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Mazzaccaro D, Righini P, Fancoli F, Giannetta M, Modafferi A, Malacrida G, Nano G. Blunt Thoracic Aortic Injury. J Clin Med 2023; 12:jcm12082903. [PMID: 37109240 PMCID: PMC10142366 DOI: 10.3390/jcm12082903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Fabiana Fancoli
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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Deng H, Tang TX, Tang LS, Chen D, Luo JL, Dong LM, Gao SH, Tang ZH. Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics. J Clin Med 2021; 10:jcm10225220. [PMID: 34830504 PMCID: PMC8623488 DOI: 10.3390/jcm10225220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The coexistence of thoracic fractures and blunt aortic injury (BAI) is potentially catastrophic and easy to be missed in acute trauma settings. Data regarding patients with thoracic fractures complicated with BAI are limited. Methods: The authors conducted a prospective, observational, single-center study including patients with thoracic burst fractures. A multivariate logistic regression model was developed to determine the risk factors of aortic injury. Results: In total, 124 patients with burst fractures of the thoracic spine were included. The incidence of BAI was 11.3% (14/124) in patients with thoracic burst fractures. Among these patients, 11 patients with BAI were missed diagnoses. The main risk factors of BAI were as follows: Injury severity score (OR 1.184; 95% CI, 1.072–1.308; p = 0.001), mechanism of injury, such as crush (OR 10.474; 95% CI, 1.905–57.579; p = 0.007), flail chest (OR = 4.917; 95% CI, 1.122–21.545; p = 0.035), and neurological deficit (OR = 8.299; 95% CI, 0.999–68.933; p = 0.05). Conclusions: BAI (incidence 11.3%) is common in patients with burst fractures of the thoracic spine and is an easily missed diagnosis. We must maintain a high suspicion of injury for BAI when patients with thoracic burst fractures present with these high-risk factors.
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Affiliation(s)
- Hai Deng
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Ting-Xuan Tang
- Class 1901, School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China;
| | - Liang-Sheng Tang
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Deng Chen
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Jia-Liu Luo
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Li-Ming Dong
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Si-Hai Gao
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (S.-H.G.); (Z.-H.T.); Tel.: +86-27-83665306 (Z.-H.T.)
| | - Zhao-Hui Tang
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
- Correspondence: (S.-H.G.); (Z.-H.T.); Tel.: +86-27-83665306 (Z.-H.T.)
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Erdoğan KE, Beşler MS, Canyiğit M, Hıdıroğlu M. Endovascular repair of a distal thoracic aortic transection in association with traumatic burst fracture. Indian J Thorac Cardiovasc Surg 2021; 37:554-557. [PMID: 34511763 DOI: 10.1007/s12055-021-01138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
We present an endovascular repair of aortic transection at distal thoracic level due to traumatic burst fracture. The association of blunt aortic transections and thoracic burst fractures is very rare. Contemporary preferred treatment approach is endovascular aortic repair, because of low mortality rates. The aortic repair procedure should be performed before spinal stabilization surgery. In this case report, we present a 49-year-old male patient with blunt traumatic descending thoracic aortic transection, treated by endovascular aortic repair. In conclusion, the emergent endovascular repair is a preferable method to treat the traumatic distal thoracic aortic transection.
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Affiliation(s)
| | | | - Murat Canyiğit
- Department of Radiology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Mete Hıdıroğlu
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
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Kapoor H, Lee JT, Orr NT, Nisiewicz MJ, Pawley BK, Zagurovskaya M. Minimal Aortic Injury: Mechanisms, Imaging Manifestations, Natural History, and Management. Radiographics 2020; 40:1834-1847. [PMID: 33006921 DOI: 10.1148/rg.2020200066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Over the last 2 decades, increased depiction of minimal aortic injury (MAI) in the evaluation of patients who have sustained trauma has mirrored the increased utilization and improved resolution of multidetector CT. MAI represents a mild form of blunt traumatic aortic injury (BTAI) that usually resolves or stabilizes with pharmacologic management. The traditional imaging manifestation of MAI is a subcentimeter round, triangular, or linear aortic filling defect attached to an aortic wall, representing a small intimal flap or thrombus consistent with grade I injury according to the Society for Vascular Surgery (SVS). Small intramural hematoma (SVS grade II injury) without external aortic contour deformity is included in the MAI spectrum in several BTAI classifications on the basis of its favorable outcome. Although higher SVS grades of injury generally call for endovascular repair, there is growing literature supporting conservative management for small pseudoaneurysms (SVS grade III) and large intimal flaps (>1 cm, unclassified by the SVS), hinting toward possible future inclusion of these entities in the MAI spectrum. Injury progression of MAI is rare, with endovascular aortic repair reserved for these patients as well as patients for whom medical treatment cannot be implemented. No consensus on the predetermined frequency and duration of multidetector CT follow-up exists, but it is common practice to perform a repeat CT examination shortly after the initial diagnosis. The authors review the evolving definition, pathophysiology, and natural history of MAI, present the primary and secondary imaging findings and diagnostic pitfalls, and discuss the current management options for MAI. Online DICOM image stacks are available for this article. ©RSNA, 2020.
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Affiliation(s)
- Harit Kapoor
- From the Division of Emergency Radiology, Department of Radiology (H.K., J.T.L., B.K.P., M.Z.), Division of Vascular Surgery, Department of Surgery, (N.T.O.), and School of Medicine (M.J.N.), University of Kentucky Chandler Medical Center, 800 Rose St, HX315E, Lexington, KY 40536
| | - James T Lee
- From the Division of Emergency Radiology, Department of Radiology (H.K., J.T.L., B.K.P., M.Z.), Division of Vascular Surgery, Department of Surgery, (N.T.O.), and School of Medicine (M.J.N.), University of Kentucky Chandler Medical Center, 800 Rose St, HX315E, Lexington, KY 40536
| | - Nathan T Orr
- From the Division of Emergency Radiology, Department of Radiology (H.K., J.T.L., B.K.P., M.Z.), Division of Vascular Surgery, Department of Surgery, (N.T.O.), and School of Medicine (M.J.N.), University of Kentucky Chandler Medical Center, 800 Rose St, HX315E, Lexington, KY 40536
| | - Michael J Nisiewicz
- From the Division of Emergency Radiology, Department of Radiology (H.K., J.T.L., B.K.P., M.Z.), Division of Vascular Surgery, Department of Surgery, (N.T.O.), and School of Medicine (M.J.N.), University of Kentucky Chandler Medical Center, 800 Rose St, HX315E, Lexington, KY 40536
| | - Barbara K Pawley
- From the Division of Emergency Radiology, Department of Radiology (H.K., J.T.L., B.K.P., M.Z.), Division of Vascular Surgery, Department of Surgery, (N.T.O.), and School of Medicine (M.J.N.), University of Kentucky Chandler Medical Center, 800 Rose St, HX315E, Lexington, KY 40536
| | - Marianna Zagurovskaya
- From the Division of Emergency Radiology, Department of Radiology (H.K., J.T.L., B.K.P., M.Z.), Division of Vascular Surgery, Department of Surgery, (N.T.O.), and School of Medicine (M.J.N.), University of Kentucky Chandler Medical Center, 800 Rose St, HX315E, Lexington, KY 40536
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