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Florou M, Kepertis C, Stavridis K, Abatzis-Papadopoulos M, Tsopozidi M, Anastasiadis K, Tigkiropoulos K, Mouravas V. Endovascular Treatment With a Balloon-Expandable Covered Stent in a Polytrauma 12-Year-Old Patient With Traumatic Abdominal Aortic Rupture. Cureus 2024; 16:e63135. [PMID: 39055463 PMCID: PMC11271972 DOI: 10.7759/cureus.63135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Βlunt trauma is a common injury in children; however, blunt abdominal aortic trauma is extremely rare and is accompanied by high rates of morbidity and mortality. We report our initial experience with the endovascular management of an abdominal aortic rupture in a 12-year-old boy after he was involved in a motor vehicle accident. The patient was a backseat-restrained passenger. Upon admission, he had a Glasgow Coma Scale of 15, was hemodynamically stable, and complained of abdominal pain. The computed tomography revealed a rupture in the abdominal aorta along with a distally extending pseudoaneurysm, free fluid in the peritoneal cavity, and a large retroperitoneal hematoma. The rest associated injuries were a Grade III splenic injury, a retroclival epidural hematoma in the first cervical vertebra level, a right clavicle fracture, a bilateral minor pneumothorax, along with bilateral pulmonary lacerations and contusions in the thoracic vertebrae. Given the extent of the intraabdominal injuries and the risk for open laparotomy, the decision to proceed with endovascular stenting instead of open surgical repair was made. The patient tolerated the procedure well and an angiography confirmed the result. The postoperative period was uneventful and the associated injuries were treated conservatively without complications. Although blunt abdominal aortic trauma is extremely rare in children, endovascular management seems to be a new and feasible therapeutic approach.
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Affiliation(s)
- Maria Florou
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Chrysostomos Kepertis
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Kyriakos Stavridis
- Department of Vascular Surgery, Papageorgiou General Hospital, Thessaloniki, GRC
| | | | - Maria Tsopozidi
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Kleanthis Anastasiadis
- Department of Pediatric Surgery, Papageorgiou General Hospital, Thessaloniki, GRC
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Konstantinos Tigkiropoulos
- 1st Department of Surgery, Division of Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
- Department of Vascular Surgery, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Vassileios Mouravas
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
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Kaikaus J, Cheadle G, Dwivedi AJ, Sigdel A. Endovascular Repair of Traumatic Infrarenal Aortic Injury in an 8-Year-Old. Am Surg 2023; 89:3879-3880. [PMID: 37147572 DOI: 10.1177/00031348231173973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The patient is an 8 year-old male presenting to outside facility following high-speed motor vehicle collision in which he was a restrained passenger. CT imaging at that time demonstrated a traumatic infrarenal aortic pseudoaneurysm, extensive pneumoperitoneum and free fluid, and an unstable L2 vertebral body fracture. He underwent exploratory laparotomy with small bowel resection prior to transfer. The patient was left in discontinuity and temporary closed. Vascular surgery was consulted upon arrival to tertiary care children's hospital. The decision was made to proceed with emergent endovascular repair. An aortogram confirmed the location of the aortic disruption well below the renal arteries, superior to the bifurcation. An 11 mm × 5 cm Viabahn covered stent was placed across the injury with adequate proximal and distal seal. This is a case of seatbelt-related pediatric infrarenal aortic injury in the setting of polytrauma. Endovascular repair was pursued in this damage-control setting.
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Affiliation(s)
- Jahanzeb Kaikaus
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Gerald Cheadle
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Amit J Dwivedi
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Abindra Sigdel
- Department of Surgery, University of Louisville, Louisville, KY, USA
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3
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Warner D, Holmes KW, Afifi R, Russo ML, Shalhub S. Emergency vascular surgical care in populations with unique physiologic characteristics: Pediatric, pregnant, and frail populations. Semin Vasc Surg 2023; 36:340-354. [PMID: 37330246 DOI: 10.1053/j.semvascsurg.2023.04.015] [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: 03/08/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
Vascular surgical emergencies are common in vascular surgical care and require complex decision making and multidisciplinary care. They are especially challenging when they occur in patients with unique physiological characteristics, such as pediatric, pregnant, and frail patients. Among the pediatric and pregnant population, vascular emergencies are rare. This rarity challenges accurate and timely diagnosis of the vascular emergency. This landscape review summarizes these three unique populations' epidemiology and emergency vascular considerations. Understanding the epidemiology is the foundation for accurate diagnosis and subsequent management. Considering each population's unique characteristics is crucial to the emergent vascular surgical interventions decision making. Collaborative and multidisciplinary care is vital in gaining expertise in managing these special populations and achieving optimal patient outcomes.
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Affiliation(s)
- David Warner
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239
| | - Kathryn W Holmes
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Melissa L Russo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239.
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Lee KB, Solano A, Baig MS, Gonzalez-Guardiola G, Timaran CH, Keller MR, Kirkwood ML, Shih M. Endovascular Reconstruction Aortic Bifurcation for Aortic Pseudoaneurysm in a Pediatric Trauma Patient. J Vasc Surg Cases Innov Tech 2023; 9:101140. [PMID: 37125341 PMCID: PMC10140168 DOI: 10.1016/j.jvscit.2023.101140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 03/07/2023] Open
Abstract
Endovascular treatment options for vascular injury in pediatric patients are quite limited owing to concerns regarding long-term durability and the lack of devices suitable for the pediatric anatomy. However, in rare circumstances, open surgical therapy will not be an option, and patients will require unconventional endovascular solutions for lifesaving or limb-saving therapies. In the present report, we describe an endovascular treatment of a pediatric patient for whom initial surgical management of a blunt abdominal aortic injury had failed, with subsequent development of an aortic pseudoaneurysm. A 10-year-old girl had presented after a high-speed motor vehicle accident with a seatbelt sign. Multiple abdominal injuries were identified, including blunt aortic injury, significant devitalization of the small bowel, colonic perforation with fecal contamination, multiple lumbar spine fractures, and pulmonary contusions. The patient developed bilateral lower extremity ischemia from the aortic injury and had initially undergone open repair. One month later, the patient had developed a pseudoaneurysm of the aorta near the aortic bifurcation. Because of the hostile abdomen and ensuing short gut syndrome, the pseudoaneurysm was managed using endovascular techniques. The limb of an Excluder internal iliac branch endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ) was used as the endograft. The aortic bifurcation was raised and reconstructed using four Viabahn self-expanding stents (W.L. Gore & Associates). The completion angiogram showed complete resolution of the pseudoaneurysm. The follow-up computed tomography angiogram showed widely patent stent grafts with complete resolution of the pseudoaneurysm. Endovascular management of traumatic vascular injuries in pediatric patients is feasible. The likelihood of reintervention in the future is high with patient growth. However, it is a viable option in lifesaving or limb-saving situations in which open repair is high risk.
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Affiliation(s)
- K. Benjamin Lee
- Correspondence: K. Benjamin Lee, MD, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Professional Office Bldg 1, Ste 620, 5959 Harry Hines Blvd, Dallas, TX 75390-9157
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5
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A single center experience on the management of pediatric blunt aortic injury. J Vasc Surg 2022; 75:1570-1576. [PMID: 34995718 DOI: 10.1016/j.jvs.2021.12.067] [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: 05/19/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Blunt abdominal aortic injury in pediatrics is a rare clinical entity with which most vascular surgeons have minimal experience. Evidence for management recommendations is limited. Herein we report a single institution's experience in the care of pediatric abdominal aortic injuries. METHODS This is a retrospective review of consecutive pediatric patients diagnosed with blunt traumatic abdominal aortic injury at our institution between 2008 and 2019. RESULTS Sixteen pediatric patients (50% male) were identified, ranging in age between 4-17 years. All were involved in motor vehicle collisions and were restrained passengers with a seatbelt sign. Five patients (31%) were hypotensive en route or upon arrival. Seven patients (44%) were transferred from another hospital. The median Injury Severity Score (ISS) was 34 (Interquartile range, IQR 19-35). The infrarenal aortic injuries were stratified according to the aortic injury grading classification: n=5/2/7/2 (grades 1-4, respectively). Concurrent non-aortic injuries included solid organ (63%, n=10), hollow viscus (88%, n=14), brain (25%, n=4), hemo/pneumothorax (25%, n=4), spine fractures (81%, n=13), and non-spine fractures (75%, n=12). In total, 56% of patients (n=9/16) required aortic repair: three needed immediate revascularization for distal ischemia. The remaining six patients (38%) underwent a delayed repair with a median time to repair of 52 days (range 2-916 days). Half of delayed repairs occurred during the index hospitalization. On repeat axial imaging, the three delayed-repair patients were found to have enlarging pseudoaneurysms or flow-limiting dissections and subsequently underwent repair during index hospitalization. Only one patient underwent endovascular repair. No deaths occurred, and the median follow-up length was 7 months (IQR 3-28 months) in this study population. All postoperative patients demonstrated stable imaging without requiring further intervention. Seven patients, whose injury grades ranged between 1 and 3, were observed. Their repeat imaging demonstrated either stability or resolution of their aortic injury. Remarkably, half of patients were lost to follow up after discharge or following their first postoperative clinic visit. CONCLUSIONS Delayed aortic intervention can be safely performed in the majority of pediatric patients with blunt abdominal aortic injuries with preserved distal perfusion to the lower extremities. This suggests that transfer to a tertiary center with vascular expertise is a safe and feasible management strategy. However, progression of aortic injuries was seen as early as within 48 hours and as late as 30 months post injury, underscoring the importance of long-term surveillance. Unfortunately, in this cohort, 50% of the children were lost to follow up, highlighting the need for a more structured surveillance strategy.
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Patel S, Sheahan CM, Fontenot DD, Sheahan MG. Aortic Transection after Blunt Abdominal Trauma in a Child. Ann Vasc Surg 2020; 66:671.e11-671.e14. [PMID: 32035264 DOI: 10.1016/j.avsg.2020.01.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022]
Abstract
Abdominal aortic injury secondary to blunt abdominal aortic trauma (BAAI) is rare in children but frequently occurs in association with other injuries, including bowel injury and vertebral fracture. We present a case of a 14-year-old boy who sustained a partial transection of the infrarenal aorta with a lumbar chance fracture and small bowel injury after a motor vehicle accident. Repair was performed with bowel resection followed by Dacron graft interposition. We reviewed the literature on BAAI in children with a focus on the method of repair of these injuries.
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Affiliation(s)
- Shivik Patel
- Louisiana State University Health Sciences Center, New Orleans, LA
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7
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Nicholas NW, Shaw DR, Puppala S. Pictorial review on the endovascular management of paediatric aortic injuries. Br J Radiol 2020; 93:20190017. [PMID: 31899661 DOI: 10.1259/bjr.20190017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.
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Affiliation(s)
- Neville W Nicholas
- Department of Interventional Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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8
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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: 1.5] [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.
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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
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Apodaka Diez A, Mikelarena Monteiro E, Gallardo Hoyos Y, Fonseca Legrand JL. Management and Evolution of a Wallstent Migration in a Pediatric Blunt Traumatic Abdominal Aortic Injury. Ann Vasc Surg 2017; 47:281.e15-281.e19. [PMID: 28947217 DOI: 10.1016/j.avsg.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/04/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022]
Abstract
Blunt traumatic abdominal aortic injury in children is a rare but a severe condition. The clinical manifestation often involves other intra-abdominal visceral injuries and vertebral fractures. The best therapeutic management is still unclear with few reported endovascular cases treated. The following is the case of a 13-year-old male with an aortic abdominal dissection, spleen laceration, jejunal contusion, and hemoperitoneum after a motor vehicle collision. An endovascular approach was decided upon after the progression of the intimal aortic tear. A self-expanding stent was implanted into the injured position with an immediate proximal migration to the visceral aorta. It was decided not to retrieve the stent because of added comorbidity, and an open repair of the dissection was performed using a graft bypass. The patient has completed a 6-year image surveillance without complications or growth alterations. To our knowledge, this is the first reported childhood case of an intraoperative stent migration during the endovascular treatment of a blunt traumatic abdominal aortic injury. The possible cause of the complication and the management of these kinds of injuries are reviewed in detail in this article.
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Affiliation(s)
- Ana Apodaka Diez
- Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain.
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10
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Deeney S, Bruny JL. Endovascular repair of traumatic aortic injury in a 16 month old. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sadaghianloo N, Jean-Baptiste E, Breaud J, Declemy S, Kurzenne JY, Hassen-Khodja R. Blunt abdominal aortic trauma in paediatric patients. Injury 2014; 45:183-91. [PMID: 23174319 DOI: 10.1016/j.injury.2012.10.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 10/06/2012] [Accepted: 10/27/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Blunt abdominal aortic trauma (BAAT) is a very rare occurrence in children, with significant morbidity and mortality. Varied clinical presentations and sparse literature evidence make it difficult to define the proper management policy for paediatric patients. METHOD We report our centre's data on three consecutive children with BAAT managed between 2006 and 2010. A Medline search was also performed for relevant publications since 1966, together with a review of references in retrieved publications. RESULTS Forty children (range 1-16 years) were included in our final analysis. Motor vehicle crashes (MVC) were the leading cause of injury (65%). The in-hospital mortality rate was 7.5% (3/40). Nine patients (22.5%) ended up with residual sequelae. Main primary aortic lesions were complete wall rupture (12.5%), intimal transection (70%) and pseudoaneurysm (15%). Twenty-eight children underwent aortic surgical repair (70%). Among the 12 non-operatively managed patients, 41.6% had complications, including one death. CONCLUSION Symptomatic lesions and complete ruptures should undergo immediate surgical repair. Circumferential intimal transections are at high risk of complication and should also receive intervention. Partial intimal transections and delayed pseudoaneurysms can be initially observed by clinical examination and imaging. Patients with these latter pathologies should be operated on at any sign of deterioration.
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Affiliation(s)
- Nirvana Sadaghianloo
- Université de Nice Sophia Antipolis, France; Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, France
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12
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Traumatic abdominal aortic rupture treated by endovascular stent placement in an 11-year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Blunt abdominal aortic injury. J Vasc Surg 2012; 55:1277-85. [DOI: 10.1016/j.jvs.2011.10.132] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 09/15/2011] [Accepted: 10/13/2011] [Indexed: 11/19/2022]
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14
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Lieberman I, Chiasson D, Podichetty VK. Aortic disruption associated with L2-L3 fracture-dislocation in a case of child abuse: a case report. J Bone Joint Surg Am 2010; 92:1670-4. [PMID: 20595576 DOI: 10.2106/jbjs.i.01404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Isador Lieberman
- Texas Back Institute, 6020 West Parker Road, Plano, TX 75093, USA.
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Kobayashi T, Matsuda K, Iwase F, Miyazaki Y, Amenomori S, Kikuchi H, Nakajima M. Blunt abdominal aortic injury in a child: a case report. ACTA ACUST UNITED AC 2010. [DOI: 10.3893/jjaam.21.343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Four-Year Follow-Up of Endograft Repair of Traumatic Aortic Transection in a 10-Year-Old. Vasc Endovascular Surg 2009; 43:597-8. [DOI: 10.1177/1538574409334832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sidhu MK, Hogan MJ, Shaw DWW, Burdick T. Interventional radiology for paediatric trauma. Pediatr Radiol 2009; 39:506-15. [PMID: 19089416 DOI: 10.1007/s00247-008-1082-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 09/15/2008] [Accepted: 09/21/2008] [Indexed: 01/01/2023]
Abstract
Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting, interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional radiology techniques also have a significant role in treating delayed complications of trauma, including embolization of arterial pseudoaneurysms and pulmonary embolism prophylaxis in individuals immobilized due to the trauma or its operative treatment.
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Affiliation(s)
- Manrita K Sidhu
- Seattle Radiologists, The Everett Clinic, AIC, Seattle, WA 98104, USA.
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Abstract
BACKGROUND/PURPOSE Blunt trauma is the leading cause of pediatric injury, but pediatric aortic injuries are rare. We undertook this study to investigate the demographics, treatment, and outcomes of children with blunt aortic injuries and report our experience over a 10-year period. METHODS After Institutional Review Board approval, a 10-year retrospective review of all pediatric patients admitted with blunt aortic injury was performed. Patient demographics, injury details and severity score (Injury Severity Score), treatment, and outcomes were recorded. RESULTS There were 11 children, with ages ranging from 7 to 19 years. The most common mechanism of injury was motor vehicle crashes (8). Initial computed tomography demonstrated all 11 injuries: 7 thoracic aortic (TA) and 4 abdominal aortic (AA) injuries. Associated injuries were common. The TA injuries included 4 transections, 2 intimal flaps, and 1 pseudoaneurysm. Three of these were managed nonoperatively. The AA injuries included 3 intimal flaps and 1 dissection. Three of these were also managed nonoperatively. There were no complications in the 4 children with AA or in the 3 children with TA managed nonoperatively. Complications in the 4 children undergoing operative repair of the TA included paraplegia, renal failure, recurrent laryngeal nerve injury, and pulmonary embolus. The mean hospital stay was 8 days. All children survived, with all but one discharged directly to home. CONCLUSIONS Blunt aortic injury in children is uncommon and is primarily associated with motor vehicle crashes. Injuries to the abdominal aorta were seen with restrained children vs those to the thoracic aorta that were seen in children who were unrestrained.
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