Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

Arbabi, Cassra; DuBose, Joseph J.; Charlton-Ouw, Kristofer M.; Starnes, Benjamin W.; Saqib, Naveed U.; Quiroga, Elina; Miller, Charles C.; Azizzadeh, Ali; Afifi, Rana O.; McNutt, Michelle K.; Al-Rustum, Zain; Shrestha, Binod Bade; Dipasupil, Edmundo; Starnes, Ben; Gilani, Rami; Turay, David; Luo-Owen, Xian; Bee, Tiffany K.; Moyer, Suzanne; DuBose, Joe; Shutze, William P.; Dockery, William D.; Petrey, Laura B.; Phelps, Timothy N.; Fox, Chuck; Moore, Ernest E.; Cralley, Alexis; Teixeira, Pedro G.; Leede, Emily; Buchanan, Frank R.; Ramos, Emilio; Ngoue, Marielle; Fox, Nicole; Shea, Lisa; Zielinski, Martin D.; Fischmann, Marianna Martini; Inaba, Kenji; Khor, Desmond; Magee, Gregory A.; Sheahan, Malachi; Unruh, Marie; Parry, Neil; Dubois, Luc; Berne, John D.; Puente, Ivan; Gomez, Mario; Mederos, Dalier R.; Bini, John K.; Herzing, Karen; Hardman, Claire; Schanzer, Andres; Aiello, Francesco; Arous, Edward J.; Arous, Elias J.; Jones, Douglas W.; Judelson, Dejah R.; Messina, Louis M.; Nguyen, Tammy; Simons, Jessica; Steppacher, Robert; Rezende-Neto, João; Haan, James M.; Lightwine, Kelly; Dunn, Julie; Smoot, Brittany; Hörer, Tal M.; McGreevy, David; Riambau, Vincent; Mestres, Gaspar; Yugueros, Xavier; Passman, Marc A.; Beck, Adam W.; Patterson, Mark A.; Pearce, Ben; Spangler, Emily L.; McFarland, Graeme E.; Sutzko, Danielle C.; Smeds, Matt; Zakhary, Emad; Williams, Michael L.; Wittgen, Catherine M.; Vogel, Todd R.; Eagleton, Matt; Gewertz, Bruce L.; Barmparas, Galinos; Kundi, Rishi; Morrison, Jonathan J.; Rossi, Peter J.; Pacini, Davide; Botta, Luca; Amodio, Ciro; Rimoldi, Pierantonio; D’Alessio, Ilenia; Compagnoni, Nicola Monzio; Aftab, Muhammad; Al-Musawi, Mohammed; Reece, T. Brett; Pal, Jay D.; Jacobs, Donald L.; Malgor, Rafael D.; Zarkowsky, Devin S.; Rajani, Ravi R.; Benarroch‐Gampel, Jaime; Ramos, Christopher; Schermerhorn, Marc L.; Wyers, Mark C.; Hamdan, Allen D.; Stangenberg, Lars; Lee, Andy; Davies, Mark; Jayakumar, Lalithapriya; Sideman, Matthew J.; Mitromaras, Christopher; Miserlis, Dimitrios; Brahmbhatt, Reshma; Darling, R. Clement; Caliste, Xzabia; Chang, Benjamin; Hnath, Jeffrey; Kreienberg, Paul B.; Kryszuk, Alexander; Laser, Adriana; Roddy, Sean P.; Saltzberg, Stephanie S.; Shah, Melissa; Warner, Courtney J.; Yeh, Chin-Chin; Reva, Viktor; Zhigalo, Viktor; Krasikov, Alexander V.; Trimarchi, Santi; Domanin, Maurizio; Babrowski, Trissa; Milner, Ross; Pocivavsek, Luka; Skelly, Christopher L.; Malka, Kimberly T.; Nolan, Brian

doi:10.1016/j.jvs.2021.08.084

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…To calculate Windkessel parameters, the systolic and diastolic pressure for each outlet were needed. The systolic and diastolic blood pressure for this patient were set to 120 mmHg 63 and 77.5 mmHg 32 respectively. Process of deriving and tuning Windkessel parameters for each outlet was based on the work of Alimohammadi 65 .…”

Section: Methodsmentioning

confidence: 99%

In-silico investigations of haemodynamic parameters for a blunt thoracic aortic injury case

Dadras,

Jabbari,

Asl

et al. 2023

Sci Rep

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Accounting for 1.5% of thoracic trauma, blunt thoracic aortic injury (BTAI) is a rare disease with a high mortality rate that nowadays is treated mostly via thoracic endovascular aortic repair (TEVAR). Personalised computational models based on fluid–solid interaction (FSI) principals not only support clinical researchers in studying virtual therapy response, but also are capable of predicting eventual outcomes. The present work studies the variation of key haemodynamic parameters in a clinical case of BTAI after successful TEVAR, using a two-way FSI model. The three-dimensional (3D) patient-specific geometries of the patient were coupled with three-element Windkessel model for both prior and post intervention cases, forcing a correct prediction of blood flow over each section. Results showed significant improvement in velocity and pressure distribution after stenting. High oscillatory, low magnitude shear (HOLMES) regions require careful examination in future follow-ups, since thrombus formation was confirmed in some previously clinically reported cases of BTAI treated with TEVAR. The strength of swirling flows along aorta was also damped after stent deployment. Highlighting the importance of haemodynamic parameters in case-specific therapies. In future studies, compromising motion of aortic wall due to excessive cost of FSI simulations can be considered and should be based on the objectives of studies to achieve a more clinical-friendly patient-specific CFD model

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Section: Methodsmentioning

confidence: 99%

In-silico investigations of haemodynamic parameters for a blunt thoracic aortic injury case

Dadras,

Jabbari,

Asl

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The most commonly described physical mechanism is rapid deceleration with the application of either anteroposterior or lateral forces upon the relatively mobile ascending thoracic aorta, with shearing forces predominantly at the aortic isthmus. The other major physical theory underlying BTAI is direct penetrating injury from rib and thoracic vertebral fractures ( 5 - 7 ). About 80% of patients with BTAI die before admission, and the in-hospital mortality rate is as high as 50% ( 5 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…The other major physical theory underlying BTAI is direct penetrating injury from rib and thoracic vertebral fractures ( 5 - 7 ). About 80% of patients with BTAI die before admission, and the in-hospital mortality rate is as high as 50% ( 5 , 8 ). BTAI can be detected easily by computed tomography (CT) of the chest or great vessel post-trauma, with a diagnostic accuracy of up to 100% ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Wang¹,

Wu²,

Guo³

et al. 2022

J Thorac Dis

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Background: Delayed thoracic aortic injury (DTAI) induced by left closed rib fractures (RFs) is a clinically rare blunt injury to the thoracic aorta with an insidious onset. DTAI is very prone to missed diagnosis due to the unreliability of using the initial post-injury computed tomography (CT) scan to explicitly detect any signs of an aortic injury, potentially leading to a fatal hemorrhage. Timely diagnosis and treatment are therefore key to preventing such deadly complications. With that said, not all cases of left RFs lead to delayed aortic injuries, so how can surgeons tell which cases are to be culled and focused on? Also, what kinds of treatment should be administered upon detection? Methods: A retrospective analysis was performed on the clinical data of DTAI cases induced by left closed RF that were admitted to our Hospital from June 2015 through June 2020. Injuries to the aortic tunica adventitia or the elastic layer were intraoperatively confirmed. CT scan findings, locations and numbers of RFs, as well as the choices of surgical procedure were reviewed postoperatively. In addition, a literature review was conducted to analyze characteristics shared by similar cases.Results: This study included 7 patients treated by our hospital and 8 reported in the literature. The broken ends of RFs causing aortic wall injury (including the tunica adventitia) were all found in the medial to the lateral erector spinae. All patients in our hospital received internal fixation for RFs and thoracoscopic removal of free bone fragments (if any). Concomitant injuries were managed either by simultaneous or staged surgery.Conclusions: For multiple left RFs with the broken ends located in the inside of the lateral erector spinae, the number of fractured ribs ≥4 and a smaller number of fractured ribs with multiple fractures in a single rib are important factors for DTAI. Active surgical intervention is recommended for patients with these important factors. The specific intervention is tailored to each patient's particular needs to eliminate the risk of developing life-threatening thoracic aortic injury (TAI) and rupture.

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Systematic Review and Meta-Analysis of Nonoperative Management for SVS Grade II Blunt Traumatic Aortic Injury

De Freitas,

Joyce,

Yang

et al. 2024

Annals of Vascular Surgery

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Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

Cited by 9 publications

References 12 publications

In-silico investigations of haemodynamic parameters for a blunt thoracic aortic injury case

In-silico investigations of haemodynamic parameters for a blunt thoracic aortic injury case

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Systematic Review and Meta-Analysis of Nonoperative Management for SVS Grade II Blunt Traumatic Aortic Injury

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