Penetrating Injury to the Proximal Descending Aorta: Can we do Better in the Endovascular Era?

Younis, Aurwa; Galili, Offer; Heldenberg, Eitan; Glick, Yaïr; Kessel, Boris

doi:10.26676/jevtm.v1i1.4

Cited by 1 publication

(2 citation statements)

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“…Patients may present with hemorrhage, cardiac tamponade, or systemic air embolism, which can be detected early on anteroposterior chest radiography, the most important initial screening tool. It can show multiple signs such as widening of the superior mediastinum >8 cm and/or 25% of the width of the thorax (most common), loss of aortic knob, the obvious double contour of the aorta/abnormalities of the transverse aortic arch (sensitive finding), obliteration of the aortopulmonary window on lateral chest radiography (sensitive finding), massive hemothorax, and right deviation of the nasogastric, endotracheal, or esophageal tubes [8]. Normal vital signs with abnormal findings suggestive of a vascular injury should undergo CT aortography, the gold standard test, to confirm the diagnosis and facilitate operative planning since aortic injury grading is classified based on CT findings [25,34].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case and Presentation of Traumatic Penetrating Aortic Arch Injury: A Case Report and Literature Review

Alali¹,

Essa²,

Alasheikh³

et al. 2022

Cureus

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A penetrating injury to the thoracic aorta is an extremely rare, life-threatening condition, with a high overall mortality rate. The incidence of a penetrating injury to the aortic arch is unknown because the majority of patients die before receiving adequate treatment due to excessive bleeding. Through a literature review, 23 cases of favorable outcomes were found. We report the first case from the Arab Gulf states. We present the extremely rare case of a 23-year-old male who presented to the emergency department with stable hemodynamics after being stabbed in the left supraclavicular region. The investigation revealed that he suffered from aortic arch transection and contrast extravasation. The patient was rushed to the operating room, where a primary repair was performed through a median sternotomy approach. The patient was discharged on the 14th postoperative day without complications. Penetrating chest trauma (aortic arch injury) is uncommon, and it is typically fatal at the scene or time of injury, even in patients who arrive at the emergency department alive or while undergoing surgery. CT aortography should be performed on patients with normal vital signs but abnormal clinical findings suggestive of a vascular injury. For injuries of types II to IV without concomitant injuries, immediate surgical repair is recommended. Aortic arch penetrating injuries continue to be extremely lethal. Emergency surgical repair remains the standard of care and is associated with high morbidity and mortality rates. However, managing such uncommon injuries remains a formidable challenge. We encourage additional studies.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, rapid detection and decisive intervention are paramount. However, the majority of such aortic trauma patients are treated in hospitals where cardiac and vascular surgeons are unfamiliar with these complicated aortic injuries [8][9][10].…”

Section: Introductionmentioning

confidence: 99%