Penetrating Trauma to the Aortic Arch: A Case Report

Hoffberger, Jonathan; Rossi, Heather L.; Keen, Richard R.; Savage, Edward B.

doi:10.1097/01.ta.0000085851.74222.90

Cited by 9 publications

(6 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concomitant injuries can be repaired during aortic valve repair. Endoscopy and bronchoscopy can be performed when a life-threatening aortic injury is under control [13] . Our experience con rms the effective procedure: in the rst step, use an endovascular stent graft to ensure that the penetrating aortic injury remains stable; in the second step, perform a bronchoscopic evaluation to remove the foreign body.…”

Section: Clinical Discussionmentioning

confidence: 99%

A rare case of penetrating thoracic aortic injury

Huang

Chen

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction and importance Thoracic aortic injuries could be lethal events. Penetrating injuries to aortic are highly fatal, but these cases are rare in hospital. Case presentation A 54-year-old man presented with cough for half a month and cough up blood for half a day before he went into our hospital. No obvious positive sign was detected in physical examination. Clinical findings and investigations Chest computed tomography (CT) showed positive foreign body in the mediastinum, which penetrated the left main bronchus from front to back and penetrated the thoracic aorta backwards. Interventions and outcome an endovascular stent graft was implanted to ensure that the penetrating aortic injury remains stable; then bronchoscopic evaluation was performed to remove the foreign body. The patient recovered uneventfully. No discomfort has been complained of during regular follow-up. Relevance and impact endovascular stent repair is an effective lifesaving method for patients with penetrating aortic injury and with surgical contraindications.

show abstract

Section: Clinical Discussionmentioning

confidence: 99%

A rare case of penetrating thoracic aortic injury

Huang

Chen

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Sternotomy has been recommended for proximal arch injuries and thoracotomy for sub-clavian and distal injuries [ 1 , 2 ]. In some cases, the external bleeding point was controlled with a finger, and after sternotomy, sudden exsanguinating bleeding was controlled in the same way [ 1 , 3 , 4 ]. Pate stated that anteriorly located aorta injuries can be repaired with finger control and a partial clamp [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…All authors agree that injuries at the posterior surface of the arch are more challenging and have a poorer prognosis. CPB and hypothermic circulatory arrest represent a safe approach for complex injuries [ 2 – 4 ]. It is also recommended to carry out this type of repair with moderate hypothermia after axillary cannulation [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Unusual Presentation of a Penetrating Aortic Arch Injury

Vural

Patel

Mustafa

2017

Korean J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

A 27-year-old man was admitted with a penetrating injury at the mid-manubrium. Computed tomographic (CT) angiography showed a filling defect in the aortic arch. This was evaluated as a sign of injury and the patient underwent an emergency operation. No active bleeding or clot was found in the mediastinum during the operation. The laceration point was between the innominate and the left carotid artery posteriorly. The injury was approached using hypothermic circulatory arrest. Aortotomy and exploration showed a 2-cm-long full-thickness aortic injury with an overlying clot. A filling defect on angiography as a sign of a penetrating arch injury has never been reported previously, but was the main pathological finding on CT angiography in our case. The aorta is a high-pressure system and injuries to it should be treated aggressively.

show abstract

“…Larger, complex injuries may require reconstruction with the use of interposition grafts and cardiopulmonary bypass for repair. 6,11 Although spinal cord protections with adjuvant perfusion techniques are not commonly used for acute management of penetrating injury, ischaemic damage is uncommon in survivors of PAI. 4 Alternatively, in studies investigating paraplegia following repair of the descending thoracic aorta following BAI, the overall incidence of postoperative paraplegia averages 8%.…”

Section: Discussionmentioning

confidence: 99%

“…For access to the aortic arch as well as the ascending thoracic aorta, a median sternotomy can be performed. 4,11 Further exposure of the transverse arch can be obtained if necessary by extending the median sternotomy incision to the neck and dividing the innominate vein. Small anterior or lateral lacerations can be repaired primarily with running 4/0 polypropylene sutures following proximal and distal control of the aorta.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of aortic arch injury following penetrating trauma

Mohammed

Cheung

Parikh

et al. 2015

annals

View full text Add to dashboard Cite

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...

show abstract

Penetrating Trauma to the Aortic Arch: A Case Report

Cited by 9 publications

References 6 publications

A rare case of penetrating thoracic aortic injury

A rare case of penetrating thoracic aortic injury

Unusual Presentation of a Penetrating Aortic Arch Injury

Conservative management of aortic arch injury following penetrating trauma

Contact Info

Product

Resources

About