Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492007000100009
Jornal Vascular Brasileiro
Review Article

Current diagnosis and management of blunt traumatic rupture of the thoracic aorta

Estado atual do diagnóstico e tratamento das lesões traumáticas da aorta torácica

Vishal Bansal; Jeanne Lee; Raul Coimbra

Downloads: 0
Views: 867

Abstract

The diagnosis and management of aortic lacerations has been gradually improving. Historically, aortic lacerations were a common cause of exsanguination with extremely high mortality rate. However, in modern trauma systems with advanced resuscitation and rapid radiology imaging, the diagnosis of an aortic injury is improving with an emphasis on preventing the progression of intimal flaps and pseudoaneurysms to frank dissection or rupture. Both diagnostic modalities and the paradigm of immediate operative intervention have changed. The evolution of endovascular stenting may play a future role in definitive care.

Keywords

Thoracic trauma, thoracic aorta, thoracic aortic rupture, endovascular repair, endoprosthesis, stent graft, paraplegia

Resumo

O diagnóstico e tratamento das lesões traumáticas da aorta torácica vêm gradualmente melhorando. Historicamente, as lesões traumáticas da aorta torácica eram causa freqüente de exanguinação, apresentando altas taxas de mortalidade. Por outro lado, após o desenvolvimento de sistemas modernos de atendimento às vítimas de traumatismos, com protocolos avançados de reanimação volêmica e rápida avaliação radiológica, o diagnóstico de lesões da aorta torácica tem melhorado significativamente. A ênfase atual está centrada na prevenção da progressão das lesões intimais menores e pseudo-aneurismas até a dissecção franca ou ruptura aórtica. As modalidades diagnósticas sofreram alterações, bem como o paradigma de intervenção cirúrgica imediata. A evolução de próteses endovasculares poderá desempenhar um importante papel no tratamento definitivo.

Palavras-chave

Trauma torácico, aorta torácica, ruptura traumática da aorta torácica, tratamento endovascular, endoprótese, paraplegia

References

Tambyraja AL, Scollay JM, Beard D, Henry JM, Murie JA, Chalmers RT. Aortic trauma in Scotland--a population based study. Eur J Vasc Endovasc Surg. 2006;32:686-9.

Chen FH, Shim WH, Chang BC, Park SJ, Won JY, Lee DY. False aneurysms at both ends of a descending thoracic aortic stent-graft: complication after endovascular repair of a penetrating atherosclerotic ulcer. J Endovasc Ther. 2003;10:249-53.

Smith RS, Chang FC. Traumatic rupture of the aorta: still a lethal injury. Am J Surg. 1986;152:660-3.

Fabian TC, Richardson JD, Croce MA. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma. 1997;42:374-80.

Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal blunt aortic injuries: a review of 242 autopsy cases. J Trauma. 2001;50:113-5.

Balci AE, Kazez A, Eren S, Ayan E, Ozalp K, Eren MN. Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg. 2004;26:387-92.

Feczko JD, Lynch L, Pless JE, Clark MA, McClain J, Hawley DA. An autopsy case review of 142 nonpenetrating (blunt) injuries of the aorta. J Trauma. 1992;33:846-9.

Parmley LF, Mattingly TW, Manion WC, Jahnke EJ Jr. Nonpenetrating traumatic injury of the aorta. Circulation. 1958;17:1086-101.

Cohen AM, Crass JR, Thomas HA, Fisher RG, Jacobs DG. CT evidence for the "osseous pinch" mechanism of traumatic aortic injury. AJR Am J Roentgenol. 1992;159:271-4.

Javadpour H, O'Toole JJ, McEniff JN, Luke DA, Young VK. Traumatic aortic transection: evidence for the osseous pinch mechanism. Ann Thorac Surg. 2002;73:951-3.

Blackmore CC, Zweibel A, Mann FA. Determining risk of traumatic aortic injury: how to optimize imaging strategy. AJR Am J Roentgenol. 2000:174.

Katyal D, McLellan BA, Brenneman FD, Boulanger BR, Sharkey PW, Waddell JP. Lateral impact motor vehicle collisions: significant cause of blunt traumatic rupture of the thoracic aorta. J Trauma. 1997;42:769-72.

Cook J, Salerno C, Krishnadasan B, Nicholls S, Meissner M, Karmy-Jones R. The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta. J Thorac Cardiovasc Surg. 2006;131:594-600.

Fishman JE. Imaging of blunt aortic and great vessel trauma. J Thorac Imaging. 2000;15:97-103.

Mirvis SE, Bidwell JK, Buddemeyer EU. Value of chest radiography in excluding traumatic aortic rupture. Radiology. 1987;163:487-93.

Patel NH, Stephens KE Jr., Mirvis SE, Shanmuganathan K, Mann FA. Imaging of acute thoracic aortic injury due to blunt trauma: a review. Radiology. 1998;209:335-48.

Cook AD, Klein JS, Rogers FB, Osler TM, Shackford SR. Chest radiographs of limited utility in the diagnosis of blunt traumatic aortic laceration. J Trauma. 2001;50:843-7.

Symbas PJ, Horsley WS, Symbas PN. Rupture of the ascending aorta caused by blunt trauma. Ann Thorac Surg. 1998;66:113-7.

Wong H, Gotway MB, Sasson AD, Jeffrey RB. Periaortic hematoma at diaphragmatic crura at helical CT: sign of blunt aortic injury in patients with mediastinal hematoma. Radiology. 2004;231:185-9.

Mirvis SE, Shanmuganathan K, Buell J, Rodriguez A. Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury. J Trauma. 1998;45:922-30.

Dyer DS, Moore EE, Mestek MF. Can chest CT be used to exclude aortic injury?. Radiology. 1999;213:195-202.

Miller FB, Richardson JD, Thomas HA, Cryer HM, Willing SJ. Role of CT in diagnosis of major arterial injury after blunt thoracic trauma. Surgery. 1989;106:596-602.

Bruckner BA, DiBardino DJ, Cumbie TC. Critical evaluation of chest computed tomography scans for blunt descending thoracic aortic injury. Ann Thorac Surg. 2006;81:1339-46.

Smith MD, Cassidy JM, Souther S. Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. N Engl J Med. 1995;332:356-62.

Saletta S, Lederman E, Fein S, Singh A, Kuehler DH, Fortune JB. Transesophageal echocardiography for the initial evaluation of the widened mediastinum in trauma patients. J Trauma. 1995;39:137-41.

Hudson HM 2nd, Woodson J, Hirsch E. The management of traumatic aortic tear in the multiply-injured patient. Ann Vasc Surg. 1991;5:445-8.

Hunt JP, Baker CC, Lentz CW. Thoracic aorta injuries: management and outcome of 144 patients. J Trauma. 1996;40:547-55.

Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg. 2004;41:211-380.

Karmy-Jones R, Carter YM, Nathens A. Impact of presenting physiology and associated injuries on outcome following traumatic rupture of the thoracic aorta. Am Surg. 2001;67:61-6.

Akins CW, Buckley MJ, Daggett W, McIlduff JB, Austen WG. Acute traumatic disruption of the thoracic aorta: a ten-year experience. Ann Thorac Surg. 1981;31:305-9.

Galli R, Pacini D, Di Bartolomeo R. Surgical indications and timing of repair of traumatic ruptures of the thoracic aorta. Ann Thorac Surg. 1998;65:461-4.

Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency?. World J Surg. 1995;19:119-25.

Maggisano R, Nathens A, Alexandrova NA. Traumatic rupture of the thoracic aorta: should one always operate immediately?. Ann Vasc Surg. 1995;9:44-52.

Carter YM, Karmy-Jones R, Aldea GS. Delayed surgical management of a traumatic aortic arch injury. Ann Thorac Surg. 2002;73:294-6.

Mattox KL, Wall MJ Jr. Historical review of blunt injury to the thoracic aorta. Chest Surg Clin N Am. 2000;10:167-82.

von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year metaanalysis of mortality and risk of paraplegia. Ann Thorac Surg. 1994;58:585-93.

Rousseau H, Soula P, Perreault P. Delayed treatment of traumatic rupture of the thoracic aorta with endoluminal covered stent. Circulation. 1999;99:498-504.

Lachat ML, Pfammatter T, Witzke HJ. Endovascular repair with bifurcated stent-grafts under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Vasc Endovasc Surg. 2002;23:528-36.

Brandt M, Hussel K, Walluscheck KP. Stent-graft repair versus open surgery for the descending aorta: a case-control study. J Endovasc Ther. 2004;11:535-8.

Andrassy J, Weidenhagen R, Meimarakis G, Lauterjung L, Jauch KW, Kopp R. Stent versus open surgery for acute and chronic traumatic injury of the thoracic aorta: a single-center experience. J Trauma. 2006;60:765-71.

Ott MC, Stewart TC, Lawlor DK, Gray DK, Forbes TL. Management of blunt thoracic aortic injuries: endovascular stents versus open repair. J Trauma. 2004;56:565-70.

Peterson BG, Matsumura JS, Morasch MD, West MA, Eskandari MK. Percutaneous endovascular repair of blunt thoracic aortic transection. J Trauma. 2005;59:1062-5.

Mioto Neto B, Aun R, Estenssoro AEV, Puech-Leão P. Tratamento das lesões de aorta nos traumatismos torácicos fechados. J Vasc Bras. 2005;4:217-26.

Von Ristow A. Tratamento das lesões de aorta nos traumatismos torácicos fechados [editorial]. J Vasc Bras. 2005;4:215-6.

Hoornweg LL, Dinkelman MK, Goslings JC. Endovascular management of traumatic ruptures of the thoracic aorta: a retrospective multicenter analysis of 28 cases in The Netherlands. J Vasc Surg. 2006;43:1096-102.

Borsa JJ, Hoffer EK, Karmy-Jones R. Angiographic description of blunt traumatic injuries to the thoracic aorta with specific relevance to endograft repair. J Endovasc Ther. 2002;9(2):II84-91.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddfe1ee0e88254e3a4ce1d5 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections