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Traumatic rupture of the thoracic aorta is a life threatening situation, and may be secondary to several mechanisms; mainly penetrating or iatrogenic lesions and blunt trauma. Although penetrating mechanisms predominate, the number of patients with aortic disruption due to blunt trauma has continued to increase. This paper shows an overview focusin...
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... a chest X-ray, as initial radio- logical evaluation, in every high-speed trauma patient with suspected blunt traumatic aortic injury. There are several radiological findings reported for traumatic aor- tic rupture. Many studies have shown that the widened mediastinum on chest X-ray is present in more than 90% of thoracic aortic injuries (24) (Fig. 3). Other frequent signs are irregularity or blurring of the aortic knob con- tour, presence of a left apical cap and a tracheal dis- placement (25). With a 90% sensitivity, a 25% specifici- ty, and a 95% negative preditive value, the chest X-ray is a valuable screening tool for mediastinal haemorrhage, but is worth little as far as ...
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... In relation to BTAR, this study demonstrates that complex secondary flows in the aorta may still develop without chest trauma in car accidents. Whether the corresponding transverse wall shear stress could actually cause rupture may not be the case, however it may have a significant role in explaining why rupture sometimes occurs away from the aortic isthmus such as in the ascending or descending aorta (Chiesa et al., 2003) or in the absence of any thoracic injury whatsoever (Sevitt, 1977). With regard to the most damaging scenario, it is difficult to draw from this study due to the interplay between wall shear stress magnitude and duration. ...
Much debate surrounds the mechanisms responsible for the occurrence of blunt traumatic aortic rupture in car accidents, particularly on the role of the inertial body force experienced by the blood due to the abrupt deceleration. The isolated influence of such body forces acting on even simple fluid flows is a fundamental problem in fluid dynamics that has not been thoroughly investigated. This study numerically investigates the fundamental physical problem, where the pulsatile flow in a straight circular pipe is subjected to a transverse body force on a localized volume of fluid. The body force is applied as a brief rectangular impulse in three distinct cases, namely during the accelerating, peak, and decelerating phases of the pulsatile flow. A dimensionless number, termed the degree of influence of the body force (Ψ), is devised to quantify the relative strength of the body force over the flow inertia. The impact induces counter-rotating cross-stream vortices at the boundaries of the forced section accompanied by complex secondary flow structures. This secondary flow is found to develop slowest for an impact occurring during an accelerating flow and fastest during a decelerating flow. The peak skewness of the velocity field, however, occurred at successively later times for the three respective cases. After the impact, these secondary flows act to restore the unforced state and such dominant spatial structures are revealed by proper orthogonal decomposition of the velocity field. This work presents a new class of problems that requires further theoretical and experimental investigation. (arXiv: https://arxiv.org/abs/1812.06844)
... La rotura traumática de aorta torácica (RTAT) se asocia con traumatismos cerrados provocados habitualmente en accidentes de tráfico, en los que se produce una desaceleración brusca o un impacto contra el tórax. Ocurre en el 0,8% de los accidentes de tráfico y es responsable de hasta el 16% de los fallecimien-tos acaecidos en éstos [1,2]. Se estima que entre un 60 y un 80% de los accidentados que han sufrido una RTAT fallecen en el lugar del accidente y el tratamiento del 20% [3] restante de los pacientes que llegan al hospital es controvertido, sobre todo antes de la llegada de la cirugía endovascular. ...
Objetivo. Presentar nuestra experiencia en el manejo de la rotura traumática de la aorta torácica en los traumatismos cerrados. Introducción. La rotura de la aorta torácica en traumatismos cerrados es una entidad grave, asociada a una elevada morbimortalidad con el tratamiento quirúrgico convencional. La cirugía endovascular se está imponiendo en el tratamiento de la patología vascular torácica, por lo que, dada su menor agresividad, parece estar aún más indicada en esta patología. Casos clínicos. Caso 1: varón de 34 años que, tras un accidente de motocicleta, presentaba un politraumatismo con múltiples fracturas óseas, lesiones abdominales y craneales. Fue trasladado a nuestro centro con un diagnóstico de rotura aórtica torácica e intervenido de forma urgente mediante dos endoprótesis. El control a los 24 meses se observó la exclusión completa de la lesión sin fugas. Caso 2: varón de 19 años que, tras un accidente de tráfico, presentaba un politraumatismo con múltiples fracturas óseas, lesiones abdominales y craneales. Fue trasladado a nuestro centro con un diagnóstico de rotura aórtica e intervenido de forma urgente mediante una endoprótesis. El control a los seis meses se observó la exclusión completa de la lesión sin fugas. Conclusión. La rotura de la aorta torácica en traumatismos cerrados es una entidad de elevada morbimortalidad y la reparación endovascular, a nuestro juicio, constituye una opción válida.
... It is reported to occur in 0.8% of motor vehicle collisions and to account for 16% of the fatalities from motor vehicle accidents. 1,2 Mortality at the scene has been reported as 80% in autopsy series. 3 Although it accounts for less than 1% of the trauma admissions to level I trauma centers, TAI represents the second most common cause of death due to blunt trauma after head injury. ...
... Although patients with aortic rupture may be in profound shock on their arrival, most of them who survive to be seen at the hospital (85%) are relatively hemodynamically stable. 4 They may complain of chest pain, dyspnea, hemoptysis from associated rib fractures and pulmonary injury, hoarseness from stretching of the recurrent laryngeal nerve as it passes around the aortic arch, hypertension in the upper extremities, a systolic murmur in the precordium, anuria paraplegia, or may have no symptoms related to their aortic injury. 4 ' 10 The reported case was a hemodynamically stable trauma patient, with multiple rib fractures, without any clinical or radiological signs indicating aortic injury. ...
A case of delayed rupture of the thoracic aorta into the esophagus after blunt thoracic injury is reported. It involved a hemodynamically stable 18-year-old male patient without any clinical or radiological signs to indicate aortic injury. Aortoesophageal fistula presented in the fifth post traumatic day, with a sudden dyspnea episode, intraperitoneal hemorrhage and lower gastrointestinal bleeding, due to intraperitoneal and intragastric rupture of intramural esophageal hematoma.
Of 145 autopsies on subjects of impact trauma, 35 had lacerations of the aorta located as follows: proximal aorta ( 5 ), isthmus (22), and descending aorta ( 11 ) (three subjects had lacerations of the isthmus and the descending aorta). Four of the five lacerations of the proximal aorta ruptured into the pericardial sac. All lacerations at the isthmus were full thickness. Five were double, parallel, adjacent lacerations, of which only one was circumferential. Three of the 22 also had intimal tears of the descending aorta. One of the 22 lacerations was tamponaded and did not rupture into a body cavity. In eight, rupture and bleeding occurred into both pleural cavities, whereas 12 had rupture only into the left pleural cavity. Fourteen of the 22 had evidence of transient tamponade in the form of a mediastinal hematoma. Of the 11 subjects with lacerations of the descending aorta, one had only intimal tears. The other ten had full thickness lacerations that were located throughout the descending aorta. Four of the ten had more than one aortic laceration. Six of the total 11 had a vertebral dislocation. Three of the ten also had a laceration at the isthmus. Severe wounds of the head and thoracoabdominal viscera other than the aorta were common. Most subjects died at the scene.
Novel to this study are the explicit descriptions of 1) aortic lacerations involving less than the circumference of the aorta, 2) aortic lacerations that are double, and 3) the tendency for double lacerations to be less than circumferential.
Trauma patients in the Intensive Care Unit require all the complexities of modern day critical care. In an ideal world intensive care management of the seriously injured patient would start in the pre-hospital setting and continue until there was either no longer a requirement or continued treatment was considered to be futile. By definition, multi-trauma patients are critically ill from the time they receive their injuries. In some countries sophisticated pre-hospital intensive care is commenced at the scene by trained physicians but, more commonly, intensive care for trauma patients is commenced in the Emergency Department [1]. Once admitted to the Intensive Care Unit (ICU) several aspects of the continued resuscitation need to be addressed:
physiological optimisation which requires monitoring and intervention;
anatomic optimisation which requires continued assessment and planning of interventions including surgery;
identification of all injuries to avoid missing injuries;
prevention of late complications, particularly multiple organ failure. The reasons for admitting trauma patients to an ICU are diverse and include: to allow continued airway protection (intubation) and controlled ventilation;
continued resuscitation in an attempt to achieve appropriate haemodynamic goals. This may require the use of inotropes as well as fluids and blood products;
the management of severe head injuries;
the support of organs that are failing or that are likely to fail;
to permit invasive monitoring that is not available at other hospital sites; to correct coagulopathy and major metabolic derangement;
to permit active rewarming in those patients who are hypothermic;
to provide a higher level of nursing care to high risk patients e.g. the elderly and those with serious co-morbidity.
Arterienverletzungen entstanden früher vorwiegend durch Kriegseinflüsse, werden heute aber infolge ständig wachsender Unfallzahlen auch im zivilen Leben immer häufiger beobachtet, sowohl bei offener Gewebsdurchtrennung wie auch als Folge stumpfer Gewalteinwirkung bei Frakturen, Luxationen, Distorsionen und schweren Prellungen oder Quetschungen [23, 95]. Hierzu kommen Dezelerationsunfälle mit Einrissen der Brustaorta und Abrissen von Organarterien [118]. Mit der Erweiterung und zunehmenden Radikalität chirurgischer Eingriffe wächst auch die Zahl der iatrogenen Arterienschädigungen [63, 64, 88, 95, 97, 112, 126] Die relative Häufigkeit der Arterienverletzungen läßt sich aus der Literatur nur grob abschätzen, sie dürfte nach Debakey und Simeone [20] für die beiden Weltkriege etwa 1 % der Verwundeten betragen, wenn man die sofort ihren Verletzungen Erlegenen nicht berücksichtigt. Im Korea-Krieg stieg diese Zahl auf 2,4% [48, 135]. Für die Friedenschirurgie geben die bisher veröffentlichten Berichte kein genaues Bild. Immerhin beobachteten Morris u. Mitarb. [79] und Ferguson u. Mitarb. [34] innerhalb von 10 Jahren je 200 Arterienverletzungen.
In our research we have discussed a rare case of penetration of screw into the thoracic aorta after stabilization of thoracic spine due to compressive fracture of IV thoracic vertebra. We have focused on existence of potential danger of damage of aorta during stabilization of the posterior part of thoracic spine. We have emphasized the meaning of prophylactic implantation of stent-graft into the site of potential damage of aorta before the restabilization of the vertebral column.
Victims of blunt thoracic trauma are some of the most severely injured presenting to the operating room for emergency surgery.
These individuals tax both anaesthesia and critical care skills during the intraoperative period. The major causes of intraoperative
death are exsanguination and asphyxia. The anaesthetist is the best qualified individual to deal with these intraoperative
problems.
Les victimes de traumatismes thoraciques ferme comptent parmi les blessés les plus sérieux qui se présentent en salle d’opération
pour la chirurgie urgente. Ces patients mettent à l’#x2019; epreuve la compétence de l’anesthésiste et du réanimateur à la
période peropératoire. Les causes les plus fréquentes de décès sont l’exsanguination et l’asphyxie. L’anesthésiste demeure
la personne la mieux qualifiée pour prendre charge de ces problèmes.
Minimally invasive endovascular treatment of a traumatic rupture of the thoracic aorta is a new strategy in the care of multitrauma patients. We report the experience in The Netherlands with endovascular management of patients with acute traumatic ruptures of the thoracic aorta.
We reviewed 28 patients with a traumatic thoracic aortic rupture treated with a thoracic aortic endograft between June 2000 and April 2004. All patients underwent treatment at one of the four participating level 1 trauma centers. Data collected included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Follow-up data consisted of computed tomographic angiography and plain chest radiographs at regular intervals.
All patients (mean age, 40.9 years; SD, 18.5 years) experienced severe traumatic injury, and the mean injury severity score was 37.1 (SD, 7.8). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 58 minutes (interquartile range, 47-88 minutes). The overall hospital mortality was 14.3% (n = 4), and all deaths were unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during a median follow-up of 26.5 months (interquartile range, 10-34.6 months). Postoperative data showed no severe endovascular graft- or procedure-related morbidity, except for one patient with an asymptomatic collapse of the endovascular graft during regular follow-up. This was corrected by placing a second graft.
This study shows that the results of immediate endovascular repair of a traumatic aortic rupture are at least equal to those of conventional open surgical repair. Especially in these multitrauma patients with traumatic ruptures of the thoracic aorta, endovascular therapy seems to be preferable to conventional open surgical repair.
