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Traumatic aortic injury

Maen Aboul Hosn, Rachael Nicholson, Joseph Turek, William J Sharp, Luigi Pascarella
Traumatic aortic injuries in children and adolescents are rare. Although endovascular repair has become the preferred approach for such injuries in adults, open repair has endured as the gold standard in children owing mainly to the smaller aortic and access vessel diameter and the scarcity of long term follow up data. We report a successful endovascular repair of a traumatic thoracic aortic injury in an eight year old girl using a Zenith Alpha thoracic endograft (Cook Medical, Bloomington, Ind). We also review the literature on endovascular treatment of traumatic aortic injuries in the pediatric population...
November 28, 2016: Annals of Vascular Surgery
Dorian Verscheure, Julien Gaudric, Clémence Jouhannet, Laurent Chiche, Fabien Koskas
Traumatic injury of the left common carotid is rare but severe disease, and is an uncommon situation in emergency units. Thoracic aortic lesions are often associated with other injuries, making their treatment challenging. We report the case of a successful hybrid approach to treat this lesion using a total supra aortic vessels debranching and a thoracic endovascular graft to cover the rupture, in a 38 years old polytraumatized patient. After aortic, abdominal and orthopaedic surgery, the patient recovered well...
November 24, 2016: Annals of Vascular Surgery
Biniam Kidane, Vaibhav Gupta, Mostafa El-Beheiry, Kelly Vogt, Neil G Parry, Richard Malthaner, Thomas L Forbes
OBJECTIVE: Blunt traumatic thoracic aortic injuries (BTAI) can be lethal, but advances in trauma systems and in surgical care have helped reduce mortality. The purpose of this study was to investigate whether time from injury to presentation is associated with mortality following BTAI. METHODS: Using the Ontario Trauma Registry, all patients were identified who were hospitalized with BTAI between 1999 & 2009. Variables including age, sex, Injury Severity Score, Charlson comorbidity index, systolic blood pressure on admission, operative intervention, and time from injury to presentation were analysed using multivariate logistic regression to determine independent predictors of mortality...
November 24, 2016: Annals of Vascular Surgery
Jacek Wojciechowski, Lukasz Znaniecki, Kamil Bury, Kamil Chwojnicki, Jan Rogowski
PURPOSE: Traumatic aortic injury (TAI) is a rare but life-threatening type of injury. We investigate whether the anatomy of the aortic arch influences the severity of aortic injury. METHODS: This is a retrospective study of twenty-two cases treated with TEVAR for TAI in our department from 2009 to 2014. Aortic injury was assessed in accordance with the recommendations of the Society of Vascular Surgery. We measured the aortic arch angle and the aortic arch index, based on the initial angio-CT scan, in each of the analyzed cases...
November 17, 2016: Surgery Today
Funda Karbek Akarca, Tanzer Korkmaz, Celal Çınar, Elif Dilek Çakal, Murat Ersel
BACKGROUND: The purpose of our study was to retrospectively evaluate traumatic aortic transection patients and their bedside plain chest radiographs for signs of aortic injury. METHODS: Emergency department (ED) patients from a 5-year period with traumatic aortic transection who were over 18 years of age were included in the study. Demographic characteristics, mechanism of trauma, Revised Trauma Score, Glasgow Coma Score, vital signs, physical exam findings, laboratory parameters, length of stay in the ED, and patient outcomes were documented...
September 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
B Verillaud, L Robard, J Michel, V Pruliere Escabasse, E Béquignon, L Crampette, O Malard
OBJECTIVES: The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on second-line treatment of epistaxis in adults, after failure of anterior and/or anterior-posterior nasal packing. METHODS: A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience...
October 17, 2016: European Annals of Otorhinolaryngology, Head and Neck Diseases
Maria Ceja Rodriguez, Augustus Realyvasquez, Joseph Galante, William Pevec, Misty Humphries
No abstract text is available yet for this article.
August 2016: Journal of Vascular Surgery
Neal S Gerstein, Lindsay J Jinkins, Liem C Nguyen, Timothy M Maus, Todd S Dettmer, Lev Deriy
Aortic rupture and transection are constituents of the acute aortic syndrome. Injury to the thoracic aorta during motor vehicle crashes is associated with blunt chest trauma and rapid deceleration mechanisms. Type A dissections and/or rupture of the aorta at the level of the aortic isthmus are the more common presentations of aortic injuries associated with motor vehicle crashes. We present the case of atypical echocardiographic findings of a nearly complete circumferential transection of the proximal ascending aorta injury after a motorcycle crash...
October 4, 2016: Echocardiography
Ludovic Canaud, Vincent Ziza, Baris Ata Ozdemir, Jean-Philippe Berthet, Charles-Henri Marty-Ané, Pierre Alric
BACKGROUND: The aim of this study was to evaluate outcomes of left subclavian artery (LSA) revascularization for hybrid aortic arch debranching. METHODS: Between 1998 and 2015, 68 patients (41 men, mean age 67+/-16 years) underwent TEVAR with LSA coverage, 19.2% (n = 13) were never revascularized and the remaining patients underwent LSA revascularization (n = 55; 80.8%) . Revascularization was achieved by LSA-carotid transposition via a medial approach in 81.8% (n = 45) and a lateral approach in 18...
September 23, 2016: Annals of Vascular Surgery
Alan L Beal, Mark N Ahrendt, Eric D Irwin, John W Lyng, Steven V Turner, Christopher A Beal, Matthew T Byrnes, Greg A Beilman
BACKGROUND: We evaluated the ability of experienced trauma surgeons to accurately predict specific blunt injuries, as well as patient disposition from the emergency department (ED), based only on the initial clinical evaluation and prior to any imaging studies. It would be hypothesized that experienced trauma surgeons' initial clinical evaluation is accurate for excluding life-threatening blunt injuries and for appropriate admission triage decisions. METHODS: Using only their history and physical exam, and prior to any imaging studies, three (3) experienced trauma surgeons, with a combined Level 1 trauma experience of over 50 years, predicted injuries in patients with an initial GCS (Glasgow Coma Score) of 14-15...
2016: World Journal of Emergency Surgery: WJES
Shawn Haji-Momenian, Jonathan Rischall, Neil Okey, Myles Taffel, Nadia Khati, Robert Zeman
This study aimed to determine the incidence of non-traumatic acute aortic injury (AAI) extending from the chest into the abdomen or pelvis in emergency department (ED) patients with acute aortic syndrome (AAS), to estimate the effective dose of the abdominopelvic portion of these CT exams, and to compare the number needed to screen (NNS) with the collective population radiation dose of imaging those stations. All patients (n = 238) presenting to the ED with AAS between March 2014 and June 2015 who were imaged per CT AAI protocol (noncontrast and contrast-enhanced CT angiography of the chest, abdomen, and pelvis) were retrospectively identified in this IRB-approved HIPAA-compliant study...
August 27, 2016: Emergency Radiology
Gaspar Mestres, Marvin E Garcia, Xavier Yugueros, Rodrigo Urrea, Paolo Tripodi, Fernando Gomez, Jordi Maeso, Vicenç Riambau
PURPOSE: The objective of this study is to analyze the original curvature of the aortic arch and thoracic aorta, and how it is modified after the placement of a thoracic endograft. METHODS: We retrospectively analyzed all patients primarily treated for thoracic aortic aneurysms and blunt traumatic aortic injuries by means of an endograft sealed into the aortic arch (zones Z1-Z3) in two different centers (Vascular Surgery Division, Hospital Clinic, UB; and Vascular and Endovascular Surgery Department, Hospital Vall d'Hebron, UAB; Barcelona, Spain), between 2010-2015...
August 11, 2016: Annals of Vascular Surgery
Hironari No, Satoru Nishida, Takeshi Takagi, Ryosuke Mohri
A 15-year-old boy was referred to our emergency room due to a penetrating injury of the back. Computed tomography( CT) demonstrated a descending aortic injury at the Th9/10 level, bilateral hemothorax, and spinal cord injury. Although surgical treatment was indicated, multiple organ injury complicated open surgical repair, which required cardiopulmonary bypass with full heparinization. Therefore, the patient was scheduled to undergo thoracic endovascular aortic repair (TEVAR). A 23×33-mm Excluder aortic extension cuff was chosen for the small, 15-mm diameter aorta...
August 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Miroslawa Mytsyk, Martin T R Grapow, Jasmin Shahinian, Markus Maurer, Lorenz Gurke, Friedrich S Eckstein
An incomplete traumatic rupture of the ascending aorta is a rare but life-threatening condition. Hence, the assessment of the extent of the injury prior to therapy is crucial. We report a case of a 50-year-old male with traumatic aortic rupture who underwent emergency surgery after the evaluation of computed tomography scan (CT-scan). The surgical treatment involved replacement of the ascending aorta and stent implantation in descending aorta due to its covered rupture.
2016: Journal of Cardiothoracic Surgery
Amit Chakraborty, Paul F von Herrmann, Ryan E Embertson, Kevin P Landwehr, Michael A Winkler
A case of a tornado victim with a delayed presentation of injury to the aortic isthmus is discussed. Tornado forces resemble the forces of high energy explosions, and the injuries that can occur as a result of these forces can be bizarre. The patient presented with the unique computed tomography (CT) findings of isolated pseudoaneurysm of the thoracic aorta in the absence of other traumatic injury to the thorax. Equivocal results of the initial CT aortogram (CTA) were confirmed with ECG-synchronized CTA (ECG-CTA), demonstrating the superiority of ECG-CTA as compared to standard CTA...
July 2016: Clinical Imaging
Chih-Hsien Lee, Jau-Kang Huang, Ten-Fang Yang
BACKGROUND: Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition. This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. METHODS: In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan...
June 2016: Journal of Thoracic Disease
Bibombe P Mwipatayi, Ali Daneshmand, Haider K Bangash, Jackie Wong
Iliacus compartment syndrome is a rare retroperitoneal compartment neuropathy caused by bleeding within the iliacus muscle leading to hematoma formation and compression upon the femoral nerve, causing both sensory and motor deficits. A 75-year-old Caucasian man presented with severe right hip pain associated with motor and sensory deficit in the right lower extremity, 2 weeks post elective balloon aortic valvuloplasty for critical aortic stenosis. A non-contrast computed tomography scan revealed low-attenuation areas in keeping with an iliacus hematoma...
2016: Journal of Surgical Case Reports
Donald G Harris, Joseph Rabin, Abhishek Bhardwaj, Angelina S June, Connor P Oates, Danon Garrido, Shahab Toursavadkohi, Ali Khoynezhad, Robert S Crawford
BACKGROUND: Current blunt thoracic aortic injury (BTAI) guidelines recommend early repair of traumatic pseudoaneurysms (PSAs) due to risk for subsequent aortic rupture. Recent analyses indicate that early repair is required only in the setting of high-risk features, while delayed repair is safe and associated with lower morbidity and mortality in appropriately selected patients. To evaluate the appropriate indications for nonoperative management (NOM) of traumatic PSAs, we performed a systematic review of studies reporting outcomes for this management strategy...
August 2016: Annals of Vascular Surgery
Ronald M Bilow, Kathirkamanathan Shanmuganathan, John H Harris
BACKGROUND: Terminology and classifications are the vehicles by which pathologic conditions are identified and understood. It is critically important for the patient admitted with suspected blunt thoracic aortic injury that admitting physicians have a thorough knowledge of acute traumatic aortic tear and its natural history. OBJECTIVES: The objectives of this review were as follows: (1) to introduce a pathology-based terminology and classification of acute traumatic aortic injuries that unambiguously defines each, and (2) to emphasize the clinical relevance of acute traumatic tear to post-hospital admission deaths in blunt thoracoabdominally injured patients...
August 2016: Journal of Emergency Medicine
N R Chernaya, R Sh Muslimov, I E Selina, L S Kokov, E S Vladimirova, M S Navruzbekov, V A Gulyaev
Traumatic rupture of the aorta is the second most common cause of death in closed chest injury. The latest findings of autopsy showed that 80% of lethal outcomes in aortic injury occur in the prehospital period. Taking into consideration the incidence and high rate of death prior to the diagnosis stage, aortic rupture in closed thoracic injury is an important problem. Due to the characteristic mechanism of the development (during sharp deceleration of the body) this type of traumatic lesion of the aorta became known as "deceleration syndrome"...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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