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Slocum C, Chiba H, Emigh B, Tam B, Schellenberg M, Inaba K, Matsushima K. Nationwide Analysis of Penetrating Thoracic Aortic Injury: Injury Patterns, Management, and Outcomes. J Surg Res 2023; 284:290-295. [PMID: 36621259 DOI: 10.1016/j.jss.2022.11.077] [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: 08/18/2022] [Revised: 10/14/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Penetrating thoracic aortic injuries (PTAI) represent a rare form of thoracic trauma. Unlike blunt thoracic aortic injuries (BTAI), only scarce data, included in small case series, are currently available for PTAI. The purpose of this study was to describe injury patterns, surgical management, and outcomes of patients with PTAI and compare to those with BTAI. MATERIALS AND METHODS A 9-y retrospective cohort study (2007-2015) was conducted using the National Trauma Data Bank. Patient demographics, injury profile, procedures performed, and patient outcomes were compared between the PTAI and BTAI group. RESULTS A total of 2714 patients with PTAI and 14,037 patients with BTAI were identified. Compared to BTAI, PTAI patients were younger (28 versus 42 y, P < 0.001), more often male (89.1% versus 71.7%, P < 0.001), and more likely to arrive without signs of life (27.6% versus 7.5%, P < 0.001). PTAI patients had less associated injuries, overall, compared to those with BTAI; however, were more likely to have injuries to the esophagus, diaphragm, and heart. Patients with PTAI were less likely to undergo endovascular (5.8% versus 30.5%, P < 0.001) or open surgical repair (3.0% versus 4.2%, P < 0.001) compared to BTAI. While the large majority of PTAI patients expired before their hospital arrival or in the emergency department, the in-hospital mortality rate among those who survivedemergency department stay was 43.1%. CONCLUSIONS Most patients with PTAI present to the hospital without any signs of life, and their overall mortality rate is extremely high. Only a small portion of PTAI patients who survived the initial resuscitation period underwent surgical interventions for thoracic aortic injuries. Further studies are still warranted to clarify the indications and types of surgical interventions for PTAI.
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Affiliation(s)
- Charles Slocum
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Hiroto Chiba
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Benjamin Tam
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California.
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Kumar A, Choudhary N, Priyadarshi P, Bagaria D, Alam J, Soni KD, Khan MA, Yadav R, Kumar A, Gamanagatti S, Banerjee N, Sagar S, Mishra B, Gupta A, Kumar S. Clinical Spectrum and Outcome Analysis of Blunt Thoracic Aortic Injuries: a 10-year Experience from a Level I Trauma Center. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03741-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Shibahashi K, Matsunaga H, Ishida T, Sugiyama K, Hamabe Y. A new screening model for quantitative risk assessment of blunt thoracic aortic injury. Eur J Trauma Emerg Surg 2022; 48:4607-4614. [DOI: 10.1007/s00068-022-01925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
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IMPACT OF THORACIC ENDOVASCULAR AORTIC REPAIR TIMING ON AORTIC REMODELING IN ACUTE TYPE B AORTIC INTRAMURAL HEMATOMA. J Vasc Surg 2021; 75:464-472.e2. [PMID: 34506888 DOI: 10.1016/j.jvs.2021.08.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/09/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Thoracic endovascular aortic repair (TEVAR) is increasingly utilized in the management of acute type B aortic intramural hematoma (TBIMH). Optimal timing for intervention has not been described. The aim of this study was to evaluate TEVAR timing on post-operative aortic remodeling. METHODS A retrospective chart review was performed on patients who underwent TEVAR for TBIMH from January 2008 to September 2018. Imaging was reviewed pre- and postoperatively. Primary data points included true lumen diameter (TLD) and total aortic diameter (TAD) at the site of maximal pathology. Primary endpoint was aortic remodeling evidenced by a TAD/TLD ratio closest to 1.0. Secondary outcome was occurrence of aortic-related adverse events and mortality (AREM): aortic rupture, aortic-related death, progression to dissection or need for aortic re-intervention within 12 months. Patients undergoing emergent TEVAR (within 24 hours, 'eTEVAR') were compared to the remainder - delayed TEVAR ('dTEVAR'). RESULTS We analyzed 71 patients that underwent TEVAR FOR TBIMH; 25 underwent emergent TEVAR and 46 patients underwent dTEVAR (median: 5.5 days, range: 2-120 days). There were no differences in demographics and comorbidities and patients did not differ in presenting IMH thickness (12.6±3.1 mm vs. 11.3±4.1 mm, p=0.186) nor presenting TAD/TLD ratio (1.535±0.471 vs. 1.525±0.397, p=0.928) for eTEVAR and dTEVAR groups, respectively. eTEVAR patients had larger average presenting maximal descending aortic (DTA) diameter (45.8±14.3 mm vs. 38.2±7.5 mm, p=0.018) and higher incidence of penetrating aortic ulcer (PAU) on presenting CT angiography (52.0% vs 21.7%, p=0.033). Thirty day mortality was 2/25 (8.0%) for eTEVAR and 2/45 (4.4%) for dTEVAR (p=0.602). Postoperative aortic remodeling was more complete in the dTEVAR group (1.23±0.12 vs. 1.33±0.15, p=0.004). Case-control matching (controlling for presenting DTA diameter and PAU) on 30 patients still showed better aortic remodeling in the dTEVAR group (1.125±0.100 vs 1.348±0.42, p<0.001). The incidence of AREM was higher in the eTEVAR - 6/25 (24.0%) - group compared to the dTEVAR group - 2/46 (4.3%). At 12 months, freedom from AREM was higher in the dTEVAR group (95.7% vs. 76.0%, p=0.011). Postoperative TAD/TLD ratio was the best predictor for late aortic-related adverse events (AUROC=0.825, p=0.003). CONCLUSION TEVAR for acute type B IMH within 24 hours of admission is associated with lower aortic remodeling and higher occurrence of late aortic related adverse events and mortality. Delaying TEVAR when clinically possible could improve aortic remodeling and aortic-related outcomes.
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Salsano A, Salsano G, Spinella G, Zaottini F, Mavilio N, Perocchio G, Pane B, Ricci D, Pratesi G, Castellan L, Santini F. Endovascular Versus Open Surgical Repair for Ruptured Descending Aortic Pathologies: A Systematic Review and Meta-Analysis of Observational Studies. Cardiovasc Intervent Radiol 2021; 44:1709-1719. [PMID: 34173045 DOI: 10.1007/s00270-021-02893-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ruptured descending thoracic aorta (rDTA) is an harmful condition requiring emergent treatment. Thoracic endovascular aortic repair (TEVAR) is replacing the traditional open repair in the majority of descending thoracic aortic disease. An unanimous agreement regarding the optimal approach to treat rDTA has not been reached yet due to the lack of evidences supporting the improvement of long-term survival. The present meta-analysis of observational cohort studies aims to estimate the outcome of endovascular (TEVAR) versus surgical (OR) approach in the treatment of rDTA. METHODS Prisma Statement for performing and reporting meta-analysis has been used. MEDLINE, Scopus and the Cochrane Library databases were searched. A meta-analysis of observational cohort studies that examined the outcomes after OR and TEVAR for the management of rDTA was performed. RESULTS A total of 10,466 patients with rDTA were screened. Endovascular therapy was associated with a lower risk of in-hospital mortality compared with open repair (Risk Ratio[RR] 0.63; 95% CI0.57-0.70). The risk of stroke rate was not statistically different between endovascular versus open approach (RR0.86; 95% CI0.62-1.19). Endovascular treatment had benefits on paraplegia (RR0.70; 95% CI0.55-0.91) and other neurological complications (RR0.24; 95% CI0.10-0.56). TEVAR was associated with lower renal failure, cardiac complications and vascular injuries. Late mortality (Hazard Ratio[HR] 0.84; 95% CI0.63-1.13) and re-intervention rate (RR1.48; 95% CI0.80-2.74) were not significantly different between TEVAR and OR. CONCLUSIONS TEVAR seems to offer advantages in terms of early mortality and complications rate. Moreover, data on late mortality and re-intervention are encouraging to consider endovascular treatment comparable to open repair for acute thoracic aorta emergency on long-term follow-up.
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Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Giancarlo Salsano
- Dipartimento di Radiologia e Neuroradiologia, IRCCS Ospedale Policlinico San Martino, L.Go Rosanna Benzi, 10, 16132, Genoa, Italy.
| | - Giovanni Spinella
- Department of Integrated Sciences (DISC), University of Genova, Genova, Italy.,Division of Vascular Surgery, Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Zaottini
- Dipartimento di Radiologia e Neuroradiologia, IRCCS Ospedale Policlinico San Martino, L.Go Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Nicola Mavilio
- Dipartimento di Radiologia e Neuroradiologia, IRCCS Ospedale Policlinico San Martino, L.Go Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Giacomo Perocchio
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Bianca Pane
- Department of Integrated Sciences (DISC), University of Genova, Genova, Italy.,Division of Vascular Surgery, Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Ricci
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Giovanni Pratesi
- Department of Integrated Sciences (DISC), University of Genova, Genova, Italy.,Division of Vascular Surgery, Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucio Castellan
- Dipartimento di Radiologia e Neuroradiologia, IRCCS Ospedale Policlinico San Martino, L.Go Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Integrated Sciences (DISC), University of Genova, Genova, Italy
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Outcome Comparison of TEVAR with and without Left Subclavian Artery Revascularization from Analysis of Nationwide Inpatient Sample Database. Ann Vasc Surg 2019; 58:174-179. [DOI: 10.1016/j.avsg.2019.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 11/20/2022]
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Hasjim BJ, Grigorian A, Barrios C, Schubl S, Nahmias J, Gabriel V, Spencer D, Donayre C. National Trends of Thoracic Endovascular Aortic Repair versus Open Thoracic Aortic Repair in Pediatric Blunt Thoracic Aortic Injury. Ann Vasc Surg 2019; 59:150-157. [PMID: 30802562 DOI: 10.1016/j.avsg.2018.12.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Blunt thoracic aortic injury (BTAI) occurs in <1% of all trauma admissions. Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment modality in adult patients with BTAI, but its use in pediatrics is currently not supported by device manufacturers and lacks United States Food and Drug Administration approval. We hypothesized that there would also be an increased use of TEVAR in the pediatric population, thus conferring a lower risk of mortality compared with open thoracic aortic repair (OTAR). METHODS The National Trauma Data Bank (2007-2015) was queried for patients ≤17 years with BTAI. The primary outcomes were the incidences of TEVAR and OTAR. Secondary outcome was risk of mortality in those undergoing intervention. A multivariable logistic regression model was used to determine the risk of mortality in OTAR versus TEVAR. RESULTS We identified 650 pediatric BTAI patients with 159 (24.5%) undergoing intervention. Of these, 124 underwent TEVAR (78.0%) and 35 (22.0%) underwent OTAR. The rate of TEVAR steadily increased from 2007 to 2015 (15.4% vs. 27.1%, P < 0.001). Patients receiving OTAR and TEVAR had a similar injury severity score and rate of hypotension on admission (P > 0.05). Compared with OTAR, TEVAR patients had a higher rate of any traumatic brain injury (TBI) (63.7% vs. 37.1%, P = 0.005) and shorter hospital and intensive care unit length of stay (LOS) (16.4 vs. 21.4 days, P = 0.02; 10.1 vs. 12.2 days, P = 0.01). TEVAR and OTAR, even when stratified by ≤14 years and 15-17 years, had no difference in risk for mortality (odds ratio 1.20, confidence interval 0.29-5.01, P = 0.80). CONCLUSIONS The rate of TEVAR in pediatric BTAI nearly doubled from 2007 to 2015. Compared with OTAR, TEVAR was associated with a shorter hospital LOS despite a higher rate of TBI. There was no difference in risk for mortality between TEVAR and OTAR. Longitudinal studies to determine the long-term efficacy and complication rates, including reintervention, development of endoleak, and/or need for further operations, are needed as this technology is being rapidly adopted for pediatric trauma patients.
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Affiliation(s)
- Bima J Hasjim
- Department of Surgery, University of California, Irvine, Orange, CA, USA.
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Cristobal Barrios
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Viktor Gabriel
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Dean Spencer
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Carlos Donayre
- Division of Vascular Surgery, Department of Surgery, University of California, Orange, Irvine, CA, USA
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Pagliariccio G, Salati M, Roncon A, Gironi G, Carbonari L. Endovascular Treatment of Blunt Thoracic Aortic Injury by Fractured Rib. Ann Vasc Surg 2019; 57:272.e15-272.e17. [PMID: 30684606 DOI: 10.1016/j.avsg.2018.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022]
Abstract
We treated an 89-year-old patient affected by a descending thoracic aorta lesion due to a rib fracture with a penetrating costal stump. An urgent combined thoracic and endovascular surgical approach was performed, removing the rib fragment and positioning an aortic endoprosthesis simultaneously. Postoperative angio-computed tomography scan demonstrated the correct position of the endoprosthesis without any leakage or periaortic hemorrhage.
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Affiliation(s)
- Gabriele Pagliariccio
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy.
| | - Michele Salati
- Department of Thoracic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Alberto Roncon
- Department of Thoracic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Giulia Gironi
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Luciano Carbonari
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy
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Chou EL, Twerdahl EH, Eagleton MJ. Endovascular management of penetrating and non-penetrating aortic injury. VASA 2018; 48:23-33. [PMID: 30227809 DOI: 10.1024/0301-1526/a000740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aortic trauma is a devastating injury often associated with significant polytrauma. Penetrating injury of the aorta is highly lethal and therefore rarely encountered in the hospital setting. The management of blunt trauma of the aorta has changed significantly over the past decade, principally due to improved imaging technology and the development of endovascular therapy. The most common site of injury is the proximal descending thoracic aorta. The degree of aortic wall injury guides the indication for therapy, while a combination of the degree of injury and the extent of co-morbid injuries drives the timing of repair. Lower grade injuries frequently do not require any surgical intervention. Thoracic aortic endograft repair can be performed in a safe, expeditious fashion. Short-term and mid-term outcomes appear excellent, with patient survival based mainly on concomitant traumatic injuries. Long-term outcomes are less well known. Future endeavors will be guided toward gaining a better understanding of the indications for repair and the long-term outcomes for endograft devices designed for this purpose.
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Affiliation(s)
- Elizabeth L Chou
- 1 Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, USA
| | - Eric H Twerdahl
- 1 Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, USA
| | - Matthew J Eagleton
- 1 Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, USA
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Dios-Barbeito S, Durán-Muñoz-Cruzado V, Martín-García C, Rubio-Manzanares-Dorado M, Padillo-Ruiz F, Pareja-Ciuró F. ¿Qué pacientes politraumatizados graves se benefician de la realización de un total-body CT ? Med Intensiva 2018; 42:129-131. [DOI: 10.1016/j.medin.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/06/2017] [Accepted: 03/03/2017] [Indexed: 01/02/2023]
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Schicho A, Lürken L, Meier R, Stroszczynski C, Schreyer A, Dendl LM, Schleder S. Non-penetrating traumatic injuries of the aortic arch. Acta Radiol 2018; 59:275-279. [PMID: 28565961 DOI: 10.1177/0284185117713352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In severely injured trauma patients, non-penetrating aortic arch injuries (NAAI) have a remarkable incidence and mortality. Both diagnostics and therapy of NAAI recently underwent significant changes. Purpose To assess mortality, morbidity, and the risk factors associated with NAAI in severely injured patients (Injury Severity Score [ISS] ≥16) under the light of recent technical and procedural advances in trauma care. Material and Methods A total of 230 consecutive trauma patients with ISS ≥16 admitted to our level-I trauma center during a 24-month period, were prospectively included and underwent standardized whole-body computed tomography (CT) in a 2 × 128-detector-row scanner. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded for patients with NAAI. Localization of NAAI was described referring to Mitchell and Ishimaru; severity was graded according to the proposal of Heneghan et al. Results Thirteen of 230 patients had a NAAI, yielding an incidence of 5.6%. Mean age and ISS was not elevated in NAAI (44.4 ± 14.8 years, ISS = 38 ± 12.4). Mortality was 23.1%. One patient had severe neurologic sequelae from a stroke; all surviving patients had to undergo (transient) anticoagulant therapy. Trauma mechanism was of high kinetic energy in all cases. Concomitant injuries were predominantly thoracic (rib fractures = 76.9%, thoracic spine fracture = 38.5%). Conclusion Whenever an individual possibly encountered a deceleration-acceleration trauma mechanism, a high level of suspicion for NAAI should be maintained. It remains to be determined whether recent advances in mortality are due to changes in trauma care or due to improved vehicle and road safety.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Ramona Meier
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Andreas Schreyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lena-Marie Dendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schleder
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Patelis N, Katsargyris A, Klonaris C. Endovascular Repair of Traumatic Isthmic Ruptures: Special Concerns. Front Surg 2017; 4:32. [PMID: 28660196 PMCID: PMC5466971 DOI: 10.3389/fsurg.2017.00032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/26/2017] [Indexed: 01/16/2023] Open
Abstract
Injury of the aortic isthmus is the second most frequent cause of death in cases of blunt traumatic injury. Conventional open repair is related to significant morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) has increasing role in traumatic isthmic rupture, as it avoids the thoracotomy-related morbidity, aortic cross clamping, and cardiopulmonary bypass. Additionally to the technical difficulties of open repair, multi-trauma patients may not tolerate the manipulations necessary to undergo open surgery, due to concomitant injuries. TEVAR is a procedure easier to perform compared to open surgery, despite that a considerable degree of expertise is necessary. Direct comparison of the two methods is difficult, but TEVAR appears to offer better results than open repair in terms of mortality, incidence of spinal cord ischemia, renal insufficiency, and graft infection. TEVAR is related to a-statistically not significant-trend for higher re-intervention rates during the follow-up period. Current guidelines support TEVAR as a first-line repair method for traumatic isthmic rupture. Certain specific considerations related to TEVAR, such as the timing of the procedure, the type and oversizing of the endograft, heparinization during the procedure, the necessity of cerebrospinal fluid drainage, type of anesthesia, and the necessary follow-up strategy remain to be clarified. TEVAR should be considered advantageous compared to open surgery, but future developments in endovascular materials, along with accumulating long-term clinical data, will eventually improve TEVAR results in traumatic aortic isthmic rupture (TAIR) cases. This publication reviews the role, outcomes, and relevant issues linked to TEVAR in the repair of TAIR.
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Affiliation(s)
- Nikolaos Patelis
- First Department of Surgery, Vascular Unit, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Chris Klonaris
- First Department of Surgery, Vascular Unit, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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