Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital

Abstract

Background: Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition.This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. Methods:In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan.Results: The median age of the patients was 49±22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights.The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively.Conclusions: Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.

A Case of Traumatic Retrograde Type A Aortic Dissection Accompanied by Multiorgan Injuries

“…They found that the omission of systemic anticoagulation during TEVAR is occasionally possible, and this is particularly beneficial in patients with concomitant intracranial or abdominal bleeding. 2 ) TEVAR seemed a promising procedure for immediate intervention if only the descending aorta was affected; however, in our patient, the whole aortic arch was involved, and the landing of the proximal site of the stent graft in the dissecting aortic arch could induce an additional intimal tear because of the fragility of the aortic wall secondary to the fresh dissection. However, in one study, systemic anticoagulation for open repair of BAI did not disturb NOM of grade I or II hepatic injury.…”

“…Considering these facts, RAAD of our patient also warranted immediate surgical, endovascular, and medical interventions to prevent adverse consequences. Lee et al 2 ) reported good outcomes of TEVAR in patients with BAI and multiorgan injuries. They found that the omission of systemic anticoagulation during TEVAR is occasionally possible, and this is particularly beneficial in patients with concomitant intracranial or abdominal bleeding.…”

“…The open repair procedures for BAI warrant anticoagulation, which worsens bleeding from other injured organs; these challenges have been resolved in similar cases by performing thoracic endovascular aortic repair (TEVAR). 2 ) However, TEVAR is not performed at all institutions, and its application in RAAD has not been established. Partial cardiopulmonary bypass (CPB) with full heparinization is reportedly possible in a patient with only grade I or II solid organ injury 3 ) ; however, RAAD repair in our patient required both total CPB and deep hypothermia for circulatory arrest, which should ideally be avoided in trauma patients.…”

Throracic Aortic Dissection Concomitant Multitrauma: A Case Report

“…Torasik aort diseksiyonu genellikle trafik kazası veya yüksekten düşmenin neden olduğu ani akselerasyonu (travmanın hızlı ivmesine bağlı) takip eden ani deselerasyona (çarpma veya düşmenin tamamlanması sonrası ani durma) bağlı olarak gelişmektedir. [2] . Yaralanma genellikle sol subklavyen arterin distalindeki aortanın istmus bölgesinde oluşur.…”

“…TEVAR (torasik endovasküler aort tamiri) çeşitli torasik aort patolojileri için uygulanabilen, endovasküler bir stent greftin görüntüleme yardımıyla torasik aortaya uzak bir periferik konumdan yerleştirilmesi işlemidir. Açık cerrahiye göre daha az invaziv bir işlem olması, düşük doz heparin kullanılması gibi nedenlerle yüksekten düşmeye bağlı akut çoklu travma hastalarının yönetiminde dahi iyi bir seçenek olarak uygulanabilir [2] . TEVAR yapılan hasta gruplarında mortalite ve morbidite oranlarının daha düşük olduğu yapılan çalışmalarda gösterilmiştir.…”