Traumatic rupture of the thoracic aorta: third decade of experience

Jamieson, W.R. Eric; Janusz, Michael T.; Gudas, Virginia M.; Burr, Lawrence H.; Fradet, Guy; Henderson, Charmaine

doi:10.1016/s0002-9610(02)00851-6

Cited by 106 publications

(72 citation statements)

References 11 publications

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“…This concept of instant treatment is also practiced by other authors [12,13]. In-hospital mortality rates increase from 32% on the first day, to 61% within the first week, and 74% after 2 weeks [14,15].…”

Section: Discussionmentioning

confidence: 77%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

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Objective: Endoluminal aortic stent grafting offers a potentially less invasive alternative to open chest surgery, especially in patients with polytrauma. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture. Methods: Retrospectively, 74 patients with acute traumatic aortic rupture were analyzed. Most of the patients had a rupture limited to the isthmus, and severe associated injuries. Thirty-five patients (6 female, 29 male, mean age 36 years) underwent surgical repair. Two patients were operated upon without cardiopulmonary bypass. In 39 patients (5 female, 34 male, mean age 36 years) thoracic endografts were implanted. The delay between trauma and treatment was comparable in the two groups. Results: Hospital mortality was 20% (7 of 35 patients) in the surgical group and 7.7% (3 of 39 patients) in the endovascular group. The most common cause of death in the surgical group was brain death in severe traumatic patients. Ten surgical complications occurred in 5 patients: respiratory insufficiency (n = 3), pulmonary infection (n = 2), recurrent nerve palsy (n = 2), repeat thoracotomy (n = 2), and compartment syndrome (n = 1). No patient in this group had paraplegia. Except for one case, which required conversion to conventional surgery, stent-graft implantation was successful in all cases, without peri-interventional complications or procedure-induced paraplegia. In 9 patients the left subclavian artery was covered with the device. Two patients underwent surgical repair 15 days and 4 months after endografting because of injury of the aortic wall by the stent and development of a spurious aneurysm, respectively. Conclusions: In the treatment of traumatic thoracic aortic rupture, the early outcome of patients treated with endovascular stent grafts appears to be better than that with conventional surgical repair. The new technique allows safe and successful repair of this life-threatening injury in the early phase of trauma management. How far this potential benefit is sustained in the long term remains unclear at present. #

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Section: Discussionmentioning

confidence: 77%

Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture☆

Buz¹,

Zipfel²,

Mulahasanovic³

et al. 2008

European Journal of Cardio-Thoracic Surgery

106

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“…Particularly severe vascular lesions, responsible of significant hemodynamic instability, at higher risk for patient life, could justify a delay in the final surgical treatment [19]. Just in these patients the concept of damage control become of great importance.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous pedicle screw fixation in polytrauma patients

Scaramuzzo

Tamburrelli²,

Piervincenzi

et al. 2013

Eur Spine J

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“…4 Up to 90% of patients suffering blunt aortic injury (BAI) expire before reaching a hospital; and of those that do, another half dies within 24 hours. 13,8,11,9 BAI also carries a significant morbidity, including spinal cord ischemia and stroke reported as high as 20% and 8% respectively. 5 Spinal cord ischemia can be the direct result of aortic injury or can be the complication of open and endovascular repairs of the aortic injury.…”

Section: Discussionmentioning

confidence: 99%