Traumatic rupture of the aorta

Turney, Stephen Z.; Attar, Safuh; Ayella, Robert J.; Cowley, R. Adams; McLaughlin, Joseph S.

doi:10.1016/s0022-5223(19)39620-5

Cited by 89 publications

(16 citation statements)

References 6 publications

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“…Overall survival is worse with increasing age, with mortality in excess of 80% in patients older than 55 years (36). If detected in a timely manner, it is estimated that 60%-80% of patients with ATAI who reach the hospital alive will survive following definitive therapy (13,37,38). Therefore, prompt recognition and treatment of these injuries are critical for long-term survival.…”

Section: Morbidity Mortality and Outcomementioning

confidence: 99%

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

et al. 2008

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Despite recent advances in prehospital care, multidetector computed tomographic (CT) technology, and rapid definitive therapy, trauma to the aorta continues to be a substantial source of morbidity and mortality in patients with blunt trauma. The imaging evaluation of acute aortic injuries has undergone radical change over the past decade, mostly due to the advent of multidetector CT. Regardless of recent technologic advances, imaging of the aorta in the trauma setting remains a multimodality imaging practice, and thus broad knowledge by the radiologist is essential. Likewise, the therapy for acute aortic injuries has changed substantially. Though open surgical repair continues to be the mainstay of therapy, percutaneous endovascular repair is becoming commonplace in many trauma centers. Here, the historical and current status of imaging and therapy of acute traumatic aortic injuries will be reviewed.

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Section: Morbidity Mortality and Outcomementioning

confidence: 99%

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

et al. 2008

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“…However, the possible benefits of this management strategy are negated when one considers that 2% to 5% of these patients develop secondary rupture, mostly within one week of the initial injury. 9 –12 In our study, all patients underwent immediate endovascular repair after radiographic evidence of aortic injury.…”

Section: Discussionmentioning

confidence: 97%

“…Despite advances and refinement of surgical techniques, the morbidity and mortality of early surgical repair of TAR remains high, and ranges from 15% to 30% in contemporary studies. 8,9 Some reports have advocated a delay in the surgical treatment of TAR in stable patients, with close arterial pressure monitoring. However, the possible benefits of this management strategy are negated when one considers that 2% to 5% of these patients develop secondary rupture, mostly within one week of the initial injury.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Traumatic Thoracic Aortic Transection

Asmat

Tan

Caleb

et al. 2009

Asian Cardiovasc Thorac Ann

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The conventional treatment of traumatic thoracic aortic transection is open surgical repair but it is associated with high rates of morbidity and mortality, particularly in patients with multiple injuries. We reviewed our experience of endovascular repair of traumatic thoracic aortic transection. Between March 2002 and December 2007, 7 patients (male 6, female 1; mean age 40 years) with multiple injuries secondary to blunt trauma underwent endovascular stenting. One patient required adjunctive surgery to facilitate endovascular stenting. Mean intensive care unit stay was 8.6 days (range, 3-16 days). Arterial access in all patients was obtained by femoral cut-down. The mean operating time was 122 min. Technical success was achieved in all cases. There was no mortality. One patient suffered a right parietal stroke, but none developed procedure-related paralysis. The mean follow-up period was 18.6 months (range, 6-48 months). There was no evidence of endoleak, stent migration, or late pseudoaneurysm formation on follow-up computed tomography. Endovascular stents can be used to treat traumatic thoracic aortic transection, with low rates of morbidity and mortality. Although early and midterm results are promising, the long-term durability of endovascular stenting for traumatic thoracic aortic transection remains unknown.

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“…While many of these patients have serious associated injuries that no doubt contribute to their overall outcome, the perioperative mortality associated with surgery for traumatic aortic injury ranges from 0% to 42%, while morbidity secondary to spinal cord ischemia occurred in 3% to 36% of cases. 4,7,[13][14][15][16][17][18][19][20][21][22][23][24][25] Endograft placement potentially simplifies the repair of BTAI by eliminating both thoracotomy and aortic cross-clamping. There are, however, several physical parameters that an endograft must accommodate for it to effectively repair the injury.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Description of Blunt Traumatic Injuries to the Thoracic Aorta with Specific Relevance to Endograft Repair

Borsa

Hoffer²,

Karmy-Jones

et al. 2002

J Endovasc Ther

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Purpose: To describe the precise anatomical location and extent of injury (based on angiography) in a series of patients with blunt thoracic aortic injury (BTAI) and evaluate the findings relative to the potential for endograft repair. Methods: Thoracic aortograms from 50 trauma patients (37 men; mean age 37 years, range 13–87) with BTAI were retrospectively reviewed. Parameters important for endograft repair were recorded, including the length of the pseudoaneurysm, the distance between the origin of the most distal arch vessel and the pseudoaneurysm, the diameter of the aorta both above and below the pseudoaneurysm, and finally, the curvature of the aorta in the vicinity of the pseudoaneurysm. Results: The mean distance from the left subclavian artery to the superior aspect of the injury measured 5.8 mm along the lesser curve and 14.9 mm along the greater curve. The mean length of the injury was 17.0 mm and 26.0 mm along the lesser and greater curves, respectively. The mean aortic diameter adjacent to the injury measured 19.3 mm. The mean degree of curvature of the aorta over the length of the injury was 27.2°, with a mean radius of curvature of 32.6 mm at the superior aspect of the injury and 39.3 mm inferiorly. Conclusions: In most cases of BTAI, the location of the injury will necessitate covering the origin of the left subclavian artery if endovascular repair is to be performed. The curvature of the aorta in the region predisposed to these injuries requires that the endograft be very flexible and/or precurved.

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Traumatic rupture of the aorta

Cited by 89 publications

References 6 publications

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

Endovascular Management of Traumatic Thoracic Aortic Transection

Angiographic Description of Blunt Traumatic Injuries to the Thoracic Aorta with Specific Relevance to Endograft Repair

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