Blunt traumatic aortic injury: Initial experience with endovascular repair

Azizzadeh, Ali; Keyhani, Kourosh; Miller, Charles C.; Coogan, Sheila M.; Safi, Hazim J.; Estrera, Anthony L.

doi:10.1016/j.jvs.2009.02.234

Cited by 341 publications

(264 citation statements)

References 22 publications

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“…12 This study received approval from the University of Western Ontario's Research Ethics Board for Health Sciences Research Involving Human Subjects.…”

Section: Methodsmentioning

confidence: 99%

“…13 Using a recently developed grading system, 12 the SVS recommends conservative management with serial imaging for type I injuries (intimal tear) and repair of type II, III and IV injuries. Our retrospective review generally supports this guideline and reinforces the requirement for serial imaging.…”

Section: Recherchementioning

confidence: 99%

“…Thus, our MAI group also included patients with pseudoaneurysms with minimal mediastinal hematoma, although most patients had intimal flaps. In the future, it will be important for all investigators to use a common grading system of injuries, 12 as in the SVS treatment guideline. 13 To fully determine whether minimal aortic injuries can be safely managed nonoperatively in the long term, 2 major factors are necessary: adequate duration of followup and good radiologic surveillance tools.…”

Section: Recherchementioning

confidence: 99%

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Natural history of minimal aortic injury following blunt thoracic aortic trauma

Kidane

Abramowitz²,

Harris³

et al. 2012

Can J Surg

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Background: Endovascular repair of blunt traumatic thoracic aortic injuries (BTAI) is common at most trauma centres, with excellent results. However, little is known regarding which injuries do not require intervention. We reviewed the natural history of untreated patients with minimal aortic injury (MAI) at our centre. Methods:We conducted a retrospective database review to identify all patients with a BTAI between October 2008 and March 2010. The cohort comprised patients initially untreated because of the lesser degree of injury of an MAI. We reviewed initial and follow-up computed tomography (CT) scans and clinical information. Results:We identified 69 patients with a BTAI during the study period; 10 were initially untreated and were included in this study. Degree of injury included intimal flaps (n = 7, 70%), pseudoaneurysms with minimal hematoma (n = 2, 20%) and circumferential intimal tear (n = 1, 10%). Six (60%) patients were male, and the median age was 40 years. Duration of clinical follow-up ranged from 1 month to 6 years (median 2 mo) after discharge, whereas CT radiologic follow-up ranged from 1 week to 6 years (median 6 wk). Seven (70%) patients had complete resolution or stabilization of their MAI, 1 (10%) with circumferential intimal tear showed extension of the injury at 8 weeks postinjury and underwent successful repair, and 2 (20%) were lost to follow-up.Conclusion: There appears to be a subset of patients with BTAI who require no surgical intervention. This includes those with limited intimal flaps, which often resolve. Radiologic surveillance is mandatory to ensure MAI resolution and identify any progression that might prompt repair.Contexte : La plupart des centres de traumatologie ont souvent recours à la répara-tion endovasculaire des traumatismes fermés de l'aorte thoracique (TFAT), et cette dernière donne d'excellents résultats. Toutefois, on en connaît peu sur le type de blessures qui ne requièrent pas d'intervention. Nous avons passé en revue l'histoire naturelle des patients qui ont été vus dans notre centre pour un traumatisme léger de l'aorte, mais qui n'ont pas été traités.

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“…12 This study received approval from the University of Western Ontario's Research Ethics Board for Health Sciences Research Involving Human Subjects.…”

Section: Methodsmentioning

confidence: 99%

Section: Recherchementioning

confidence: 99%

Section: Recherchementioning

confidence: 99%

See 1 more Smart Citation

Natural history of minimal aortic injury following blunt thoracic aortic trauma

Kidane

Abramowitz²,

Harris³

et al. 2012

Can J Surg

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“…He had been involved in a traffic accident 6 years earlier, during which he had suffered a BTAI (pseudoaneurysm; Society of Vascular Surgery4 grade III, Japanese Association for the Surgery of Trauma Classification5 IIIa) requiring treatment by TEVAR. The proximal side of the stent graft was in the subclavian artery, and the distal side was in the descending aorta at the Th6 level.…”

Section: Casementioning

confidence: 99%

A case of paraplegia that developed 6 years after thoracic endovascular aortic repair for blunt traumatic aortic injury

Takahashi

Shoko

Taketazu

et al. 2017

Acute Medicine & Surgery

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CaseThoracic endovascular aortic repair (TEVAR) is becoming the standard therapy for blunt thoracic aortic injury (BTAI). However, the long‐term outcomes of TEVAR for BTAI remain unclear. A 36‐year‐old man was admitted to our emergency department with dyspnea. He had been involved in a serious traffic accident 6 years earlier, requiring TEVAR for BTAI.OutcomeAcute heart failure and pneumonia were diagnosed on this admission. His respiratory condition improved, but paraplegia developed 10 h after hospitalization. Magnetic resonance imaging showed an intraspinal longitudinal area of signal hyperintensity, and spinal cord infarction was diagnosed.ConclusionAlthough the causal relationship between the TEVAR and spinal cord infarction remains unclear, paraplegia as a long‐term complication after TEVAR does not appear to have been reported previously, and so represents a potentially important complication.

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“…BAI presents as a wide range of pathologies, from small intimal defects to full-thickness aortic transections with rupture. According to the classification proposed, Azizzadeh et al [6] suggested type I (intimal tear), type II (intramural hematoma), type III (pseudoaneurysm), or type IV aortic injuries (rupture). Types I and II were considered low-risk injuries; and types III and IV, high-risk injuries.…”

mentioning

confidence: 99%