Die traumatische Aortenruptur

Verkehrsunfälle sind für den größten Teil der traumatischen Aortenrupturen verantwortlich, meist zusammen mit weiteren schweren Begleitverletzungen. Die prähospitale Sterblichkeit ist hoch. Bei Verdacht auf eine beteiligte Aortenverletzung, aufgrund eines hohen traumatic aortic injury scores, ist eine Computertomographie durchzuführen. Es erfolgt eine Triage der Verletzungen, und die Versorgungspriorität der Aorta richtet sich nach dem Schweregrad der Aorten- und Begleitverletzungen sowie dem Zustand des Patienten. Bis zur definitiven Versorgung der aortalen Läsion muss der Blutdruck konsequent gesenkt werden. Grad I und II können in Einzelfällen unter enger Kontrolle inital konservativ gemanagt werden. Grad III (gedeckte Ruptur) und Grad IV (freie Ruptur) benötigen eine raschestmögliche Versorgung (interventionell, chirurgisch). In ausgesuchten Fällen kann auch eine verzögerte Versorgung günstig sein.

Als bevorzugte Versorgungsform hat sich die interventionelle Stentgrafttherapie etabliert.

Imaging of the Postsurgical Thoracic Aorta: A State-of-the-Art Review

Techniques for repair of the aorta currently include open and endovascular methods, hybrid approaches, minimally-invasive techniques, and aortic branch vessel reimplantation or bypass. Collaboration among radiologists and vascular and cardiothoracic surgeons is essential. An awareness of the various surgical techniques, expected postoperative appearance, and potential complications is essential for radiologists. This review will cover the postoperative appearance of the thoracic aorta with a focus on the ascending aorta. The value of three-dimensional image evaluation will also be emphasized.

Polytrauma to right diaphragm, descending thoracic aorta, and innominate artery

Traumatic diaphragmatic rupture with concomitant great vessel injuries is a catastrophic and life-threatening injury group that requires immediate identification and management. It can be both diagnostically and therapeutically very challenging. We report a case of combined traumatic diaphragmatic, aortic and innominate artery injuries, which was managed successfully. To have a fruitful outcome, management of this injury complex should preferably be staged depending on the hemodynamic stability of the patient. In a patient with traumatic diaphragmatic injuries, one should also have a high index of suspicion of associated great vessel injuries.

Vocal cord paralysis after aortic surgery

OBJECTIVE

The purpose of this study was to investigate variables associated with vocal cord paralysis during complex aortic procedures.

DESIGN

A retrospective review.

SETTING

A tertiary care center.

PARTICIPANTS

Four hundred ninety-eight patients who underwent aortic surgery between 2002 and 2007.

METHODS

Two groups were studied. Group A patients had procedures only involving their aortic root and/or ascending aorta. Group B patients had procedures only involving their aortic arch and/or descending aorta.

RESULTS

The incidence of vocal cord paralysis was higher (7.26% v 0.8%) in group B patients (p < 0.0001). Increasing the duration of cardiopulmonary bypass time was associated with an increased risk of vocal cord paralysis and death in both groups A and B (p = 0.0002 and 0.002, respectively). Additionally, within group B, descending aneurysms emerged as an independent risk factor associated with vocal cord paralysis (p = 0.03). Length of stay was statistically significantly longer among group A patients who suffered vocal cord paralysis (p = 0.017) and trended toward significance in group B patients who suffered vocal cord paralysis (p = 0.059). The association between tracheostomy and vocal cord paralysis among group A patients reached statistical significance (p = 0.007) and trended toward significance in group B patients (p = 0.057).

CONCLUSIONS

Increasing duration of cardiopulmonary bypass time was associated with a higher risk of vocal cord paralysis in patients undergoing aortic surgery. Additionally, within group B patients, descending aortic aneurysm was an independent risk factor associated with vocal cord paralysis. Most importantly, vocal cord paralysis appeared to have an association between an increased length of stay and tracheostomy among a select group of patients undergoing aortic surgery.

Pressure controlled clamp using shape memory alloy for minimal vessel invasion in blood flow occlusion

PURPOSE

Vessel damage after clamping may affect the success of surgical operations. A new pressure controlled clamp (SMA clamp) was designed using super elastic property of shape memory alloy (SMA) to realize atraumatic vessel occlusion. The ability and biological effect of the SMA clamp to control pressure was investigated in vivo.

METHODS

The loading-displacement curves of the SMA clamps (experimental group) and conventional clamp (control group) by occlusion of pig carotid arteries were evaluated using a clamping-pressure analyzing system. To investigate macroscopically and histologically the vessel damage of the SMA and conventional clamps, pig carotid arteries were stained with Evan's blue and its histological sections were stained with Elastica Massion after clamping for fifteen minutes.

RESULTS

Constant value was shown in the loading-displacement curve of SMA clamp. In the control group, damaged area stained with Evan's blue in the vessel wall showed enlargement with the pressure increasing. Less areas in experimental groups are observed than that in the control group. Histological section in the experimental group showed no obvious except a slight compressive damage in the tunica intima. In the control group, vessel wall showed irreversible damages.

CONCLUSIONS

This experiment indicated that the SMA clamp, which has a unique mechanical property, can be used without vessels damage. This pressure controlled clamp can be a selection in clinical apparatus to improve surgical safety.