Early Clinical Diagnosis and Treatment of Traumatic Aortic Injury Caused by Thoracic and Abdominal Injuries: A Series of Four Cases with Literature Review

Wu, Qiqi; Sun, Shanshan; Xie, Jie; Li, Tianyu; Li, Hui; Bai, Xiangjun; Li, Zhanfei; Wang, Wei

doi:10.1155/2021/9995749

Cited by 5 publications

(9 citation statements)

References 27 publications

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“…TAIs are extremely rare but carry a high fatality rate, resulting in considerable importance in identifying predictors of TAIs [3]. Many health conditions are associated with altitude and with TAIs, but this is the first study to our knowledge to examine the association of altitude and TAIs.…”

Section: Discussionmentioning

confidence: 96%

“…*Correspondence: davidbme49@gmail.com Demonstrated predictors for TAI include hypotension < 90 mmHg, long-bone fractures, pulmonary contusions, left scapula fractures, hemothorax, pelvic fractures, aortic intimal flap, aortic thrombus formation, multiple-trauma, widened mediastinum, and mediastinal hematomas [2,3,5]. In non-traumatic cases, risk factors for spontaneous aortic injuries include: older age, smoking, prior aneurysms, congestive heart failure, hypertension, diabetes mellitus, atherosclerosis, history of cardiac surgery, congenital disorders, and inflammatory diseases [6].…”

Section: Open Accessmentioning

confidence: 99%

“…A vast majority of cases do not make it to the hospital due to the high on-scene mortality rate [2]. In patients who survive the initial injury and are admitted to the hospital, rapid detection and treatment of TAIs are important to improve the survival rate, as most patients die within 24 hours of injury [2,3]. Fast deceleration, torsion, shearing forces, compression, upward thrust of the mediastinum, osseous pinch, sudden blood pressure elevation and stretching of the aorta over the spine are mechanisms thought to explain TAI [2,4].…”

Section: Introductionmentioning

confidence: 99%

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Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States

et al. 2022

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Background: Traumatic aortic injuries (TAIs) are rare but are associated with a high mortality. Prior studies have shown skiers and pilots, whose injuries occur at high altitudes, are at an increased risk for a TAI. The purpose of this study was to examine the effect of altitude on the incidence of TAIs across all causes of injury.Methods: This retrospective cohort study at six Level I trauma centers (8/1/2016-1/1/2020) included adult blunt trauma patients with a chest or abdomen injury. High altitude injuries (> 5000 ft.) were compared to low altitude injuries (≤ 5000 ft.). The primary outcome was incidence of TAI.Results: There were 8562 patients, 37% were at high altitude and 63% at low altitude. High altitude patients were older (p < 0.01), more often Caucasian (p < 0.01) and had a higher ISS (p < 0.01). There was a significantly greater incidence of TAI at high altitude than low altitude (1.5% vs. 1.1%, p = 0.01). The median altitude was significantly higher for patients with a TAI than for patients without a TAI (5100 ft. vs. 1400 ft., p = 0.01). After adjustment, high altitude patients had 2-fold [OR: 2.4 (1.6, 3.7)] greater odds of having a TAI than low altitude patients. Conclusion:TAIs were more prevalent among high altitude injuries. Providers should be aware of the increased incidence of TAIs at high altitudes particularly when there is a delay in diagnosis and transfer to a trauma center with appropriate resources to manage these critical injuries. TAI screening at high altitude trauma centers may improve survival rates.

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Section: Discussionmentioning

confidence: 96%

Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States

et al. 2022

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“…Regarding treatment strategies for BTAI, major methods include medical management, TEVAR, and a surgical approach. [22] Because TEVAR is a less invasive treatment for BTAI, its favorable early outcomes have been described. [17] Research suggests that the mortality of BTAI is remarkably lower in patients treated with delayed repair than in those with immediate repair.…”

Section: Discussionmentioning

confidence: 99%

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

Li¹,

Lin²,

Lü³

2022

World Journal of Emergency Medicine

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BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed.RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS:In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an eff ective therapeutic option for TAD.

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“…Early diagnosis of BTAI is challenging due to the presence of concomitant life-threatening injuries in patients with severe thoracic trauma [7]. Clinical suspicion, hemodynamic stability, availability, and speed of access to imaging modalities are all part of the diagnostic procedure for BTAI [8]. Notably, clinical symptoms such as systemic hypotension, upper limb hypertension, asymmetry of limb pulses, and flow murmurs are not diagnostically trustworthy [9].…”

Section: Introductionmentioning

confidence: 99%

Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital

Al-Thani

Hakim

Asim

et al. 2022

Eur J Trauma Emerg Surg

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Background Blunt Thoracic aortic injury (BTAI) is the second leading cause of mortality after head injuries in blunt trauma patients. There is a paucity of information on the presentation, management and outcome of BTAIs from the Middle Eastern region. We explored the patterns, management options and outcomes of BTAIs in a level I trauma center. Methods We conducted a retrospective observational study on all adult patients who were admitted with BTAIs between 2000 and 2020. Patients were compared for the management option (conservative vs endovascular aortic repair (TEVAR) vs open surgery) and outcomes. Comparison between the respective groups was performed using one-way analysis of variance for continuous variables, and Pearson chi-square test for categorical variables. Kaplan–Meier curve and Cox regression analysis were performed for the outcome. Results Eighty-seven patients had BTAI (82% male) with mean age 37.3 ± 14.5 years. The mean injury severity score was 30 ± 10 and the aortic injury grade was III (I–IV). Grade III (41.4%) and Grade IV (33.3%) injuries were more common followed by Grade II (13.8%) and Grade I (11.5%). Forty percent of cases were treated conservatively whereas aortic interventions were performed in 60% of cases (n = 52). The TEVAR was performed in 33 patients (63.5%), and 19 (36.5%) were treated with open surgery (14 with graft interposition and 5 with clamp and direct repair). The aortic injury grade was significantly higher in the intervention groups as compared to the conservative group (p = 0.001). Patients with Grade IV injuries were more likely to be treated by open repair whereas a higher frequency of patients with grade III was managed by TEVAR (p = 0.001). All the patients with Grade I–II were treated conservatively. The overall in-hospital mortality rate was 25.3% and it was significantly higher in the conservative group (40.0%) in comparison to the open repair (31.6%) and TEVAR (6.1%) group (P = 0.004). More of the non-survivors sustained head injuries (P = 0.004), had higher ISS (P = 0.001) and greater aortic injury grades (P = 0.002), and were treated non-operatively (P = 0.001). Conclusions BTAI seems not common in trauma, however, one quarter of cases died in a level 1 trauma center, prehospital deaths were not analyzed, and postmortem examination was lacking. The associated head injury and aortic injury grade have an impact on the management option and hospital outcome. The conservative and TEVAR options were performed almost equally in 78% of cases. TEVAR and open surgery were performed only for aortic injury grade III or IV whereas the conservative treatment was offered for selected cases among the 4 injury grades. However, the mortality was higher in the conservative followed by the open surgery group and mostly due to the associated severe head injury. TEVAR should be considered for patients requiring intervention unless contraindicated due to technical difficulties. Appropriately selected patients with low-grade injuries may be managed conservatively. Long-term follow-up is needed in young adults for concerns of aortic remodeling and complications.

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Early Clinical Diagnosis and Treatment of Traumatic Aortic Injury Caused by Thoracic and Abdominal Injuries: A Series of Four Cases with Literature Review

Cited by 5 publications

References 27 publications

Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States

Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital

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