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Benjamin Bottet, François Bouchard, Christophe Peillon, Jean-Marc Baste
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was what are the optimum treatment modality and timing of intervention for blunt thoracic aortic injury (BTAI) in the modern era? Of the 697 papers found using the reported search, 14 (5 meta-analyses, 2 prospective and 7 retrospective studies) represented the best evidence to answer the clinical question. The author, journal, country, date of publication, patient group studied, study type, relevant outcomes, results and weakness of these papers are tabulated...
August 29, 2016: Interactive Cardiovascular and Thoracic Surgery
Sagar S Gandhi, Joseph V Blas, Stewart Lee, John F Eidt, Christopher G Carsten
OBJECTIVE: Blunt thoracic aortic injuries (BTAIs) have historically been treated with open surgery; thoracic endovascular aortic repair (TEVAR), however, is rapidly becoming the standard of care for all grades of injury. Previous studies have shown successful, conservative management of low-grade (I and II) BTAI, but limited literature exists regarding nonoperative management (NOM) for high-grade BTAI. The purpose of this study was to evaluate NOM for grade III BTAI compared with TEVAR...
July 22, 2016: Journal of Vascular Surgery
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
Andrew S Williams, Mathieu Castonguay, Shawn K Murray
Blunt thoracic aortic injury (BTAI) resulting from cardiopulmonary resuscitation (CPR) is rarely reported and most reports are of aortic rupture. Clinical reports have also documented aortic dissection and intramural hematomas with sequential imaging showing the development of these aortic injuries after the administration of CPR, suggesting that non-transmural aortic injury may also result from CPR. We report partial separation of an aortic intimal atheromatous plaque as a component injury in a case with multiple complications of manual CPR...
May 30, 2016: International Journal of Legal Medicine
Donald G Harris, Joseph Rabin, Benjamin W Starnes, Ali Khoynezhad, R Gregory Conway, Bradley S Taylor, Shahab Toursavadkohi, Robert S Crawford
Developments in diagnosis and treatment have transformed the management of blunt thoracic aortic injuries (BTAIs). For patients in stable condition, treatment practice has shifted from early open repair to nonoperative management for low-grade lesions and routine delayed endovascular repair for more significant injuries. However, effective therapy depends on accurate staging of injury grade and stability to select patients for appropriate management. Recent developments in BTAI risk stratification enable lesion-specific management tailored to the patient and aortic lesion...
May 21, 2016: Journal of Vascular Surgery
Alexander Gombert, Mohammad Esmaeil Barbati, Jochen Grommes, Houman Jalaie, Karina Schleimer, Michael J Jacobs, Johannes Kalder
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) are rare but life threatening. Most BTAI are caused by high-energy trauma. Among children with blunt trauma, the incidence of BTAI is below 1 percent. The present case deals with covered thoracic aortic rupture of a 15-year-old boy. Emphasizing the value and the difficulties of endovascular surgery in children is the motivation for this case report. CASE REPORT: We are presenting the case of a 15-year-old boy, who suffered multiple traumata after accident...
May 2016: Annals of Vascular Surgery
Gerald R Fortuna, Alexa Perlick, Joseph J DuBose, Samuel S Leake, Kristofer M Charlton-Ouw, Charles C Miller, Anthony L Estrera, Ali Azizzadeh
OBJECTIVE: The current Society for Vascular Surgery Clinical Practice Guidelines suggest urgent (<24 hours) thoracic endovascular aortic repair for grade (G) II to G IV blunt thoracic aortic injuries (BTAIs). The purpose of this study was to determine whether some patients may require more emergency treatment. METHODS: We reviewed imaging variables of prospectively collected BTAI patients between 1999 and 2014. We used computed tomographic angiography to classify BTAIs into four categories: G I, intimal tear; G II, intramural hematoma; G III, aortic pseudoaneurysm; and G IV, free rupture...
May 2016: Journal of Vascular Surgery
Shinsuke Tanizaki, Shigenobu Maeda, Hideyuki Matano, Makoto Sera, Hideya Nagai, Taizo Nakanishi, Hiroshi Ishida
OBJECTIVE: The efficacy of nonoperative management of blunt thoracic aortic injury (BTAI) was evaluated in patients with pseudoaneurysm. METHODS: A retrospective review was done for patients with BTAI at Fukui Prefectural Hospital during a 9-year period. Charts were reviewed for age, gender, Injury Severity Score, Abbreviated Injury Scale for each body area, initial type of aortic injury, site of aortic injury, type of definitive management, complications, and outcomes...
February 2016: Journal of Vascular Surgery
J Pillai, C Yazicioglu, T Monareng, T B Rangaka, R Jayakrishnan, M G Veller
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) remain a leading cause of death after blunt trauma. In severe injuries, thoracic endovascular aortic repair (TEVAR) has provided a less invasive alternative to conventional open repair. OBJECTIVE: To report the TEVAR-related complications and uncertainties in patients who presented with traumatic pseudoaneurysms (grade III BTAI). METHODS: From April 2004 to February 2012, 55 patients (42 male, mean age 34...
March 2015: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Jayandiran Pillai, Taalib Monareng, Thomas B Rangaka, Ceyhan Yazicioglu, Raj Jayakrishnan, Martin G Veller
The internal iliac artery and cruciate anastomosis are important collateral vessels in severe aortoiliac occlusive disease. This report describes a patient with left leg rest pain due to occlusion of the left common and external iliac arteries. In addition, there was a high-grade stenosis of the right common iliac artery. Direct catheter canulation of the left internal iliac artery revealed that it was patent. Endovascular stent placement was successful in re-establishing blood flow into the left internal iliac artery...
March 2015: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Dominic Pang, Diane Hildebrand, Paul Bachoo
BACKGROUND: Blunt traumatic thoracic aortic injury (BTAI) is a life-threatening surgical emergency associated with mortality up to 8000 per year, most commonly caused by rapid acceleration/deceleration injury sustained through motor vehicle accident and/or blunt thoracic trauma. BTAI has high pre-hospital mortality following the primary injury, with only 10% to 15% of patients surviving long enough to reach the hospital. Open surgical repair had remained the standard treatment option for BTAI since successfully introduced in 1959...
2015: Cochrane Database of Systematic Reviews
Mostafa H El-Beheiry, Biniam Kidane, Meaghan Zehr, Kelly Vogt, Neil G Parry, Richard Malthaner, Thomas L Forbes
BACKGROUND: Blunt traumatic thoracic aortic injury (BTAI) can be a highly lethal injury but in the last decade major advances have been made in diagnostic accuracy, injury grading, and therapy. Traditionally, emphasis has been on studying survival postinjury with a paucity of studies examining the discharge characteristics of patients that survive a BTAI. The purpose of this study is to define the epidemiology and predictors of disposition in patients with BTAI in a provincial database...
January 2016: Annals of Vascular Surgery
Dimitrios Challoumas, Georgios Dimitrakakis
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...
2015: Open Cardiovascular Medicine Journal
Adam Gutierrez, Kenji Inaba, Stefano Siboni, Zachary Effron, Tobias Haltmeier, Paul Jaffray, Sravanthi Reddy, Alexander Lofthus, Elizabeth Benjamin, Joseph Dubose, Demetrios Demetriades
BACKGROUND: The early and accurate identification of patients with blunt thoracic aortic injury (BTAI) remains a challenge. Traditionally, a portable AP chest X-ray (CXR) is utilized as the initial screening modality for BTAI, however, there is controversy surrounding its sensitivity. The purpose of this study was to assess the sensitivity of CXR as a screening modality for BTAI. METHODS: After IRB approval, all adult (≥18 yo) blunt trauma patients admitted to LAC+USC (01/2011-12/2013) who underwent CXR and chest CT were retrospectively reviewed...
January 2016: Injury
R D Malgor, Th V Bilfinger, J McCormack, A K Tassiopoulos
BACKGROUND: Blunt thoracic aortic injury (BTAI) is rare and associated with significant morbidity and mortality in trauma patients. As the population ages and life expectancy increases, the frequency of this injury will increase in the elderly and thus it behoves us to understand treatment and outcome in this patient population. METHODS: We analysed prospectively collected data of 10 patients > 80 years old with BTAI (Group A) treated among 26,000 trauma patients over a 20-year period in a Level 1 trauma center to investigate BTAI morbidity and mortality...
May 2015: Acta Chirurgica Belgica
Gabriele Piffaretti, Gianpaolo Carrafiello, Anna Maria Ierardi, Giovanni Mariscalco, Edoardo Macchi, Patrizio Castelli, Matteo Tozzi, Marco Franchin
The aim of this study is to report the use of thoracic endovascular aortic repair (TEVAR) in blunt thoracic aortic injuries (BTAIs) presenting with complex anatomies of the aortic arch vessels. Two patients were admitted to our hospital for the management of BTAI. Anomalies were as follow: aberrant right subclavian artery (n = 1) and right-sided aortic arch with 5 vessels anatomy variant (n = 1). TEVAR was accomplished using parallel graft with periscope configuration in the patient with the aberrant right subclavian artery...
August 2015: Annals of Vascular Surgery
J J Dubose, A Azizzadeh, A L Estrera, H J Safi
Blunt thoracic aortic injury (BTAI) remains a common cause of death following blunt mechanisms of trauma. Among patients who survive to reach hospital care, significant advances in diagnosis and treatment afford previously unattainable survival. The Society for Vascular Surgery (SVS) guidelines provide current best-evidence suggestions for treatment of BTAI. However, several key areas of controversy regarding optimal BTAI care remain. These include the refinement of selection criteria, timing for treatment and the need for long-term follow-up data...
October 2015: Journal of Cardiovascular Surgery
Chien-Chao Lin, Kuo-Sheng Liu, Huan-Wu Chen, Yao-Kuang Huang, Jaw-Ji Chu, Feng-Chun Tsai, Pyng Jing Lin
PURPOSE: This study reviews our 17-year experience of managing blunt traumatic aortic injury (BTAI). METHODS: We analyzed information collected retrospectively from a tertiary trauma center. RESULTS: Between October 1995 and June 2012, 88 patients (74 male and 14 female) with a mean age of 39.9 ± 17.9 years (range 15-79 years) with proven BTAI were enrolled in this study. Their GCS, ISS, and RTS scores were 12.9 ± 3.7, 29.2 ± 9...
February 2016: Surgery Today
Biniam Kidane, Madelaine Plourde, Sami A Chadi, Alla Iansavitchene, Maureen O Meade, Neil G Parry, Thomas L Forbes
OBJECTIVE: Loss to follow-up (LTFU) can be a major difficulty for any clinical research study. The objective of this systematic review was to assess the extent of LTFU and its potential effect in studies of adult trauma patients with blunt thoracic aortic injuries (BTAIs). METHODS: Studies comparing management of BTAIs were systematically reviewed. Duplicate independent review was used for study selection, data abstraction, and critical appraisals. RESULTS: Thirty-six studies were included for synthesis, of which 94...
June 2015: Journal of Vascular Surgery
Nicole Fox, Diane Schwartz, Jose H Salazar, Elliott R Haut, Philipp Dahm, James H Black, Scott C Brakenridge, John J Como, Kimberly Hendershot, David R King, Adrian A Maung, Matthew L Moorman, Kimberly Nagy, Laura B Petrey, Ronald Tesoriero, Thomas M Scalea, Timothy C Fabian
BACKGROUND: Blunt traumatic aortic injury (BTAI) is the second most common cause of death in trauma patients. Eighty percent of patients with BTAI will die before reaching a trauma center. The issues of how to diagnose, treat, and manage BTAI were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the practice management guidelines on this topic published in 2000. Since that time, there have been advances in the management of BTAI. As a result, the EAST guidelines committee decided to develop updated guidelines for this topic using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework recently adopted by EAST...
March 2015: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
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