Current diagnosis and management of blunt traumatic rupture of the thoracic aorta

Abstract

The diagnosis and management of aortic lacerations has been gradually improving. Historically, aortic lacerations were a common cause of exsanguination with extremely high mortality rate. However, in modern trauma systems with advanced resuscitation and rapid radiology imaging, the diagnosis of an aortic injury is improving with an emphasis on preventing the progression of intimal flaps and pseudoaneurysms to frank dissection or rupture. Both diagnostic modalities and the paradigm of immediate operative intervention have changed. The evolution of endovascular stenting may play a future role in definitive care.

Traumatic aortic injury: Computed tomography angiography imaging and findings revisited in patients surviving major thoracic aorta injuries

“…Chest radiographic signs of TAI have low specificity and include the following: mediastinal widening > 8 cm, abnormal aortic contour, shift of the endotracheal tube and/or trachea to the right, depression of the left or right main stem bronchus, deviation of the nasogastric tube to the right, presence of an apical pleural cap, first rib fracture, acute left-sided haemothorax, retro-cardiac density, loss of the aorto-pulmonary window, widening of the right paraspinal interface, right paratracheal stripe (> 4 mm) and a pneumothorax. 5 , 6 …”

“…Indirect or associated findings include periaortic haematoma formation, change in the normal aortic calibre and normal aortic contour. 1 , 2 , 3 , 6 , 7 , 8 In the case of equivocal findings, it becomes a diagnostic challenge for the radiologist if the direct and indirect signs of TAI are absent; in such cases, direct catheter angiography is warranted. Periaortic haematoma in the absence of associated vascular injury may represent injury to the aortic adventitia.…”

“…Although open repair of injuries to the aortic root, ascending aorta and aortic arch remains the procedure of choice in recent times, injuries to the aortic isthmus, descending and abdominal aorta have shown successful outcomes with EVAR. 2 , 3 , 6 Advantages of EVAR include a lower mortality rate, a lower risk of paraplegia and no need for invasive open thoracic surgery. However, disadvantages include regular imaging follow-up to asses for graft complications, which include graft migration, graft fracture, endoleak, graft infection and complications related to vascular access.…”

Tratamento endovascular de pseudoaneurisma de aorta torácica: relato de caso

“…Desse modo, a perda sanguínea é bem menor do que a produzida com a cirurgia convencional, a aorta não precisa ser pinçada e a recuperação do paciente é mais rápida. Vários estudos prospectivos e randomizados estão sendo conduzidos no sentido de comparar a técnica convencional com a endovascular [5][6][7][8][9][10] 14 . Já no Brasil, apesar de não haverem muitos estudos multicêntricos comparativos, houve melhora significativa da morbidade e de complicações pós-operatórias no trauma torácico desde a adoção do tratamento endovascular 15,16 .…”

Ruptura traumática da aorta por traumatismo torácico fechado

“…Jeanne Lee e Raul Coimbra, que chama a atenção para a suspeita baseada na informação do mecanismo do trauma 4 .…”