Traumatic rupture of the aorta in an 11-year-old patient: Surgical considerations in the technique of repair

Healy, David; Soo, Alan; Akbar, Muhammad; Wood, A. E.

doi:10.1016/s1479-666x(05)80069-1

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…[3][4][5]7 The operative principles in the pediatric patient are similar to adults, with the exception that graft sizing and anastamosis often has to take into account future growth and the concern that coarcation may result. 2 Because of this, primary repair (with or without resection) if possible is attractive. 2 However, if not possible, slightly over sizing the graft and creating a beveled anastamosis, coupled with anticipation of graft dilation with time, usually suffices.…”

Section: Discussionmentioning

confidence: 99%

“…2 Because of this, primary repair (with or without resection) if possible is attractive. 2 However, if not possible, slightly over sizing the graft and creating a beveled anastamosis, coupled with anticipation of graft dilation with time, usually suffices.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] This latter issue is of particular importance when considering endovascular approaches as an alternative to open operative repair. 4,5 We present a case in which endovascular stent-graft was utilized as a bridge to definitive treatment in a child suffering from traumatic thoracic aortic rupture.…”

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confidence: 99%

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A Case Report of Traumatic Aortic Rupture in a Pediatric Patient: A Possible Role for Endovascular Management as a Bridge to Definitive Repair

Martin

Barnatan

Cole

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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T raumatic rupture of the descending thoracic aorta in the pediatric population differs from adults in three areas: increased incidence of "pedestrian-struck" as the inciting mechanism, lower incidence of chest wall injuries, and most critically, operative repair is affected by size and future growth considerations. 1-3 This latter issue is of particular importance when considering endovascular approaches as an alternative to open operative repair. 4,5 We present a case in which endovascular stent-graft was utilized as a bridge to definitive treatment in a child suffering from traumatic thoracic aortic rupture. CASE REPORTThe patient, a 12-year-old helmeted male, was struck by a vehicle while riding his bicycle. Witnesses reported that he had been thrown 50 feet, and medics reported that he was unresponsive at the scene and he was intubated. After initial transfer to a local facility, he was transferred to our center, arriving ϳ3 hours postinjury. On initial survey, the patient had a systolic blood pressure of 108 mm Hg, was tachycardic and intubated. Plain chest radiography identified a right upper lobe consolidation consistent with contusion. Computed tomography (CT) angiography defined the following injuries: transection of the descending thoracic aorta ϳ11 mm distal to the origin of the left subclavian artery; hemopneumothorax (treated before CT with tube thoracostomy); left renal laceration with minimal associated retroperitoneal hemorrhage; small splenic infarct; left sacral fracture with posterior pelvic retroperitoneal hemorrhage without blush; transverse process fractures of L2 and L3; pulmonary contusion, left worse than right (Fig. 1). There was some ill-defined intraperitoneal free-fluid noted. There were no gross intracranial injuries, but mild edema was noted.On repeat examination, he was noted to have a relatively firm abdomen, was persistently tachycardic into the 120 bpm range, and there were no intraperitoneal solid organ injuries that could entirely explain this constellation. He underwent laparotomy, at which time several colonic serosal injuries were noted but no other injury requiring repair. It was also noted that he had aspirated, and bronchoscopy was performed, which was able to clear gross food particles, but it was apparent that the patient was experiencing severe chemical as well as evolving blunt traumatic pneumonitis. This was manifested by increasing parenchymal consolidation and hemoptysis. Attempts were made to isolate the left lung but this was followed by marked desaturation and the patient was transferred to the Intensive Care Unit with increasing ventilatory support requirements, with blood pressure being controlled with beta-blockers. Postoperative extremity films identified left tibia and fibula fracture.The relevant anatomic and physiologic features of the aortic disruption included an anomalous origin of the left vertebral artery from the arch just proximal to the subclavian artery; proximal aortic diameter of 15 mm and distal aortic diameter of 13 mm; pressure in femoral ...

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