Natural history of traumatic rupture of the thoracic aorta managed nonoperatively: a longitudinal analysis

Holmes, James H.; Bloch, Robert D.; Hall, Richard; Carter, Yvonne M.; Karmy‐Jones, Riyad

doi:10.1016/s0003-4975(01)03585-8

Cited by 130 publications

(80 citation statements)

References 20 publications

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“…Surgical repair with a delay between trauma and treatment, allowing the patient to recover first from other major injuries, has been advocated to improve the outcome of early conventional surgical treatment [5]. However, even in an apparently stable situation, approximately 2-5% of patients experience further rupture within the first week after the trauma [6,7].…”

Section: Introductionmentioning

confidence: 99%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

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Objective: Endoluminal aortic stent grafting offers a potentially less invasive alternative to open chest surgery, especially in patients with polytrauma. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture. Methods: Retrospectively, 74 patients with acute traumatic aortic rupture were analyzed. Most of the patients had a rupture limited to the isthmus, and severe associated injuries. Thirty-five patients (6 female, 29 male, mean age 36 years) underwent surgical repair. Two patients were operated upon without cardiopulmonary bypass. In 39 patients (5 female, 34 male, mean age 36 years) thoracic endografts were implanted. The delay between trauma and treatment was comparable in the two groups. Results: Hospital mortality was 20% (7 of 35 patients) in the surgical group and 7.7% (3 of 39 patients) in the endovascular group. The most common cause of death in the surgical group was brain death in severe traumatic patients. Ten surgical complications occurred in 5 patients: respiratory insufficiency (n = 3), pulmonary infection (n = 2), recurrent nerve palsy (n = 2), repeat thoracotomy (n = 2), and compartment syndrome (n = 1). No patient in this group had paraplegia. Except for one case, which required conversion to conventional surgery, stent-graft implantation was successful in all cases, without peri-interventional complications or procedure-induced paraplegia. In 9 patients the left subclavian artery was covered with the device. Two patients underwent surgical repair 15 days and 4 months after endografting because of injury of the aortic wall by the stent and development of a spurious aneurysm, respectively. Conclusions: In the treatment of traumatic thoracic aortic rupture, the early outcome of patients treated with endovascular stent grafts appears to be better than that with conventional surgical repair. The new technique allows safe and successful repair of this life-threatening injury in the early phase of trauma management. How far this potential benefit is sustained in the long term remains unclear at present. #

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Section: Introductionmentioning

confidence: 99%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

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“…Of the remaining cases, 72% died within 8 days, and 90% of survivors died within the first 4 months. [23] In a study of 24 cases, 15 received surgical repair; 2 (7%) cases died in the acute period (in the ED and operating room) and 2 died in the long-term conservative period. [8] In a comparison of a study conducted by the American Association for the Surgery of Trauma completed in 1997 (AAST1) and a similar study completed 10 years later (AAST2), mortality in patients who underwent open repair and EVAR was found to be 31% in AAST1 and 13% in AAST2.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of patients diagnosed with acute blunt aortic injury and their bedside plain chest radiography in the emergency department: A retrospective study

Akarca¹

2016

Ulus Travma Acil Cerrahi Derg

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“…8,9,11,[14][15][16][17] Most involved pa tients who were not surgical candidates for various reasons. An even smaller subset of studies involved the purposeful adoption of nonoperative management in MAI.…”

Section: Recherchementioning

confidence: 99%

“…When progression did occur, it ranged from 3.7% to 16.7%. 8,9,11,[14][15][16][17] The most recent study, from Stanford, represents the largest case series to date (27 patients) and looked specifically at MAI deliberately managed nonoperatively. 11 The results of our study reflect similar findings.…”

Section: Recherchementioning

confidence: 99%

“…At the therapeutic level, our study and most of the others also demonstrate that radiologic surveillance is mandatory to identify progressive aortic injury and thereby apply the appropriate therapy. 8,9,11,[14][15][16][17] Over the years, great advancements in imaging modalities have allowed for better definition of aortic injury and MAI. 8 Computed tomographic angiography has become the screening test of choice.…”

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.

show abstract

Natural history of traumatic rupture of the thoracic aorta managed nonoperatively: a longitudinal analysis

Cited by 130 publications

References 20 publications

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Evaluation of patients diagnosed with acute blunt aortic injury and their bedside plain chest radiography in the emergency department: A retrospective study

Natural history of minimal aortic injury following blunt thoracic aortic trauma

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