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Satam K, Sorondo S, Paisley M, Chandra V. Hybrid repair of an innominate artery pseudoaneurysm after blunt traumatic injury in a bovine arch. J Vasc Surg Cases Innov Tech 2023; 9:101225. [PMID: 38106347 PMCID: PMC10725054 DOI: 10.1016/j.jvscit.2023.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/08/2023] [Indexed: 12/19/2023] Open
Abstract
Innominate artery injury is an uncommon consequence of blunt trauma to the neck due to its protected position behind the thorax. A 38-year-old male presented as a trauma with a right-sided pseudoaneurysm emanating from the distal innominate artery after falling from a three-story building. On imaging, he also had a bovine arch. He underwent hybrid repair with covered stent placement from the common carotid into the innominate artery, carotid-subclavian bypass, and plugging of the subclavian artery. The patient recovered with no cerebral insult, neurological deficits, or rupture. Post-traumatic innominate artery pseudoaneurysms can successfully be repaired via a hybrid surgical approach.
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Affiliation(s)
| | - Sabina Sorondo
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
| | | | - Venita Chandra
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
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Barabino E, Ivaldi D, Pittaluga G, Nivolli A, Arnò M, Gazzo P. The spectrum of computed tomography findings in blunt trauma of the subclavian/axillary artery: a pictorial essay. Diagn Interv Radiol 2023; 29:117-127. [PMID: 36960559 PMCID: PMC10679581 DOI: 10.5152/dir.2022.211271] [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] [Received: 12/21/2021] [Accepted: 03/16/2022] [Indexed: 01/15/2023]
Abstract
Traumatic injuries of the subclavian and axillary arteries are uncommon but have high morbidity and mortality. In contrast to penetrating injuries, which are often lethal, blunt injuries present a wide and heterogeneous spectrum of imaging findings. If a vessel tear or transsection is a life-threatening circumstance, minor injuries might be overlooked in an emergency setting but could cause or aggravate the functional loss of a limb. The aim of this pictorial essay is to acquaint radiologists with the spectrum of imaging findings that could be encountered during the radiological evaluation of the subclavian/axillary artery (SAA) in trauma patients and offer tips and tricks to improve the diagnostic workup of patients with suspected blunt SAA injuries.
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Affiliation(s)
- Emanuele Barabino
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Diego Ivaldi
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Giulia Pittaluga
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Arianna Nivolli
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Matteo Arnò
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
| | - Paolo Gazzo
- Department of Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italia
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Diagnostic value of chest radiography in the early management of severely injured patients with mediastinal vascular injury. Eur J Trauma Emerg Surg 2022; 48:4223-4231. [PMID: 35389063 PMCID: PMC9532297 DOI: 10.1007/s00068-022-01966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/23/2022] [Indexed: 11/12/2022]
Abstract
Introduction Time is of the essence in the management of severely injured patients. This is especially true in patients with mediastinal vascular injury (MVI). This rare, yet life threatening injury needs early detection and immediate decision making. According to the ATLS guidelines [American College of Surgeon Committee on Trauma in Advanced Trauma Life Support (ATLS®), 10th edn, 2018], chest radiography (CXR) is one of the first-line imaging examinations in the Trauma Resuscitation Unit (TRU), especially in patients with MVI. Yet thorough interpretation and the competence of identifying pathological findings are essential for accurate diagnosis and drawing appropriate conclusion for further management. The present study evaluates the role of CXR in detecting MVI in the early management of severely injured patients. Method We addressed the question in two ways. (1) We performed a retrospective, observational, single-center study and included all primary blunt trauma patients over a period of 2 years that had been admitted to the TRU of a Level-I Trauma Center. Mediastinal/chest (M/C) ratio measurements were calculated from CXRs at three different levels of the mediastinum to identify MVI. Two groups were built: with MVI (VThx) and without MVI (control). The accuracy of the CXR findings were compared with the results of whole-body computed tomography scans (WBCT). (2) We performed another retrospective study and evaluated the usage of sonography, CXR and WBCT over 15 years (2005–2019) in level-I–III Trauma Centers in Germany as documented in the TraumaRegister DGU® (TR-DGU). Results Study I showed that in 2 years 267 patients suffered from a significant blunt thoracic trauma (AIS ≥ 3) and met the inclusion criteria. 27 (10%) of them suffered MVI (VThx). Through the initial CXR in a supine position, MVI was detected in 56–92.6% at aortic arch level and in 44.4–100% at valve level, depending on different M/C-ratios (2.0–3.0). The specificity at different thresholds of M/C ratio was 63.3–2.9% at aortic arch level and 52.9–0.4% at valve level. The ROC curve showed a statistically random process. No significant differences of the cardiac silhouette were observed between VThx and Control (mean cardiac width was 136.5 mm, p = 0.44). Study II included 251,095 patients from the TR-DGU. A continuous reduction of the usage of CXR in the TRU could be observed from 75% in 2005 to 25% in 2019. WBCT usage increased from 35% in 2005 to 80% in 2019. This development was observed in all trauma centers independently from their designated level of care. Conclusion According to the TRU management guidelines (American College of Surgeon Committee on Trauma in Advanced Trauma Life Support (ATLS®), 10th edn, 2018; Reissig and Kroegel in Eur J Radiol 53:463–470, 2005) CXR in supine position is performed to detect pneumothorax, hemothorax and MVI. Our study showed that sensitivity and specificity of CXR in detecting MVI was statistically and clinically not reliable. Previous studies have already shown that CXR is inferior to sonography in detecting pneumothorax and hemothorax. Therefore, we challenge the guidelines and suggest that the use of CXR in the early management of severely injured patients should be individualized. If sonography and WBCT are available and reasonable, CXR is unnecessary and time consuming. The clinical reality reflected in the usage of CXR and WBCT over time, as documented in the TR-DGU, seems to support our statement.
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Jones KA, Sadri S, Ahmad N, Weintraub JR, Reis SP. Thoracic Trauma, Nonaortic Injuries. Semin Intervent Radiol 2021; 38:75-83. [PMID: 33883804 DOI: 10.1055/s-0041-1726005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trauma is one of the leading causes of death worldwide. Approximately two-thirds of trauma patients have thoracic injuries. Nonvascular injury to the chest is most common; however, while vascular injuries to the chest make up a small minority of injuries in thoracic trauma, these injuries are most likely to require intervention by interventional radiology (IR). IR plays a vital role, with much to offer, in the evaluation and management of patients with both vascular and nonvascular thoracic trauma; in many cases, IR treatments obviate the need for these patients to go to the operating room. This article reviews the role of IR in the treatment of vascular an nonvascular traumatic thoracic injuries.
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Affiliation(s)
- Kai A Jones
- Columbia University Vegelos College of Physicians and Surgeons, New York, New York
| | - Shirin Sadri
- Columbia University Vegelos College of Physicians and Surgeons, New York, New York
| | - Noor Ahmad
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York
| | | | - Stephen P Reis
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York
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Laugsand EA, Xanthoulis A. Management of a life-threatening intercostal artery bleeding, difficult to visualize in open surgery: a case report. J Surg Case Rep 2020; 2020:rjaa444. [PMID: 33154815 PMCID: PMC7602520 DOI: 10.1093/jscr/rjaa444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Life-threatening bleeding from an intercostal artery is a rare and challenging event. A 74-year-old patient with a right-sided pleural effusion was treated by a pigtail pleural drain. He developed a large haemothorax, initially addressed by a large bore chest tube. As he became haemodynamically unstable, he required an emergency anterolateral right thoracotomy. It was difficult to visualize and reach the bleeding vessel during open surgery. A 30° laparoscopy camera was introduced and the bleeding site was identified. An incision was made directly over the bleeding site and the two ends of the lacerated intercostal artery were ligated by two externally placed figure-of-eight sutures. The patient survived and recovered fully. As most general surgeons, even at smaller hospitals, are familiar with laparoscopy, the technique described here may be useful for other surgeons to employ if a life-threatening intercostal artery injury occurs.
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Affiliation(s)
- Eivor Alette Laugsand
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Athanasios Xanthoulis
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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6
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Müller SA, Müller-Lebschi JA, Müller AM. Komplikationsmanagement in der operativen Versorgung der Klavikulafraktur. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chapman SC, McDaniel B, Andraska E, Phillips A, Madigan MC. CT Three-Dimensional (3D) Modeling Maintains Fluoroscopy Time and Contrast Volume to a Minimum in the Endovascular Treatment of Great Vessel Injury from Iatrogenic Trauma. Ann Vasc Surg 2020; 65:283.e13-283.e17. [DOI: 10.1016/j.avsg.2019.10.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
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8
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Langa SM, Dlamini NNM, Pillay B. Spectrum of multi-detector computed tomography imaging findings of thoracic vascular injuries secondary to blunt chest trauma: Correlation with vascular intervention and patient outcomes. SA J Radiol 2019; 23:1709. [PMID: 31754533 PMCID: PMC6837788 DOI: 10.4102/sajr.v23i1.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background Thoracic vascular injuries following blunt chest trauma are the second leading cause of trauma-related deaths. Multi-detector computed tomography (MDCT) is the imaging modality of choice in detecting these injuries. Objectives To determine the spectrum of vascular injuries detected on MDCT imaging in patients who sustained blunt chest trauma, and to assess the various types of management options and patient outcomes. Method We retrospectively reviewed archived medical records of polytrauma patients who presented with blunt chest trauma and confirmed vascular injury on MDCT and vascular intervention images between May 2015 and August 2018 at Inkosi Albert Luthuli Central Hospital. Results Thirty-nine patients with vascular injury findings were analysed. The injury spectrum comprised: 15 aortic injuries (AI), 19 non-aortic injuries (NAI), 4 combined (AI and NAI) and 1 aorto-venous injury. A majority of males (69%) with an overall mean age of 39 years constituted the study cohort. The commonest injury mechanisms included motor vehicle collisions (61%) and pedestrian accidents (28%); the remaining 11% were shared amongst motorbike accidents or falling from a moving train or a height. The subclavian artery (36%) was the most common anatomical location in the NAI and the frequent imaging finding was vessel occlusion (55%). The most common imaging findings in AI were the indirect signs (20.5%) followed by a grade III injury (15.4%). Six patients with a grade III AI were successfully managed with endovascular repair. Conclusion A thorough knowledge of blunt vascular injury spectrums and imaging manifestations is critical when interpreting MDCT scans. Awareness of the mechanism of injury will trigger a high index of suspicion and probe a search for a vascular injury.
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Affiliation(s)
- Sithembiso M Langa
- Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nondumiso N M Dlamini
- Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Balasoobramanien Pillay
- Department of Vascular /Endovascular Surgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Mori S, Ai T, Otomo Y. Atypical profile of aortic injury associated with blunt trauma in the metropolitan area of Japan. Trauma Surg Acute Care Open 2019; 4:e000342. [PMID: 31467987 PMCID: PMC6699723 DOI: 10.1136/tsaco-2019-000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Aortic injury caused by blunt trauma is a critical medical condition that requires extraordinary caution in the treatment. It is often caused by direct hit and high-speed deceleration in motor vehicle accidents. We reviewed and analysed the cases of aortic injury that referred to our institution located in the midst of the metropolitan area of Tokyo, Japan. Methods We retrospectively reviewed the blunt trauma cases transferred to Tokyo Medical and Dental University Hospital in the past 10 years. All cases with aortic injury were analyzed regardless of the AIS scores. Results: Between 2007 and 2017, a total of 3500 blunt trauma cases were transferred. Nineteen cases showed aortic injuries associated with blunt trauma (Age: 63.5±15.6 y.o.; 15 males). Thirteen patients were injured by fall, four patients were senior pedestrians hit by cars, one was injured while riding a motor bike, and one was hit by a train. A total of 11 cases presented a cardiopulmonary arrest on arrival; 8 severe aortic injuries, 1 cardiac rupture; and 2 multiple injuries. Eight cases were alive on arrival; 3 Stanford type A aortic dissections, 3 Stanford type B aortic dissections, and 2 aortic ruptures. Two cases of Stanford type A dissection underwent emergency repairs, whereas all 3 type B dissections went on a good course with conservative treatment. Conclusions Aortic injury caused by blunt trauma seems to be rare in a metropolitan area in Japan. In addition, the leading cause in our cases was fall, which might be a rare cause of aortic injuries in the other countries. Our observation might be a manifestation of population aging.
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Affiliation(s)
- Shusuke Mori
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiko Ai
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan.,Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan
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Elkbuli A, Shaikh S, McKenney M, Boneva D. Subclavian artery avulsion following blunt trauma: A case report and literature review. Int J Surg Case Rep 2019; 61:157-160. [PMID: 31376736 PMCID: PMC6677780 DOI: 10.1016/j.ijscr.2019.07.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022] Open
Abstract
Subclavian artery injuries are rare, highly fatal, and constitute less than 2% of all vascular injuries. Surgical repair of these injuries can be technically challenging due to their anatomic location. Therapeutic approaches include surgical repair, endovascular repair, or a hybrid approach depending on the severity of the injury and the patient’s hemodynamic status.
Introduction Subclavian artery injuries are rare and are associated with a high morbidity and mortality. The majority of patients with blunt trauma to the subclavian artery succumb to their injury before reaching a hospital. In-hospital mortality remains high. Presentation of case We report the case of a 30-year-old male who presented with complete traumatic subclavian artery avulsion after a motorcycle collision. He presented in hemorrhagic shock. Temporary hemostatic control was achieved with endovascular balloon occlusion followed by operative intervention. Discussion Prompt diagnosis and meticulous management including early transfusion, when indicated, are necessary to salvage both the patient’s life and limb from such severe injuries. Intra-operative diagnosis of subclavian artery injury is most common due to the hemodynamic instability of most patients with such injuries; however, conventional angiography and computed tomography angiography are useful diagnostic modalities as well. Temporizing measures such as endovascular balloon occlusion to obtain vascular control may serve as a valuable adjunct to surgical repair. Conclusion Repair of a subclavian artery injury is challenging for even the most experienced of surgeons. Endovascular techniques can be therapeutic or used as an adjunct to control bleeding ad allow an open repair.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States.
| | - Saamia Shaikh
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
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Eighteen years' experience of traumatic subclavian vascular injury in a tertiary referral trauma center. Eur J Trauma Emerg Surg 2019; 45:973-978. [PMID: 30627733 PMCID: PMC6910889 DOI: 10.1007/s00068-018-01070-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/27/2018] [Indexed: 11/09/2022]
Abstract
Purpose Traumatic subclavian vascular injury (TSVI) is rare but often fatal. The precise diagnosis of TSVI remains challenging mainly because of its occult nature, less typical presentations, and being overlooked in the presence of polytrauma. Compared to penetrating injuries, it is even more difficult to identify TSVI in patients who have blunt injuries and no visible bleeding. The risk factors associated with TSVI in patients with thoracic trauma are unclear. The aims of this study were to identify risk factors for TSVI in a cohort of patients with thoracic vascular injuries and to report outcomes after clinical treatment. Methods From January 2009 to June 2017, 39586 patients were admitted to our hospital (a level I trauma center) due to trauma, and 136 patients with thoracic vascular injury were enrolled in this study. We retrospectively reviewed data from medical records including demographic characteristics, injury scoring systems (RTS, ISS, NISS, TRISS and AIS), management and outcomes. Patients were further divided into the TSVI group (patients with TSVI) and the non-TSVI group (patients with thoracic vascular injuries other than TSVI). Univariate and multivariate analyses were used to identify independent risk factors. Results The enrolled 136 patients suffered mostly from blunt trauma (89.0%) and 22 of them had TSVI. When compared to the non-TSVI group, the TSVI group had lower Glasgow Coma Scale (GCS) scores (p = 0.002; especially GCS ≤ 12), less concurrent abdominal injury (p < 0.001), lower Injury Severity Scales (ISS) (p = 0.007) and New Injury Severity Scales (NISS) (p < 0.002) but had higher Abbreviated Injury Scales (AIS) of the head ≥ 3 (p = 0.009) and rates of clavicular or scapular fractures (p = 0.013). No difference was detected between the two groups with regard to age, gender, trauma mechanism, vital signs on arrival, or rate of facial and extremities injury. In multivariate regression analyses, GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI (p = 0.026, p = 0.043 and p = 0.005, respectively) after adjustment for confounding factors. Open and endovascular repair were two surgical procedures utilized for these TSVI patients with an overall mortality rate of 18.2%. No difference was found between these groups with regard to mortality rate and the length of ICU stay, but the patients in the TSVI group had a shorter length of hospital stay. Conclusions Our results suggest that GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI in patients with thoracic vascular injuries. For patients with thoracic trauma, TSVI should be considered for prompt management when patients exhibit concurrent injuries to the head, clavicle or scapula.
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Queiroz RM, Santana DBFD, Roque D, Bernardes Filho F, Febronio EM, Valentin MVN. Blunt thoracic trauma with the formation of pseudoaneurysm with the junction of the right subclavian artery. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2018; 64:987-989. [PMID: 30570048 DOI: 10.1590/1806-9282.64.11.987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Rodolfo Mendes Queiroz
- DOCUMENTA - Hospital São Francisco - Department of Radiology and Imaging Diagnosis, Ribeirão Preto, SP, Brasil
| | | | - Daniel Roque
- DOCUMENTA - Hospital São Francisco - Department of Radiology and Imaging Diagnosis, Ribeirão Preto, SP, Brasil
| | - Fred Bernardes Filho
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto, SP, Brasil
| | - Eduardo Miguel Febronio
- DOCUMENTA - Hospital São Francisco - Department of Radiology and Imaging Diagnosis, Ribeirão Preto, SP, Brasil
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Seudoaneurisma postraumático de la arteria innominada con variante arco aórtico bovino. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schicho A, Luerken L, Stroszczynski C, Meier R, Schreyer AG, Dendl LM, Schleder S. Vascular geometry as a risk factor for non-penetrating traumatic injuries of the aortic arch. PLoS One 2017; 12:e0180066. [PMID: 28644901 PMCID: PMC5482486 DOI: 10.1371/journal.pone.0180066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess biomechanical factors in aortic arch geometry contributing to the development of non-penetrating aortic arch injury (NAAI) in multiply injured patients with an Injury Severity Score (ISS) ≥ 16. MATERIAL AND METHODS 230 consecutive multiply injured trauma patients with an ISS ≥ 16 admitted to our Level-I trauma center during a consecutive 24-month period were prospectively included of whom 13 presented with NAAI (5.7%). Standardized whole-body CT in a 2x128-detector-row scanner included a head-and-neck CTA. Aortic arch diameters, width, height, angles and thoracic width and height were measured in individuals with NAAI and ISS-, sex-, age-, and trauma mechanism-matched controls. RESULTS There was no difference between groups regarding sex, age, ISS, and aortic diameters. The aortic arch angle in individuals with NAAI (71.3° ± 14.9°) was larger than in healthy control (60.7° ± 8.6°; p*<0.05). In patients with NAAI, the distance between ascendent and descendent aorta was larger (5.2 cm ± 1.9 cm) than in control (2.8 ± 0.5 cm; ***p<0.001). The aortic arch is higher above tracheal bifurcation in NAAI (3.6 cm ± 0.6 cm) than in matched control (2.4 cm ± 0.3 cm; ***p<0.001). Accordingly, the area under the aortic arch, calculated as half of an eliptic shape, is significantly larger in patients with NAAI (15.0 cm2 ± 6.5 cm2) when compared to age- and sex-matched controls without NAAI (5.5 cm2 ± 1.3 cm2; ***p<0.001). CONCLUSION Besides the magnitude of deceleration and direction of impact, width and height of the aortic arch are the 3rd and 4th factor directly contributing to the risk of developing traumatic NAAI in severely injured patients.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Lukas Luerken
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | | | - Ramona Meier
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas G. Schreyer
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Lena-Marie Dendl
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Schleder
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Bouabdallaoui N, Debbagh H, Schoell T, Lebreton G. Surgical Management of Undiagnosed Laceration of Superior Vena Cava Caused by Blunt Trauma. Ann Thorac Surg 2017; 101:1972-4. [PMID: 27106431 DOI: 10.1016/j.athoracsur.2015.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022]
Abstract
Intrapericardial rupture of the superior vena cava resulting from blunt thoracic trauma is a rare and life-threatening condition that has to be ruled out in the presence of signs of cardiac tamponade and a history of blunt thoracic trauma. We report the case of undiagnosed superior vena cava laceration caused by a high-speed road traffic accident in a 25 year-old patient revealed by cardiac tamponade. We highlight the need of urgent surgical exploration in all patients whose condition is unstable in the setting of blunt thoracic trauma regardless of imaging conclusions.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France.
| | - Hassan Debbagh
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France; Department of Thoracic and Cardiovascular Surgery, Fort de France University Hospital, Fort de France, Martinique, France
| | - Thibaut Schoell
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France; Department of Thoracic and Cardiovascular Surgery, Fort de France University Hospital, Fort de France, Martinique, France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France
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Papadomanolakis A, Theodoridou E, Vogiatzis N, Pentheroudaki A, Daskalaki D, Lolis ED. Injury to Azygos Venous System: A Co-Existing Injury in High-Impact Lethal Trauma. World J Surg 2017; 40:1355-61. [PMID: 26817649 DOI: 10.1007/s00268-016-3411-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND About 50 cases of azygos venous system injuries following civilian trauma have been published in current literature. The purpose of our study was to investigate the incidence of these injuries, the causative mechanism and type of trauma, the co-existing injuries, and the mortality rate in our institution. METHODS We performed a retrospective review of all trauma patients who were admitted to the surgical department of the General Hospital of Rethymno during an 11-year period. Our study included patients arriving at our institution dead or alive with an azygos venous system injury following blunt or penetrating civilian trauma. RESULTS Seven patients-five men and two women-were identified with azygos venous system injuries. Five had an azygos vein laceration, one suffered from both azygos and hemiazygos vein lacerations, and the last one had sustained hemiazygos and accessory hemiazygos vein injuries. All of them suffered from a blunt trauma. Three arrived at our hospital in extremis, and all died within 24 h despite our resuscitation attempts. All of our patients were polytrauma patients. All of them had co-existing torso injuries which were severe in all but one case, three of them suffered also from serious head injuries, and all but one had at least serious extremity's injuries. CONCLUSION Azygos venous system injuries are rare, although it seems that they are more frequent than current literature would indicate. Blunt trauma mechanism seems to be predominant in civilian trauma setting, and the patients have usually sustained a lot of serious and severe co-existing injuries with high resultant lethality.
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Affiliation(s)
- Antonios Papadomanolakis
- Department of Forensics Sciences, University Hospital of Heraklion Crete, Staurakion Voutes, 71110, Heraklion, Crete, Greece
| | - Eleni Theodoridou
- Department for Thoracic and Visceral Surgery, GPR Hospital, August-Bebel-Str.49, 65428, Ruesselsheim, Germany.
| | - Nikistratos Vogiatzis
- Surgical Department, General Hospital of Rethymno, Trantalidou 17, 74100, Rethymno, Greece
| | | | - Despoina Daskalaki
- Surgical Department, General Hospital of Rethymno, Trantalidou 17, 74100, Rethymno, Greece
| | - Evangelos D Lolis
- Surgical Department, General Hospital of Rethymno, Trantalidou 17, 74100, Rethymno, Greece
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Zamani J, Aghasadeghi K, Zarrabi K, Abdi Ardekani A, Zolghadrasli A. Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma. J Cardiovasc Thorac Res 2016; 8:46-8. [PMID: 27069568 PMCID: PMC4827140 DOI: 10.15171/jcvtr.2016.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 08/13/2015] [Indexed: 12/04/2022] Open
Abstract
Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT) angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition.
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Affiliation(s)
- Jalal Zamani
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Aghasadeghi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khalil Zarrabi
- Department of Cardiac Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Søreide K. Service as joint editor-in-chief for 11 years comes to an end: adieu, godspeed and auf wiedersehn! Scand J Trauma Resusc Emerg Med 2015; 23:110. [PMID: 26718460 PMCID: PMC4696309 DOI: 10.1186/s13049-015-0192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Sladojevic M, Markovic M, Ilic N, Pejkic S, Banzic I, Djoric P, Koncar I, Tomic I, Davidovic L. Open Treatment of Blunt Injuries of Supra-Aortic Branches: Case Series. Ann Vasc Surg 2015; 31:205.e5-205.e10. [PMID: 26647209 DOI: 10.1016/j.avsg.2015.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/22/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases. CASE REPORTS We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment. CONCLUSIONS When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible.
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Affiliation(s)
- Milos Sladojevic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Miroslav Markovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sinisa Pejkic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Banzic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Djoric
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Tomic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Pereira BMT, Chiara O, Ramponi F, Weber DG, Cimbanassi S, De Simone B, Musicki K, Meirelles GV, Catena F, Ansaloni L, Coccolini F, Sartelli M, Di Saverio S, Bendinelli C, Fraga GP. WSES position paper on vascular emergency surgery. World J Emerg Surg 2015; 10:49. [PMID: 26500690 PMCID: PMC4618918 DOI: 10.1186/s13017-015-0037-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 12/18/2022] Open
Abstract
Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).
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Affiliation(s)
- Bruno Monteiro T. Pereira
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Fabio Ramponi
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Dieter G. Weber
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | | | - Belinda De Simone
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Korana Musicki
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Guilherme Vieira Meirelles
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Fausto Catena
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Luca Ansaloni
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | | | | | - Cino Bendinelli
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | - Gustavo Pereira Fraga
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
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Challoumas D, Dimitrakakis G. Blunt Thoracic Aortic Injuries: New Perspectives in Management. Open Cardiovasc Med J 2015; 9:69-72. [PMID: 26312081 PMCID: PMC4541313 DOI: 10.2174/1874192401509010069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/20/2015] [Accepted: 04/02/2015] [Indexed: 01/16/2023] Open
Abstract
Blunt thoracic aortic injuries (BTAIs) present a great challenge because of their potentially fatal outcomes. Recent advancements in their management have proved to be beneficial in terms of various parameters, including mortality and complications. Endovascular repair is now the treatment of choice in most centres and is continuously replacing the traditional open surgical method. We present a mini-review of the most recent relevant literature that briefly describes the major shifts in the diagnosis and treatment of BTAIs and compares the outcomes of the conventional surgical approach to those of the endovascular method for the definitive repair of these injuries. Although both the reviewed literature and the most recently published guidelines are in support of the use of the endovascular approach, as short and midterm results are promising, its long-term outcomes still remain in question.
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Affiliation(s)
- Dimitrios Challoumas
- Department of Upper GI Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, Univers ity Hospital of Wales, Heath Park Campus, Cardiff, CF 14 4XW, UK
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23
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Challoumas D, Dimitrakakis G. Advances in the treatment of blunt thoracic aortic injuries. Injury 2015; 46:1431-9. [PMID: 25467824 DOI: 10.1016/j.injury.2014.10.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 02/02/2023]
Abstract
Blunt thoracic aortic injuries, even though rare in incidence, carry significant mortality rates and their management still remains challenging. There have been major shifts in diagnosing and treating these injuries in the last 5 decades, which proved to be beneficial in terms of mortality and complications. Endovascular repair has been increasingly used for definitive treatment and its outcomes appear to be at least equally safe and effective as those of open repair. We present a balanced review of the relevant literature regarding the most appropriate approach and definitive treatment of these pathological entities. Based on the studies analyzed, endovascular repair is increasingly being established as the choice of treatment, however, the conventional open surgical approach still remains a safe method for severe injuries; the mortality, complication rates and proven longterm results of the latter are continuously improving. Additionally, delayed repair, where appropriate, seems to be a safe option with very low mortality rates. Despite the encouraging short and midterm outcomes reported, endovascular treatment needs to be assessed in the longterm for more accurate conclusions to be drawn about its durability and safety.
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Affiliation(s)
- Dimitrios Challoumas
- Cardiff University School of Medicine, Heath Park Campus, University Hospital of Wales, Cardiff CF14 4XW, UK.
| | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park Campus, Cardiff CF14 4XW, UK
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24
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Penn JL, Martindale JL, Milne LW, Marill KA. Aortic dissection associated with blunt chest trauma diagnosed by elevated D-dimer. Int J Surg Case Rep 2015; 10:76-9. [PMID: 25805614 PMCID: PMC4429846 DOI: 10.1016/j.ijscr.2015.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/13/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Similar to spontaneous aortic dissection, traumatic aortic dissection is diagnosed with a careful history and physical exam, chest radiograph, and ultimately, dedicated aortic imaging. The diagnosis of spontaneous aortic dissection may be aided by using the serum D-dimer test. The use of D-dimer for diagnosing aortic injury in the setting of blunt trauma has not previously been reported. PRESENTATION OF CASE We present a case of aortic dissection in a 61-year-old male diagnosed when the patient presented with chest pain after blunt chest trauma. DISCUSSION The patient had no known history or risk factors for aortic disease. None of the classic findings were present by history, physical examination or chest radiograph and the diagnosis was made as the result of an elevated D-dimer. We discuss how the D-dimer test fortuitously led to the diagnosis in this case, and the implications. CONCLUSION D-dimer could be helpful in diagnosing aortic injuries in low-risk chest trauma patients.
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Affiliation(s)
- Joshua L Penn
- Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Neville House - 236A, Boston, Massachusetts 02115, USA
| | - Jennfier L Martindale
- Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Neville House - 236A, Boston, Massachusetts 02115, USA
| | - Leslie W Milne
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 3B, Boston, Massachusetts 02114, USA
| | - Keith A Marill
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 3B, Boston, Massachusetts 02114, USA.
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25
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Oliveira N, Alves G, Rodrigues H, Gonçalves FB, Martins J, Morais JA, Ferreira ME, Castro JA, Capitão LM. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/j.ancv.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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26
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Muckart DJJ, Pillay B, Hardcastle TC, Skinner DL. Vascular injuries following blunt polytrauma. Eur J Trauma Emerg Surg 2014; 40:315-22. [DOI: 10.1007/s00068-014-0382-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
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Gunn MLD, Lehnert BE, Lungren RS, Narparla CB, Mitsumori L, Gross JA, Starnes B. Minimal aortic injury of the thoracic aorta: imaging appearances and outcome. Emerg Radiol 2014; 21:227-33. [PMID: 24414144 DOI: 10.1007/s10140-013-1187-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
The aim of this study is to describe the frequency, computed tomographic angiography (CTA) imaging appearance, management, and outcome of patients who present with minimal thoracic aortic injury. This retrospective study was Institutional Review Board-approved. Eighty-one patients with blunt traumatic aortic injuries (BTAI) were identified between 2004 and 2008, comprising 23 patients with minimal aortic injury (MAI) (mean age, 43.2 years ±18.2 years; 12 males and 11 females) and 58 patients with non-minimal aortic injury (mean age, 42.6 years ±22.7 years). CTA imaging was reviewed for each patient to differentiate those with MAI from those with non-MAI BTAI. Inclusion criteria for MAI on CTA were: post-traumatic abnormality of the internal contour of the aorta wall projecting into the lumen, intimal flap, intraluminal filling defect, intramural hematoma, and no evidence of an abnormality to the external contour of the aorta. Relevant follow-up imaging for MAI patients was also reviewed for resolution, stability, or progression of the vascular injury. The electronic medical record of each patient was reviewed and mechanism of injury, injury severity score, associated injuries, type and date of management, outcome, and days from injury to last medical consultation. Minimal aortic injury represented 28.4 % of all BTAI over the study period. Mean injury severity score (37.1), age (43.2 years), and gender did not differ significantly between MAI and non-MAI types of BTAI. Most MAI occurred in the descending thoracic aorta (16/23, 69 %). Without operative or endovascular repair, there was no death or complication due to MAI. One death occurred secondary to MAI (4.4 %) in a patient who underwent endovascular repair and surgical bypass, compared with an overall mortality rate of 8.6 % in the non-MAI BTAI group (p = 0.508). The most common CT appearance of MAI was a rounded or triangular intra-luminal aortic filling detect (18/23 patients, 78 %). In a mean of 466 days of clinical follow-up, no complications were observed in survivors treated without endovascular repair or operation. Minimal aortic injury is identified by multi-detector row CT in more than a quarter of cases of BTAI and has a low mortality. Conservative management is associated with an excellent outcome.
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Affiliation(s)
- Martin L D Gunn
- Department of Radiology, Harborview Medical Center, University of Washington, Box 359728, 325 9th Ave, Seattle, WA, 98104, USA,
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Li PS, Tsai CL, Lin TC, Hung SW, Hu SY. Endovascular treatment for traumatic thoracic aortic pseudoaneurysm: a case report. J Cardiothorac Surg 2013; 8:36. [PMID: 23452982 PMCID: PMC3639143 DOI: 10.1186/1749-8090-8-36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
Cases of an endovascular treatment for traumatic aortic injury are extremely rare. A prompt diagnosis of traumatic thoracic aortic pseudoaneurysm through a 3-dimensional computed tomographic angiography of aorta and emergency repair are mandatory to rescue the life-threatening condition. An endovascular treatment is a trend for traumatic aortic injury because of lower invasivity, morbidity and mortality. We reported a rare case of traumatic aortic injury with thoracic aortic pseudoaneurysm definitively diagnosed by the reconstructional computed tomographic angiography of aorta and successfully treated with endovascular stent-graft.
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Affiliation(s)
- Po-Sung Li
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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29
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Miettinen S, Hakala T. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report. J Med Case Rep 2012; 6:318. [PMID: 23009261 PMCID: PMC3469334 DOI: 10.1186/1752-1947-6-318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 05/02/2012] [Indexed: 11/29/2022] Open
Abstract
Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.
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Affiliation(s)
- Simo Miettinen
- Department of Surgery, North Karelian Central Hospital, Tikkamaentie 16, Joensuu, 80210, Finland.
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Gonçalves R, Saad Júnior R. [Surgical accesses to the major mediastinal vessels in thoracic trauma]. Rev Col Bras Cir 2012; 39:64-73. [PMID: 22481709 DOI: 10.1590/s0100-69912012000100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 11/15/2010] [Indexed: 08/30/2023] Open
Abstract
Trauma is the most common cause of death in the economically active population and thoracic trauma is directly or indirectly responsible for one quarter of these deaths. Lesions to the large thoracic vessels are associated with immediate or early death in the hospital setting. Patients admitted alive can be classified as stable or unstable. The access route to be elected for management of these veins will depend on this status, as well as on the anatomical particularities of the patient, which may require combined incisions for adequate access. This article provides a review and discussion of lesions to these structures as well as access routes to them.
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Left subclavian artery pseudoaneurysm after a traffic accident: a case report. Case Rep Crit Care 2011; 2011:451819. [PMID: 24826320 PMCID: PMC4010066 DOI: 10.1155/2011/451819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/16/2011] [Indexed: 11/17/2022] Open
Abstract
The left subclavian artery pseudoaneurysm is a rare entity with few cases reported in the literature. Most injuries were related to iatrogenic manipulation with catheters for canalization of central lines. In rare cases, this injury has been described secondary to a blunt trauma.
We present an unusual case of pseudoaneurysm that includes the origin of left subclavian artery in the context of severe multiple injuries after a traffic accident. There were not clavicular or rib fractures, or another type of chest trauma to justify such a vascular injury. Once the injuries that were life threatening for the patient were stabilized, it proceeded to the treatment of the pseudoaneurysm by placing an endovascular prosthesis successfully with a favorable clinical evolution.
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