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Rupture of the abdominal aorta artery due to self-inflicted injuries in a young man. Int J Surg Case Rep 2022; 93:106958. [PMID: 35378406 PMCID: PMC8980735 DOI: 10.1016/j.ijscr.2022.106958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Rupture of the abdominal aorta artery due to self-inflicted injuries. Aortic penetrating injuries have a high mortality rate. Rupture of the abdominal aortic artery in a patient with psychological problems and drug intoxication.
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Bae M, Jeon CH, Kim CW. Endovascular Repair for a Penetrating Injury of the Abdominal Aorta at the Level of the Celiac Trunk. J Vasc Interv Radiol 2021; 32:773-775. [PMID: 33610433 DOI: 10.1016/j.jvir.2021.01.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Chang Ho Jeon
- Department of Radiology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
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3
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Kayacı S, Cakir T, Dolgun M, Cakir E, Bozok Ş, Temiz C, Caglar YS. Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases. World Neurosurg 2019; 128:216-224. [PMID: 31077895 DOI: 10.1016/j.wneu.2019.04.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. METHODS Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present. RESULTS Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method. CONCLUSIONS In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.
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Affiliation(s)
- Selim Kayacı
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey.
| | - Tayfun Cakir
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Muge Dolgun
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Ertugrul Cakir
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Şahin Bozok
- Department of Cardiovascular Surgery, Faculty of Medicine, Usak University, Usak, Turkey
| | - Cüneyt Temiz
- Department of Neurosurgery, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Jovanovic M, Radojkovic M, Djordjevic P, Rancic D, Jovanovic N, Rancic Z. Recycling and Reinforcing Intimomedial Flap of the Infrarenal Aorta Using Anterior Longitudinal Ligament in Patients With Acute Trauma With Bowel Injuries. Vasc Endovascular Surg 2017; 51:501-505. [PMID: 28764607 DOI: 10.1177/1538574417722930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present a patient with blunt abdominal trauma with severe acute right limb ischemia and clinical signs of diffuse peritonitis. Computed tomography angiography showed circumferential dissection of the infrarenal aorta with occlusion of the right common iliac artery. We opted for simultaneous abdomen exploration and open repair of injured aorta. Critical weakening of the aortic wall with imminent rupture was identified intraoperatively. Aortotomy cranially from bifurcation showed circumferential intimomedial dissection. The fixation of fragile intimomedial flap of aortic dissection was achieved with reinforcement using an anterior longitudinal ligament. The long aortoiliac arteriotomy was repaired using a great saphenous vein patch. Patient had uneventful postoperative course and was discharged after 7 days. In patients with abdominal polytrauma with peritonitis, and no available endovascular tools, open surgery for circumferential aortic dissection is possible and successful. Described reinforcement of the posterior aortic wall to the anterior longitudinal ligament should be added to the armamentarium of aortic injury treatment.
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Affiliation(s)
- Milan Jovanovic
- 1 Medical Faculty of Niš, Niš, Serbia.,2 Vascular Surgery Clinic, Clinical Centre of Niš, Niš, Serbia
| | - Milan Radojkovic
- 1 Medical Faculty of Niš, Niš, Serbia.,3 General Surgery Clinic, Clinical Centre of Niš, Niš, Serbia
| | | | - Dejan Rancic
- 1 Medical Faculty of Niš, Niš, Serbia.,4 Otorhinolaryngology Clinic, Clinical Centre of Niš, Niš, Serbia
| | | | - Zoran Rancic
- 5 Clinic for Heart and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
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5
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Salsamendi J, Pereira K, Rey J, Narayanan G. Endovascular Coil Embolization in the Treatment of a Rare Case of Post-Traumatic Abdominal Aortic Pseudoaneurysms: Brief Report and Review of Literature. Ann Vasc Surg 2016; 30:310.e1-8. [DOI: 10.1016/j.avsg.2015.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
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6
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Ghazala CG, Green BR, Williams R, Wyatt MG. Endovascular management of a penetrating abdominal aortic injury. Ann Vasc Surg 2014; 28:1790.e9-1790.e11. [PMID: 24561212 DOI: 10.1016/j.avsg.2014.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/28/2014] [Accepted: 02/15/2014] [Indexed: 10/25/2022]
Abstract
Penetrating aortic trauma is associated with high mortality rates. We report the case of a 24-year-old man who presented with a self-inflicted abdominal aortic penetration injury, resulting in a pseudoaneurysm. Rather uniquely, he was managed through prophylactic stenting to his abdominal aorta; this case was also rare in that there were remarkably no associated visceral injuries. Stenting was preferred because of risks of an aortic graft in a young man. A 14-mm Atrium Advanta™ stent was deployed, and angiography confirmed adequate exclusion of the pseudoaneurysm. He had no complications at follow-up.
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Affiliation(s)
| | - Barnabas R Green
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE3 4JQ, UK
| | - Robin Williams
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE3 4JQ, UK
| | - Michael G Wyatt
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE3 4JQ, UK.
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7
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Surgical management of a ballistic trauma of the right ventricle and descending thoracic aorta. Ann Vasc Surg 2013; 28:1315.e1-4. [PMID: 24365083 DOI: 10.1016/j.avsg.2013.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/21/2022]
Abstract
Ballistic injuries of the descending aorta are uncommon and of extremely severe prognosis. We report the case of a 55-year-old man treated for such a thoracic trauma that combined wounds of the heart and descending thoracic aorta. A combination of conventional surgical and endovascular approaches enabled successful treatment.
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Sharrock AE, Midwinter M. Damage control - trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care. Ann R Coll Surg Engl 2013; 95:177-83. [PMID: 23827287 DOI: 10.1308/003588413x13511609958253] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Trauma provision in the UK is a topic of interest. Regional trauma networks and centres are evolving and research is blossoming, but what bearing does all this have on the care that is delivered to the individual patient? This article aims to provide an overview of key research concepts in the field of trauma care, to guide the clinician in decision making in the management of major trauma. METHODS The Ovid MEDLINE(®), EMBASE™ and PubMed databases were used to search for relevant articles on haemorrhage control, damage control resuscitation and its exceptions, massive transfusion protocols, prevention and correction of coagulopathy, acidosis and hypothermia, and damage-control surgery. FINDINGS A wealth of research is available and a broad range has been reviewed to summarise significant developments in trauma care. Research has been categorised into disciplines and it is hoped that by considering each, a tailored management plan for the individual trauma patient will evolve, potentially improving patient outcome.
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Affiliation(s)
- A E Sharrock
- Vascular Surgery Department, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, SP2 8BJ, UK.
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9
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Heridas por armas de aire comprimido. Cir Esp 2010; 88:119-20. [DOI: 10.1016/j.ciresp.2009.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 05/21/2009] [Accepted: 06/02/2009] [Indexed: 11/24/2022]
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Ding X, Jiang J, Su Q, Hu S. Endovascular Stent Graft Repair of a Penetrating Aortic Injury. Ann Thorac Surg 2010; 90:632-4. [DOI: 10.1016/j.athoracsur.2010.01.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/20/2010] [Accepted: 01/21/2010] [Indexed: 11/17/2022]
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Interventional Radiographic Embolization of a Traumatic Pseudoaneurysm and Associated Arteriovenous Fistulas 33 Years After Injury in a Vietnam Combat Veteran: Worth The Wait? ACTA ACUST UNITED AC 2010; 68:E32-4. [DOI: 10.1097/ta.0b013e3181574aa2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kapoor BS, Haddad HL, Saddekni S, Lockhart ME. Diagnosis and management of pseudoaneurysms: an update. Curr Probl Diagn Radiol 2009; 38:170-88. [PMID: 19464587 DOI: 10.1067/j.cpradiol.2008.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
"Pseudoaneurysm" is a term that describes disruption of an artery with patent flow in a defined space beyond the confines of the vessels. A pseudoaneurysm can involve any vascular bed and is usually associated with direct arterial injury or erosion of an artery by an adjacent tumor or inflammation. In this article, we discuss different clinical settings and various imaging modalities such as ultrasound, computerized tomography, magnetic resonance imaging, as well as conventional angiography used for the diagnosis of pseudoaneurysms. We also describe the role of newer endovascular, percutaneous, and traditional surgical approaches for the treatment of visceral and peripheral pseudoaneurysms in different clinical circumstances.
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Affiliation(s)
- Baljendra S Kapoor
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249-6830, USA.
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Baldwin Z, Phillips L, Bullard M, Schneider D. Endovascular Stent Graft Repair of a Thoracic Aortic Gunshot Injury. Ann Vasc Surg 2008; 22:692-6. [DOI: 10.1016/j.avsg.2008.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 11/09/2007] [Accepted: 01/03/2008] [Indexed: 11/24/2022]
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Kakkos SK, Shepard AD. Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature. J Vasc Surg 2008; 47:1074-82. [DOI: 10.1016/j.jvs.2007.11.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 11/01/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022]
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Hussain Q, Maleux G, Heye S, Fourneau I. Endovascular repair of an actively hemorrhaging stab wound injury to the abdominal aorta. Cardiovasc Intervent Radiol 2008; 31:1023-5. [PMID: 18389184 DOI: 10.1007/s00270-008-9327-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 02/13/2008] [Accepted: 03/03/2008] [Indexed: 11/27/2022]
Abstract
Traumatic injury of the abdominal aorta is rare and potentially lethal (Yeh et al., J Vasc Surg 42(5):1007-1009, 2005; Chicos et al., Chirurgia (Bucur) 102(2):237-240, 2007) as it can result in major retroperitoneal hemorrhage, requiring an urgent open surgery. In case of concomitant bowel injury or other conditions of hostile abdomen, endovascular repair can be an alternative treatment. This case report deals with a 50-year-old man presenting at the emergency ward with three stab wounds: two in the abdomen and one in the chest. During explorative laparotomy, liver laceration and bowel perforation were repaired. One day later, abdominal CT-scan revealed an additional retroperitoneal hematoma associated with an aortic pseudoaneurysm, located anteriorly 3 cm above the aortic bifurcation. Because of the risk of graft infection, an endovascular repair of the aortic injury using a Gore excluder stent-graft was performed. Radiological and clinical follow-up revealed a gradual shrinkage of the pseudo-aneurysm and no sign of graft infection at two years' follow-up.
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Affiliation(s)
- Qasim Hussain
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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16
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Barleben AR, Baig MS, Kubaska SM, Fujitani RM, Gordon IA, Lane JS. Endovascular Repair of an Actively Hemorrhaging Aortoduodenal Fistula. Ann Vasc Surg 2007; 21:629-32. [PMID: 17532604 DOI: 10.1016/j.avsg.2007.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 01/31/2007] [Indexed: 10/21/2022]
Abstract
Aortoenteric fistulae require urgent definitive intervention and traditionally carry a high mortality. We describe a patient who suffered a traumatic aortic dissection following an auto versus pedestrian collision. He underwent open fenestration of his infrarenal aorta and visceral resection, complicated by abdominal sepsis and enterocutaneous fistulae. One month later he developed massive hematemesis, and endoscopic examination revealed an aortoduodenal fistula. Due to an impassable abdominal wall, a stent-graft repair was performed. This report describes the successful use of endovascular techniques to achieve immediate hemostasis in an actively hemorrhaging aortoduodenal fistula. An endovascular approach provides a valuable option in settings where a hostile abdomen precludes the traditional open technique and may serve as a bridge to later definitive repair.
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Affiliation(s)
- Andrew R Barleben
- University of California Irvine Medical Center, Orange, CA 92868, USA
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Abstract
Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year, for a combined mortality of 48 deaths per 100,000 population per year. Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals. Preventability of trauma deaths has been reported as high as 76% and as low as 1% in mature trauma systems. Critical care errors may occur in a half of hospital trauma deaths, in most of the cases contributing to the death. The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions. A systematic approach to the trauma patient in the critical care unit would avoid errors and preventable deaths.
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Affiliation(s)
- Alberto Garcia
- Trauma Division, Hospital Universitario del Valle, Calle 5 No. 36-08, Cali, Columbia.
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