Initial Experiences in Management of Blunt Aortic Injury Taking Associated Brain Injury Into Consideration

Kurimoto, Yoshihiko; Morishita, Kiyofumi; Kawaharada, Nobuyoshi; Fukada, Johji; Hachiro, Yoshikazu; Fujisawa, Yasuaki; Saitoh, Tatsuya; Yama, Naoya; Hase, Mamoru; Narimatsu, Eichi; Asai, Yasufumi

doi:10.1253/circj.70.198

Cited by 10 publications

(11 citation statements)

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“…Patients diagnosed by emergent thoracotomy or who died in the emergency department before intervention were excluded or categorized separately (6,30,33,36,37,39,41).…”

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

“…Early in the experience, patients were selected for TEVAR based on contraindications to open repair for a high a risk of mortality from comorbidity and associated injuries; over time, 11 of 16 centers that described indications broadened the application to all patients with suitable anatomy (6,22,29,31,32,34,36,37,(41)(42)(43)45). In one institution, TEVAR was reserved for those with concomitant brain injury (39).…”

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

“…Of the 15 centers that reported procedural details, 80% employed mobile angiographic equipment in the operating room and 20% used operating room-compatible angiography suites (6,34). Patients were prepared for possible thoracotomy in case of need for open conversion or preprocedural rupture (which occurred in 2.7% of cases) (6,38,39,42). Local anesthesia with conscious sedation was feasible if common femoral access was used (43); however, cutdown under general anesthesia was employed by 92% of investigators.…”

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

“…A diagnostic pigtail catheter was placed in the ascending aorta and an angiogram was obtained to confirm the diagnosis and preoperative measurements. Brachial access was used for the diagnostic catheter at 37% of the centers; left at five (33,34,37,41) and right at three (39,40,42). A femoral approach for stent-graft delivery was preferred, although external iliac or aortic access was required in 11% of patients as a result of vessel size or delivery device length limitations (6,40,41,45).…”

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

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Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Hoffer

Forauer

Silas

et al. 2008

Journal of Vascular and Interventional Radiology

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“…Patients diagnosed by emergent thoracotomy or who died in the emergency department before intervention were excluded or categorized separately (6,30,33,36,37,39,41).…”

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

Section: Methods Of the Cohort Publicationsmentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Hoffer

Forauer

Silas

et al. 2008

Journal of Vascular and Interventional Radiology

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“…6,20 The on ly case series we found that specifically addresses treatment of aortic injury with TBI suggested that only endovascular procedures and conservative management should be used if TBI is present. 13 However, Mosquera et al found that with conservative, nonoperative treatment, 38% of patients experienced a complication that resulted in death or required a delayed operative intervention after discharge from the hospital.…”

Section: Hospital Managementmentioning

confidence: 99%

Management of simultaneous traumatic brain injury and aortic injury

Kitagawa

Haren

Yokobori

et al. 2013

JNS

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Object. Simultaneous traumatic brain injury (TBI) and aortic injury has been considered unsurvivable for many years because treatments such as sedation and blood pressure goals conflict for these 2 conditions. Additionally, surgical interventions for aortic injury often require full anticoagulation, which is contraindicated in patients with TBI. For these reasons, and due to the relative rarity of aortic injury/TBI, little data are available to guide treating physicians.Methods. A retrospective review was performed on all simultaneous TBI and aortic injury cases from 2000 to 2012 at a university-affiliated, Level I trauma center. Patient demographics, imaging studies, interventions, and outcomes were analyzed. Traumatic brain injury/aortic injury cases treated with endovascular stenting were specifically studied to determine trends in procedure timing, use of anticoagulation, and neurological outcome.Results. Thirty-three patients with concurrent TBI and aortic injury were identified over a 12-year period. The median patient age was 44 years (range 16-86 years) and the overall mortality rate after imaging diagnosis was 46%. All surviving patients were awake and neurologically functional at discharge, and 83% were discharged home or to rehabilitation facilities. Patients who died had a higher Injury Severity Scale score (p = 0.006). Severe TBI (p = 0.045) or hemodynamic instability (p = 0.015) upon arrival to the hospital was also correlated with increased mortality rates. Thirty-three percent of aortic injury/TBI patients (n = 11) underwent endovascular stenting, and 7 of these patients received intravenous anticoagulation therapy at the time of surgery. Six of these 7 anticoagulation-treated patients experienced no significant progression on postoperative brain CT, whereas 1 patient died of hemodynamic instability prior to undergoing further imaging.Conclusions. Simultaneous TBI and aortic injury is a rare condition with a historically poor prognosis. However, these results suggest that many patients can survive with a good quality of life. Technological advances such as endovascular aortic stenting may improve patient outcome, and anticoagulation is not absolutely contraindicated after TBI. Key woRDS • aortic injury • traumatic brain injury • aortic stentAbbreviations used in this paper: GCS = Glasgow Coma Scale; ISS = Injury Severity Scale; SAH = subarachnoid hemorrhage; SDH = subdural hematoma; TBI = traumatic brain injury.

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Conventional surgical repair of traumatic rupture of the thoracic aorta

Chiba¹,

Abé²,

Kitanaka³

et al. 2014

Gen Thorac Cardiovasc Surg

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Objective Traumatic rupture of the thoracic aorta is a life-threatening injury requiring urgent surgical intervention. Despite recent improvements in resuscitation and emergency operative techniques, the outcomes of patients with multiple injuries are still associated with a high mortality rate. We retrospectively examined the preoperative demographic data, associated complications and mortality rate of these patients.Materials and methodsWe analyzed the data (1991–2009) of 18 patients with acute traumatic rupture of the thoracic aorta. Most patients had rupture limited to the aortic isthmus and severe associated injuries in other organs. The aorta was repaired by direct suturing, patch plasty (n = 5; 27.7 %) or graft interposition (n = 9; 50 %). ResultsThe overall mortality rate was 33.3 %. All six patients who underwent emergency surgery within 2 h died, four intra-operatively and two postoperatively. The causes of the intra-operative mortality were uncontrollable hemorrhage and irreversible cardiac arrest due to penetrating injury of the thoracic aorta and intercostal arteries in three patients, and uncontrollable hemorrhage due to severe liver laceration in one. The surgical complications (42.8 %) were acute lung injury (n = 2), liver insufficiency (n = 2), acute renal failure (n = 1) and cerebral infarction (n = 1). No patients had postsurgical paraplegia. The mean period between arrival and treatment and the mean Injury Severity Score were significantly higher in group D than in group A.ConclusionTo improve the outcome of traumatic thoracic aortic injury, the degree of multi-organ damage, the priority of treatment be evaluated accurately is important.

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Initial Experiences in Management of Blunt Aortic Injury Taking Associated Brain Injury Into Consideration

Cited by 10 publications

References 10 publications

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

Management of simultaneous traumatic brain injury and aortic injury

Conventional surgical repair of traumatic rupture of the thoracic aorta

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