Natural history of minimal aortic injury following blunt thoracic aortic trauma

Kidane, Biniam; Abramowitz, Daniel; Harris, Jeremy R.; DeRose, Guy; Forbes, Thomas L.

doi:10.1503/cjs.007311

Cited by 18 publications

(9 citation statements)

References 19 publications

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“…Most studies have estimated the rate of progression to operative therapy to be 10% to 11%. 45,46 In contrast, other studies have shown a high rate (50%) of progression to pseudoaneurysm formation in follow-up. 47 The studies have used varying definitions of minimal injury, which likely contributes to the variability in outcome.…”

Section: Modern Advances In Vascular Traumamentioning

confidence: 89%

Modern Advances in Vascular Trauma

Callcut

Mell

2013

Surgical Clinics of North America

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Section: Modern Advances In Vascular Traumamentioning

confidence: 89%

Modern Advances in Vascular Trauma

Callcut

Mell

2013

Surgical Clinics of North America

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“…16 The goal of medical management in BAI is to reduce aortic shear forces with the use of antihypertensive medications and negative inotropes along with surveillance for disease progression through regular clinical and radiographic follow-ups. According to guidelines from the Society for Vascular Surgery, type I aortic injuries defined as an isolated intimal tear can be managed expectantly with serial imaging.…”

Section: Discussionmentioning

confidence: 99%

“…3 The rationale is that type I injuries are likely to heal spontaneously. 3,16 Our patient was discharged with instructions to take metoprolol 50mg twice daily for blood pressure control, refrain from all strenuous activity and attend follow-up appointments as an outpatient with regular surveillance imaging. Although follow-up CTA of the chest demonstrated enlargement of focus/enhancement adjacent to the aortic arch, blood pressure was controlled adequately and the patient was asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of aortic arch injury following penetrating trauma

Mohammed

Cheung

Parikh

et al. 2015

annals

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Aortic arch injuries following penetrating trauma are typically lethal events with high mortality rates. Traditionally, the standard of care for patients presenting with penetrating injury and aortic involvement has included surgical intervention. We report the case of a 31-year-old man who was managed non-operatively after sustaining multiple stab wounds to the left chest and presenting with mid aortic arch injury. Historically, penetrating injury to the thoracic aorta has been associated with mortality rates greater than 90% and it has one of the poorest prognoses of all penetrating injuries. 1 The majority of patients die at the scene and those who do arrive at hospital are usually in critical condition.Despite advances in trauma management and the development of dedicated trauma centres, morbidity and mortality rates have remained relatively unchanged in patients with penetrating aortic injury (PAI).1 The incidence of penetrating trauma to the aortic arch is not well documented as most patients exsanguinate before receiving treatment. 2 In an autopsy study from Athens, the authors found that traumatic aortic injury was responsible for 12.7% of all injury related fatalities and penetrating trauma was responsible for 13.6% of those deaths. 2 Also reported was the finding that the aortic arch along with the ascending aorta were the most common site of thoracic aortic injury following stab wounds.In patients who present with PAI, operative management is the norm and currently, there are no recommendations for conservative management. This is opposed to blunt aortic injury (BAI), where non-operative management has been explored and guidelines have been proposed by the Society for Vascular Surgery. 3 We present the case of a patient who was managed conservatively following an aortic arch injury secondary to penetrating trauma with strict blood pressure control and outpatient surveillance. Case HistoryA 31-year-old man received via the emergency medical services presented to our emergency department (ED) shortly after sustaining multiple stab wounds to the left anterior chest, left axilla and left upper extremity. En route, the patient's blood pressure was 112/70mmHg and he had a pulse rate of 80bpm. He was diaphoretic at the scene, which improved on arrival to the ED. A standard Advanced Trauma Life Support ® approach was initiated immediately in the trauma bay.The patient was sent for computed tomography (CT) of the chest with contrast in a stable condition. The CT revealed a left upper lobe laceration, a large left haemothorax, a small left pneumothorax and extensive haemorrhages in the mediastinum surrounding the aortic arch with a hint of tiny extrusion at the aortic arch but no obvious source of bleeding. A chest tube placed into the left haemothorax put out 1,800ml serosanguinous drainage in the first 24 hours. The subsequent CT angiography (CTA) revealed a nipple of contrast at the mid aortic arch. A mid aortic arch injury could not be distinguished on the CTA from a laceration of the arterial/ veno...

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“…4,5,49 Transection and avulsion Vessel transection may be complete or incomplete, 33 but it represents a life-threatening condition leading in almost all cases to patient death. 52 Transection or vessel avulsion is either an indication for immediate surgery (Figure 18) or embolization. Rupture is seen as an abnormality in the vessel contour due to full thickness laceration with free contrast extravasation detectable in the arterial phase ( Figure 19) and becomes a hyperdense blood collection.…”

Section: Actively Bleeding Injuriesmentioning

confidence: 99%

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications

Iacobellis

Ierardi

Mazzei

et al. 2016

BJR

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Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.

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Natural history of minimal aortic injury following blunt thoracic aortic trauma

Cited by 18 publications

References 19 publications

Modern Advances in Vascular Trauma

Modern Advances in Vascular Trauma

Conservative management of aortic arch injury following penetrating trauma

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications

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