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Ascending aorta dissection CT scan of the chest with intravenous contrast showing the aortic dissection.
Source publication
Major vascular traumatic injuries have a higher pre-hospital and in-hospital mortality rate. The different mechanisms of injury and anatomy of the aorta and inferior vena cava (IVC) make the management a constant challenge to surgeons and clinicians. Blunt traumatic aortic injury (BTAI) can occur at the thoracic or abdominal level, each of which po...
Contexts in source publication
Context 1
... signs are mediastinal or peri-aortic hematoma, retro-crural hematoma, and small caliber of the aorta distal to the injury. Definitive signs are aortic dissection (Figure 1), contained rupture, intramural thrombus, active contrast extravasation (Figure 2), and abnormalities of aortic contour [3]. ...
Context 2
... signs are mediastinal or peri-aortic hematoma, retro-crural hematoma, and small caliber of the aorta distal to the injury. Definitive signs are aortic dissection (Figure 1), contained rupture, intramural thrombus, active contrast extravasation (Figure 2), and abnormalities of aortic contour [3]. ...
Citations
... In the field of trauma treatment, the survival rate of traumatic IVC injury has not improved significantly despite the introduction of a multidisciplinary approach, the development of damage control surgery, and advances in prehospital transport. To date, most traumatic IVC injury-related research cohorts are not blunt injuries but penetrating injuries [17][18][19][20][21]. Several previous studies have analyzed case series of blunt caval injuries; however, few studies have analyzed risk factors for mortality [22][23][24]. Therefore, the purpose of this study was to analyze the clinical features of blunt IVC injuries and the risk factors affecting the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients. ...
Background
Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38–70%. To date, most studies on traumatic IVC injuries have evaluated blunt rather than penetrating injuries. We aimed to identify the clinical features and risk factors that affect the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients.Methods
We retrospectively analyzed patients diagnosed with blunt IVC injury over 8 years at a single trauma center. Clinical and biochemical parameters; transfusion, surgical, and resuscitation methods; associated injuries; intensive care unit stay; and complications data were compared between survival and death groups to identify clinical features and risk factors of blunt IVC injury-related mortality.ResultsTwenty-eight patients with blunt IVC injury were included during the study periods. Twenty-five (89%) patients underwent surgical treatment, and the mortality was 54%. The mortality rate according to the IVC injury location was the lowest for supra-hepatic IVC injury (25%, n = 2/8), whereas it was the highest for retrohepatic IVC injury (80%, n = 4/5). In the logistic regression analysis, Glasgow Coma Scale (GCS) (odds ratio [OR] = 0.566, 95% confidence interval [CI] [0.322–0.993], p = 0.047) and red blood cell (RBC) transfusion for 24 h (OR = 1.132, 95% CI [0.996–1.287], p = 0.058) were independent predictors for mortality.Conclusions
Low GCS score and high-volume packed RBC transfusion requirements for 24 h were significant predictors of mortality in patients with blunt IVC injuries. Unlike IVC injuries caused by penetrating trauma, supra-hepatic IVC injuries caused by blunt trauma have a good prognosis.
... Acute traumatic aortic injury (ATAI) is a severe condition with high pre-hospital mortality. The mortality rate is up to 95% and 30% if treated early [1,2]. The fast and readily available multidetector computed tomography (MDCT) is the preferred imaging modality to diagnose this serious condition [3]. ...
... More severe injuries can have both direct and indirect signs [3]. Injury of the isthmus portion of the aorta is more common than the involvement of descending aorta in ATAI [2,4]. Injuries can be associated with diaphragmatic injury and fracture of the thoracic vertebra. ...
... The diagnostic accuracy of MDCT in ATAI is up to 100% in various studies, sensitivity is more than 98%, and specificity is up to 100% [2]. Some studies have argued that MDCT may be better than catheter angiography [8,9]. ...
Contrast-enhanced multidetector computed tomography is currently the preferred imaging modality to diagnose acute traumatic aortic injury (ATAI). Rarely, ATAI can present with atypical findings that make the diagnosis and further management exceptionally challenging. Furthermore, ATAI can also be associated with inferior vena cava injury showing only indirect signs on later imaging. We present an unusual case of traumatic aortic disruption mimicking acute limb ischemia.
... The injured suprahepatic IVC is extremely challenging to manage operatively and requires cardiopulmonary bypass in most centres (43,44). Blunt injury may occur as an avulsion injury at the atrio-caval junction and may be self-contained or tamponaded by surrounding structures. ...
... provides a lifeline as these patients would have succumbed to massive intraoperative blood loss. Options for treatment include conservative, endovascular (even if pseudoaneurysm exists), ligation or packing and definitive vascular repair (43). Iatrogenic SVC injuries occur mainly at the confluences of the brachiocephalic veins and SVC and occur with equal frequency whether the left or right subclavian or internal jugular veins are cannulated. ...
This manuscript undertakes a brief focussed literature review of penetrating and blunt injury to the great vessels of the mediastinum (excluding iatrogenic vessel injury) and provides personal insights to the management of mediastinal vascular injury. It is not intended as a comprehensive or systematic review. Included are the aorta and its main branches, the superior vena-cava and its main tributaries (brachiocephalic veins) along with the less-appreciated, but equally serious, injuries to the pulmonary artery or vein and the Azygous or hemi-azygous veins. An overview of the epidemiology of these injuries is provided. The gross anatomy is briefly reviewed from the perspective of the surgeon., Practical diagnostic approaches, using an algorithm, operative access and repair options, along with endovascular considerations are briefly highlighted. The detail of the operative procedures will highlight practical points for concern and local tips-and-tricks. Practical take-home messages are provided from the personal perspective of the authors. This overview does not cover intercostal vessel or internal thoracic artery injury, both of which may cause significant bleeding and cardiac tamponade in the case of the latter vessel, but technically are outside the central mediastinum and are branches of great vessels and are therefore not included.
... This review seeks to describe the most important abdominal vascular injuries, their characteristics and the appropriate conducts for each type of injury. (KOBAYASHI et al., 2016;LEON et al., 2020). ...
Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes
caused by forces acting from outside the body. The number of patients with trauma is increasing as
our society becomes more sophisticated. The importance and demand of traumatology are growing
due to the development and spread of treatment and diagnostic technologies. In particular, damage
to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe;
therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to nonaortic
vessels of the thorax and aorta results in varying degrees of physical damage depending on the
mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from
non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation
disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can
often improve the prognosis. The treatment of trauma can be surgical or interventional, depending
on the patient’s condition. Among them, interventional procedures are increasingly gaining popularity
owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in
more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma
include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries.
These procedures have many advantages over surgical treatments, such as fewer internal or surgical
side effects, and can be performed more quickly than surgical procedures, contributing to improved
outcomes for patients with trauma.
Introduction
: The inferior vena cava is the most frequently injured vascular structure in penetrating abdominal trauma. We aimed to review inferior vena cava injury cases treated at a limited resources facility and to discuss the surgical management for such injures.
Methods
: This was a retrospective study of patients with inferior vena cava injuries who were treated at a single center between January 2011 and January 2020. Data pertaining to the following were assessed: demographic parameters, hypovolemic shock at admission, the distance that the patient had to be transported to reach the hospital, affected anatomical segment, treatment, concomitant injuries, complications, and mortality. Non-parametric data were analyzed using Fisher's exact, Chi-square, Mann-Whitney, or Kruskal-Wallis test, as applicable. The Student's t-test was used to assess parametric data. Moreover, multiple logistic regression analyses (including data of possible death-related variables) were performed. Statistical significance was set at p <0.05.
Results
: Among 114 patients with inferior vena cava injuries, 90.4% were male, and the majority were aged 20-29 years. Penetrating injuries accounted for 98.2% of the injuries, and the infrarenal segment was affected in 52.7% of the patients. Suturing was perfomed in 69.5% and cava ligation in 29.5% of the patients, and one patient with retrohepatic vena cava injury was managed non-operatively. The overall mortality was 52.6% with no case of compartment syndrome in the limbs. A total of 7.9% of the patients died during surgery.
Conclusions
: The inferior vena cava is often injured by penetrating mechanisms, and the most frequently affected segment was the infrarenal segment. A higher probability of death was not associated with injury to a specific anatomical segment. Additionally, cava ligation was not related to an increased probability of compartment syndrome in the leg; therefore, prophylactic fasciotomy was not supported.
