1
|
NeMoyer R, Butts C, Beckerman W, To J. Blunt Abdominal Aortic Dissection Treated by Endovascular Stent Placement. Am Surg 2020; 87:125-127. [PMID: 32845707 DOI: 10.1177/0003134820943543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rachel NeMoyer
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher Butts
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William Beckerman
- Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jennifer To
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
2
|
Karaolanis G, Moris D, McCoy CC, Tsilimigras DI, Georgopoulos S, Bakoyiannis C. Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma. Front Surg 2018; 5:7. [PMID: 29516005 PMCID: PMC5826055 DOI: 10.3389/fsurg.2018.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022] Open
Abstract
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.
Collapse
Affiliation(s)
- Georgios Karaolanis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - C. Cameron McCoy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Diamantis I. Tsilimigras
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
3
|
Dayama A, Rivera A, Olorunfemi O, Mahmoud A, Fontecha CA, McNelis J. Open and Endovascular Abdominal Aortic Injury Repair Outcomes in Polytrauma Patients. Ann Vasc Surg 2017; 42:156-161. [DOI: 10.1016/j.avsg.2016.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/26/2016] [Accepted: 11/12/2016] [Indexed: 10/19/2022]
|
4
|
Carr JA. Blunt traumatic infrarenal aortic intimal flap progressing to pseudoaneurysm over 3 months. J Surg Case Rep 2016; 2016:rjw099. [PMID: 27252519 PMCID: PMC4888757 DOI: 10.1093/jscr/rjw099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Blunt traumatic infrarenal aortic injuries are unusual, and the formation of a delayed pseudoaneurysm of the aorta is even more rare. In this report, a young woman developed a small intimal flap of the infrarenal aorta after a motor vehicle accident which progressed into a 3 cm pseudoaneurysm after 3 months. Operative repair was successful and the patient recovered. This case illustrates the importance of repeat imaging of small blunt aortic injuries since progression can occur.
Collapse
Affiliation(s)
- John Alfred Carr
- School of Medicine, Department of Trauma Surgery, Western Michigan University, Borgess Hospital, Kalamazoo, MI 49048, USA
| |
Collapse
|
5
|
Hornez E, Bourgouin S, Baudoin Y, Prunet B, Monchal T, Schlienger G, Meyrat L, Thouard H. [Management of seat-belt aorta in severe polytrauma: a review]. JOURNAL DES MALADIES VASCULAIRES 2011; 36:237-242. [PMID: 21684701 DOI: 10.1016/j.jmv.2011.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 05/05/2011] [Indexed: 05/30/2023]
Abstract
Blunt trauma of the abdominal aorta is rare. Secondary to high-energy trauma, it is observed mainly in association with complex lesions. Evaluation of injury to the aorta must be a priority due to the risk of life-threatening massive hemorrhage. The clinical presentation can be quite obvious but also variable and often misleading. If in doubt, a systematic injected whole body scan is essential to diagnose aortic lesions. Hemorrhage or ischemia dictates emergency laparotomy. Opening the retroperitoneum increases the risk of infection if there is an associated gastrointestinal tract injury and may contraindicate use of arterial prostheses. Endovascular treatment can be proposed for less symptomatic lesions, including intimal dissection. Stents can be inserted via a femoral approach. In the event of juxtarenal dissection, there is a risk of renal artery thrombosis. Endovascular treatment is currently not recommended. This treatment can be delayed for a few days if necessary. Morbidity is low and long-term results are good.
Collapse
Affiliation(s)
- E Hornez
- Service de chirurgie digestive et vasculaire, département d'anesthésie réanimation, hôpital d'Instruction des Armées, boulevard Sainte-Anne, Toulon, France.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Kulvatunyou N, Albrecht RM, Bender JS, Friese RS, Joseph B, Latifi R, O'Keefe T, Wynn JL, Rhee PM. Seatbelt Triad: Severe Abdominal Wall Disruption, Hollow Viscus Injury, and Major Vascular Injury. Am Surg 2011; 77:534-8. [DOI: 10.1177/000313481107700509] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.
Collapse
Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Roxie M. Albrecht
- Department of Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey S. Bender
- Department of Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Randy S. Friese
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Bellal Joseph
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Rifat Latifi
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Terrance O'Keefe
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Julie L. Wynn
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Peter M. Rhee
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| |
Collapse
|
7
|
Handa N, Nishina T, Nishio I, Asano M, Noda K, Ueno Y. Endovascular Stent-Graft Repair for Spontaneous Dissection of Infra-Renal Abdominal Aorta. Ann Vasc Surg 2010; 24:955.e1-4. [DOI: 10.1016/j.avsg.2010.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/20/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
|
8
|
Endovascular Management of Stenosis of the Infrarenal Aorta Secondary to Blunt Abdominal Aortic Trauma in a Multiply Injured Patient. ACTA ACUST UNITED AC 2009; 66:E81-5. [DOI: 10.1097/01.ta.0000238651.56585.e4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Kutsukata N, Mashiko K, Matsumoto H, Hara Y, Sakamoto Y, Takei K, Saito N. A case of abdominal aortic injury caused by a traffic accident. J NIPPON MED SCH 2009; 75:337-9. [PMID: 19155570 DOI: 10.1272/jnms.75.337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 30-year-old man was injured when the large motorcycle he was riding crashed into a power pole. Upon arrival at our institution, the patient complained of abdominal pain; blood pressure at admission was 160/70 mmHg, and the heart rate was 112 bpm. Abdominal ultrasonography showed a small collection of fluid in Morrison's pouch. A chest X-ray film showed a right rib fracture. Multidetector computed tomography (MD-CT) revealed pleural effusion, a hepatic lesion, and a dissection of the abdominal aorta distal to the renal artery. Because of the complicated intraluminal injuries, the insertion of a stent graft was difficult. On the 34th day after injury, elective surgery was performed. Because dissection of the lumen was observed, the vessel was replaced with an artificial graft. Medial degeneration of the aorta wall was not observed upon pathological examination, and no degenerative disorders have occurred. The postoperative progress was favorable, and the patient was discharged from hospital.
Collapse
Affiliation(s)
- Noriyoshi Kutsukata
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
10
|
Jonker FHW, Schlösser FJV, Moll FL, Muhs BE. Dissection of the Abdominal Aorta. Current Evidence and Implications for Treatment Strategies: A Review and Meta-Analysis of 92 Patients. J Endovasc Ther 2009; 16:71-80. [DOI: 10.1583/08-2601.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
|
12
|
Yulevich A, Singer-Jordan J, Grozovsky Y, Zonis Z, Sweed Y. Traumatic Abdominal Aortic Dissection in a Child. ACTA ACUST UNITED AC 2007; 62:1039-41. [PMID: 17426565 DOI: 10.1097/01.ta.0000235242.61127.b2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Imaging and Intervention of Large Arterial Trauma. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Lalancette M, Scalabrini B, Martinet O. Seat-Belt Aorta: A Rare Injury Associated with Blunt Abdominal Trauma. Ann Vasc Surg 2006; 20:681-3. [PMID: 16732445 DOI: 10.1007/s10016-006-9058-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 07/12/2005] [Accepted: 02/27/2006] [Indexed: 11/24/2022]
Abstract
Seat-belt aorta, a dissection of the intima caused by direct compression of the vessel between the horizontal part of the seat belt and the vertebrae, is a rare but classical injury associated with blunt abdominal trauma. High index of suspicion is critical since this potentially lethal lesion can be asymptomatic initially. Understanding the mechanisms of injury and being aware of the frequently associated clinical signs and injuries should allow for prompt recognition and treatment without delay.
Collapse
MESH Headings
- Accidents, Traffic
- Adult
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/injuries
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/surgery
- Humans
- Male
- Seat Belts/adverse effects
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/etiology
- Wounds, Nonpenetrating/surgery
Collapse
Affiliation(s)
- Mathieu Lalancette
- Department of General Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | | | | |
Collapse
|
15
|
Martí M, Pinilla I, Baudraxler F, Simón MJ, Garzón G. A case of acute abdominal aortic dissection caused by blunt trauma. Emerg Radiol 2006; 12:182-5. [PMID: 16738931 DOI: 10.1007/s10140-006-0473-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/16/2005] [Indexed: 11/28/2022]
Abstract
We present the case of an 18-year-old man involved in a fall with blunt abdominal trauma. The patient had hypovolemic shock and findings of an acute abdomen. Initial computed tomography (CT) showed pulmonary contusion, pneumohemothorax, hemoperitoneum, hepatic contusion, right kidney laceration and vascular avulsion, rupture of the mesenteric vein, rupture of the right rectus muscle with bowel hernia, and infrarenal aortic dissection. There were no signs of limb or medullar ischemia. After hemodynamic stabilization and surgical repair of the associated lesions, the dissection was successfully treated with a self-expanding aortic Wallstent. Postprocedure CT showed a well-positioned patent stent and the patient was discharged asymptomatic. Percutaneous endovascular stent implantation is minimally invasive and seems to be a safe treatment for traumatic dissection of the abdominal aorta.
Collapse
Affiliation(s)
- Milagros Martí
- Radiology Department, Hospital Universitario La Paz, Paseo Castellana 261, Madrid 28046, Spain
| | | | | | | | | |
Collapse
|
16
|
Chung HH, Cha SH, Cho SB, Kim JH, Lee SH, Shin JS, Park SW. Traumatic Axillary Artery Dissection with Radial Artery Embolism. Cardiovasc Intervent Radiol 2005; 29:294-7. [PMID: 16160753 DOI: 10.1007/s00270-004-8103-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram.
Collapse
Affiliation(s)
- Hwan-Hoon Chung
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Gojan Dong 516, Ansan City, Kyonggido, 425-707, South Korea
| | | | | | | | | | | | | |
Collapse
|
17
|
Teruya TH, Bianchi C, Abou-Zamzam AM, Ballard JL. Endovascular Treatment of a Blunt Traumatic Abdominal Aortic Injury with a Commercially Available Stent Graft. Ann Vasc Surg 2005; 19:474-8. [PMID: 15981125 DOI: 10.1007/s10016-005-4653-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abdominal aortic injuries are rarely encountered in blunt abdominal trauma. The traditional treatment of these injuries has been surgical exploration and repair. Endografts are commonly used in the repair of abdominal aortic aneurysms. We present a case of a blunt abdominal aortic injury treated successfully with a commercially available endograft. A 26-year-old male was involved in a rollover motor vehicle collision. Evaluation revealed an aortic injury as well as a concomitant small bowel injury. No treatment of the aorta was undertaken initially; however, on 6-month follow-up, the patient developed bilateral hip and buttock claudication. Computed tomography and aortography revealed two areas of stenosis with an associated pseudoaneurysm. The patient was treated with three 22 mm AneuRx (Medtronic, Sunnyvale, CA) aortic extender cuffs. Balloon angioplasty of the stenosis was also performed. The patient's symptoms resolved, and he was well at 9 months postprocedure. We report the use of aortic extender cuffs to treat a blunt abdominal aortic injury. The potential to treat these injuries with aortic extender cuffs emergently or electively at any institution represents an advance in the management of vascular trauma.
Collapse
Affiliation(s)
- Theodore H Teruya
- Division of Vascular Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | | | | | | |
Collapse
|
18
|
Stahlfeld KR, Mitchell J, Sherman H. Endovascular Repair of Blunt Abdominal Aortic Injury: Case Report. ACTA ACUST UNITED AC 2004; 57:638-41. [PMID: 15454816 DOI: 10.1097/01.ta.0000042018.39379.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kurt R Stahlfeld
- Department of Surgery, Mercy Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | | | | |
Collapse
|
19
|
Berthet JP, Marty-Ané CH, Veerapen R, Picard E, Mary H, Alric P. Dissection of the abdominal aorta in blunt trauma: endovascular or conventional surgical management? J Vasc Surg 2003; 38:997-1003; discussion 1004. [PMID: 14603206 DOI: 10.1016/s0741-5214(03)00613-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dissection of the abdominal aorta caused by blunt trauma is a rare injury, often complicated by thrombosis within the true and false lumens and sometimes aortic rupture. The mortality rate with conservative medical management is approximately 75%, whereas it ranges from 18% to 37% with surgical treatment. METHODS At our institution, 7 of the 87 patients admitted because of blunt aortic trauma, between January 1995 and January 2002, had abdominal aortic dissection. RESULTS Four patients were treated using endovascular techniques by percutaneous stent placement. The indications for endovascular management were lower limb ischemia in one case and extension of the dissection in two; one patient was asymptomatic. Aortic dissection was complicated by ischemic paraplegia in two patients, and both were treated by conventional operative repair. One patient was managed medically because of a minimal intimal disruption. No deaths were related to the aortic dissection or its treatment. Angiographic and computed tomographic (CT) studies showed thrombosis of the false lumen and complete obliteration of the dissection in the endovascular group. The neurologic condition of the two paraplegic patients either cleared completely or partially improved. CONCLUSION In the absence of ischemic paraplegia or other injuries that require emergency surgery, endovascular treatment is a safe and efficient method for treating traumatic infrarenal aortic dissection.
Collapse
|
20
|
Meghoo CAL, Gonzalez EA, Tyroch AH, Wohltmann CD. Complete Occlusion after Blunt Injury to the Abdominal Aorta. ACTA ACUST UNITED AC 2003; 55:795-9. [PMID: 14566144 DOI: 10.1097/01.ta.0000039053.32562.c0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Injury to the abdominal aorta after blunt trauma is uncommon. When this injury results in complete vessel occlusion, the presentation is dramatic. Timely intervention is essential. METHODS After a case report, we examined all reported cases of complete occlusion after blunt injury to the abdominal aorta and reviewed the cause, presentation, and management of this injury. RESULTS Complete vessel occlusion arises from intimal injury. The most frequent mechanism is compression from a seat belt or steering wheel during a motor vehicle crash. Patients present with absent femoral and distal pulses in association with lower extremity neuropathy. Intervention commonly involves bypass grafting of the abdominal aorta. CONCLUSION Complete occlusion after blunt trauma to the abdominal aorta is rare. Neurologic deficits most commonly arise from peripheral nerve ischemia. Reperfusion within 6 hours confers a greater chance of limb salvage and neurologic recovery.
Collapse
Affiliation(s)
- Colin A L Meghoo
- Department of Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas 79920-5001, USA.
| | | | | | | |
Collapse
|
21
|
Voellinger DC, Saddakni S, Melton SM, Wirthlin DJ, Jordan WD, Whitley D. Endovascular repair of a traumatic infrarenal aortic transection: a case report and review. VASCULAR SURGERY 2001; 35:385-9. [PMID: 11565043 DOI: 10.1177/153857440103500509] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blunt abdominal aortic trauma occurs in up to 0.04% of all nonpenetrating traumas. Although uncommon, mortality from this injury ranges from 18% to 37%. Seat belt injury is associated with almost 50% of reported blunt abdominal aortic traumas. The authors present the case of a 21-year-old man, a restrained passenger who was involved in a high-speed motor vehicle accident. In the emergency room, he had obvious evidence of lap-belt injury. His peripheral pulses were normal and there was no pulsatile abdominal mass. Computer tomography (CT) revealed a large amount of free intraperitoneal fluid throughout with signs of mesenteric avulsion and fracture/dislocation of T11-T12. The patient underwent an exploratory laparotomy. Right hemicolectomy and resection of small bowel was performed. CT angiography revealed an aortic transection and surrounding pseudoaneurysm 2 cm above the aortic bifurcation. The patient returned to the operating room for endovascular repair. Via a right femoral cutdown, a 14 mm x 5.5 cm stent-graft was placed across the distal abdominal aorta. Follow-up arteriogram revealed complete obliteration of the pseudoaneurysm without evidence of leak. There were no complications related to the aortic stent-graft in the postoperative period. The patient was discharged in good condition. As this case demonstrates, endovascular repair of traumatic aortic injury is feasible and may represent an improved treatment in certain settings.
Collapse
Affiliation(s)
- D C Voellinger
- Departments of Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | | | | | | | | | | |
Collapse
|
22
|
Czermak BV, Waldenberger P, Fraedrich G, Dessl AH, Roberts KE, Bale RJ, Perkmann R, Jaschke WR. Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results. Radiology 2000; 217:544-50. [PMID: 11058658 DOI: 10.1148/radiology.217.2.r00oc16544] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection. MATERIALS AND METHODS Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection. In five patients, the proximal entry tear was within 2 cm of the origin of the left subclavian artery, and in two patients it was beyond this site. In three patients, the noncovered proximal portion of the stent-graft was placed across the origin of the left subclavian artery. The efficacy of the procedure was assessed at follow-up studies 3, 6, 12, and 24 months after intervention. RESULTS The procedure was technically and clinically successful in six patients (86%). The left subclavian artery remained patent in all patients. In two patients with involvement of aortic branches, endovascular stent-graft placement restored adequate blood flow to the compromised branches. One patient was readmitted 1 month later because the dissection extended into the ascending aorta. In all but this patient, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. All false lumina shrank considerably. The mean follow-up time was 14 months (range, 1-25 months). CONCLUSION Type B aortic dissections within and beyond 2 cm of the origin of the left subclavian artery can be treated safely and effectively by means of endovascular stent-graft placement.
Collapse
Affiliation(s)
- B V Czermak
- Department of Radiology I, Leopold-Franzens Medical School and University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Nishimura K, Kanaoka Y, Ikebuchi M, Hiroe T, Tachibana M, Ishiguro S, Ohgi S. Percutaneous balloon fenestration in a case of traumatic abdominal aortic dissection with lower extremity ischemia. J Vasc Surg 2000; 32:616-8. [PMID: 10957673 DOI: 10.1067/mva.2000.106956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A 38-year-old man was involved in a traffic accident and experienced a heavy blow to the abdomen. He had traumatic abdominal aortic dissection with right lower extremity ischemia. He underwent percutaneous balloon fenestration, which is safe and minimally invasive, for relief of right lower extremity ischemia. He has been working for 2 years without any signs of vascular compromise. Percutaneous balloon fenestration is one of the few treatments for traumatic abdominal aortic dissection.
Collapse
Affiliation(s)
- K Nishimura
- Second Department of Surgery, Tottori University, Faculty of Medicine, Yonago, Japan
| | | | | | | | | | | | | |
Collapse
|
24
|
Mann FA, Gean AD, Kazerooni EA, Rogers LF. 1998 plenary session: Imaging symposium. An overview of acute radiology. Radiographics 1999; 19:1319-22. [PMID: 10489183 DOI: 10.1148/radiographics.19.5.g99se331319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F A Mann
- Department of Radiology, University of Washington, Seattle 98104-2499, USA
| | | | | | | |
Collapse
|