONCLUSION:In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow‐up. Nevertheless, long‐term follow‐up is necessary to confirm the effectiveness of this treatment.

Aortic Rupture in a Heart Transplant Patient Following Recent Blunt Aortic Trauma

We report a case of a patient who developed an aortic dissection with rupture. This presumably was a delayed injury following blunt thoracic trauma and highlights that concerns for aortic pathology even in this patient population.

Endovascular Repair of Traumatic Rupture of the Thoracic Aorta: Single-Center Experience

Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency and a common cause of death, usually following violent collisions. The objective of this retrospective report was to evaluate the efficacy of endovascular treatment of thoracic aortic disruptions with a single commercially available stent-graft. Nine men (mean age 29.5 years) were admitted to our institution between January 2003 and January 2006 due to blunt aortic trauma following violent motor vehicle collisions. Plain chest radiography, spiral computed tomography, aortography, and transesophageal echocardiography were used for diagnostic purposes in all cases. All patients were diagnosed with contained extramural thoracic aortic hematomas, secondary to aortic disruption. One patient was also diagnosed with a traumatic thoracic aortic dissection, secondary to blunt trauma. All subjects were poor surgical candidates, due to major injuries such as multiple bone fractures, abdominal hematomas, and pulmonary contusions. All repairs were performed using the EndoFit (LeMaitre Vascular) stent-graft. Complete exclusion of the traumatic aortic disruption and pseudoaneurysm was achieved and verified at intraoperative arteriography and on CT scans, within 10 days of the repair in all patients. In 1 case the deployment of a second cuff was necessary due to a secondary endoleak. In 2 cases the left subclavian artery was occluded to achieve adequate graft fixation. No procedure-related deaths have occurred and no cardiac or peripheral vascular complications were observed within the 12 months (range 8-16 months) follow-up. This is the first time the EndoFit graft has been utilized in the treatment of thoracic aortic disruptions secondary to chest trauma. The repair of such pathologies is technically feasible and early follow-up results are promising.

Giant Floating Aortic Thrombus: A Rare Finding on Transesophageal Echocardiography

Transesophageal echocardiography is highly sensitive for diagnosing aortic injury. We report the case of a woman presenting after a motor vehicle accident in whom large aortic thrombi were identified at the aortic isthmus by transesophageal echocardiography. Aortic injury is a known cause of morbidity and mortality following chest trauma. Aortic thrombosus is a rare and life-threatening consequence of aortic trauma. In conclusion, transesophageal echocardiography should be considered in patients who have sustained blunt aortic trauma.

Blood Pressure Control for the Patients with Blunt Aortic Trauma

Blood Pressure Control for the Patients with Blunt Aortic Trauma

Verletzungen der thorakalen Aorta

BACKGROUND: This article reviews the mechanisms of thoracic aortic injury and therapeutic options for its repair. METHODS: We retrospectively analyze our data on surgery of the thoracic aorta for blunt trauma in 25 patients during the last two decades. RESULTS: Blunt aortic trauma is a rare but life-threatening incident, mainly resulting from deceleration forces in vehicle accidents and falls from a height. Dissection and rupture of the descending aorta distal to the left subclavian artery is the most frequently seen pathological correlate. Iatrogenic injuries resulting from cardiovascular surgery and endovascular interventions may also cause aortic trauma. Results of surgery in acute cases are less good than in a stable subacute or chronic phase (mortality, 20% vs. 0%). CONCLUSIONS: Traumatic injury to the thoracic aorta is a potentially lethal problem. When acute traumatic dissection or rupture of the thoracic aorta is diagnosed, surgical aortic repair must be performed immediately. In an unstable patient or if a contraindication for surgery exists, an endovascular stent graft prosthesis is a rational alternative. For acute aortic replacement, use of extracorporeal circulation is essential for organ protection and for a satisfactory surgical outcome.

Dissection of the abdominal aorta in blunt trauma: Endovascular or conventional surgical management?

Dissection of the abdominal aorta caused by blunt trauma is a rare injury, often complicated by thrombosis within the true and false lumens and sometimes aortic rupture. The mortality rate with conservative medical management is approximately 75%, whereas it ranges from 18% to 37% with surgical treatment. At our institution, 7 of the 87 patients admitted because of blunt aortic trauma, between January 1995 and January 2002, had abdominal aortic dissection. Four patients were treated using endovascular techniques by percutaneous stent placement. The indications for endovascular management were lower limb ischemia in one case and extension of the dissection in two; one patient was asymptomatic. Aortic dissection was complicated by ischemic paraplegia in two patients, and both were treated by conventional operative repair. One patient was managed medically because of a minimal intimal disruption. No deaths were related to the aortic dissection or its treatment. Angiographic and computed tomographic (CT) studies showed thrombosis of the false lumen and complete obliteration of the dissection in the endovascular group. The neurologic condition of the two paraplegic patients either cleared completely or partially improved. In the absence of ischemic paraplegia or other injuries that require emergency surgery, endovascular treatment is a safe and efficient method for treating traumatic infrarenal aortic dissection.

Imaging of blunt aortic and great vessel trauma.

The thoracic aorta and great vessels are at risk of injury by both blunt and penetrating trauma. High-speed deceleration injury, predominately caused by motor vehicle accidents, is the primary cause of blunt traumatic aortic injury (TAI). Though largely fatal if untreated, these injuries are amenable to surgical repair if appropriately diagnosed. Algorithms for both diagnosis and treatment of TAI have undergone changes in recent years. Radiologic imaging plays a key role in the evaluation of TAI, and this review focuses on the relative roles of chest radiography, computed tomography (CT) (particularly helical CT), and aortography in the diagnostic algorithm for TAI. Other aortic imaging methods have been used in the setting of TAI, such as transesophageal echocardiography, magnetic resonance imaging, and intravascular ultrasound; although these techniques may play a complementary role in TAI evaluation, they are unlikely to have as significant an impact on routine radiologic practice as will CT.

A retrospective review of the role of transesophageal echocardiography in aortic and cardiac trauma in a level I pediatric trauma center

This study examined the role of transesophageal echocardiography in blunt aortic and cardiac trauma in a Pediatric Level I Trauma Center. In a > 5-year retrospective review, we identified 10 children with blunt cardiac (n = 4; tricuspid valve in two; mitral valve in one; aortic valve in one) and aortic (n = 6; aortic rupture in five, subintimal flap in one) trauma. Diagnosis of the cardiac injuries was made with transthoracic echocardiography, with transesophageal echocardiography providing additional anatomic detail and postoperative assessment in three of four children who required surgical intervention. Diagnosis of the aortic injuries was made with transesophageal echocardiography in five of six patients; one patient underwent aortography before transfer. Transesophageal echocardiography also identified depressed myocardial function in one child and aided in surgical management of the five aortic ruptures. In blunt chest trauma, transesophageal echocardiography provides accurate evaluation of cardiovascular structure and function and guides operative repair.

Can Helical CT Replace Aortography in Blunt Aortic Trauma?

HomeRadiologyVol. 201, No. 2 PreviousNext LettersCan Helical CT Replace Aortography in Blunt Aortic Trauma?Yvette D. Bailey, Stanley G. Cooper, Israel Schur, Rajesh PatelYvette D. Bailey, Stanley G. Cooper, Israel Schur, Rajesh PatelAuthor AffiliationsDepartment of Radiology, Columbia University College of Physicians and Surgeons, St Luke's-Roosevelt Hospital Center, 1000 10th Ave, New York, NY 10019Yvette D. BaileyStanley G. CooperIsrael SchurRajesh PatelPublished Online:Nov 1 1996https://doi.org/10.1148/radiology.201.2.579-aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Nov 1996 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 201, No. 2 Metrics Altmetric Score PDF download