• Journal of Trauma and Injury
• /
• 제29권4호
• /
• pp.146-150
• /
• 2016

Purpose: Traumatic aortic injuries are rare, but life threatening condition. They usually occur after high velocity impact on the chest or abdomen such as traffic accident or fall. We report the experiences of the traumatic aortic injuries at a single center. Methods: We retrospectively reviewed the medical records of nine patients with aortic injury resulting from the blunt trauma from Jan. 2010 to May. 2016. Results: The mean age was $51.1{\pm}20.8$ years old, and ten (90.9%) were men. The mechanisms of injury were traffic accidents in seven patients (motorcycle accidents; 3, car accidents; 4), and four in fall injury. Most common injured sites were thoracic aorta (9, 81.8%). Aortic injuries were repaired by endovascular approach in four patients, and by open graft surgery in four. Two patients were managed conservatively. Nine patients survived without any complications. Conclusion: We had experienced different approaches for management of aortic injuries after blunt trauma according to locations and severity of lesions.

• Journal of Trauma and Injury
• /
• 제34권2호
• /
• pp.81-86
• /
• 2021

Purpose: This study investigated the clinical outcomes of trauma patients with blunt thoracic aortic injuries at a single institution. Methods: During the study period, 9,501 patients with traumatic aortic injuries presented to Trauma Center of Gil Medical Center. Among them, 1,594 patients had severe trauma, with an Injury Severity Score (ISS) of >15. Demographics, physiological data, injury mechanism, hemodynamic parameters associated with the thoracic injury according to chest computed tomography (CT) findings, the timing of the intervention, and clinical outcomes were reviewed. Results: Twenty-eight patients had blunt aortic injuries (75% male, mean age, 45.9±16.3 years). The majority (82.1%, n=23/28) of these patients were involved in traffic accidents. The median ISS was 35.0 (interquartile range 21.0-41.0). The injuries were found in the ascending aorta (n=1, 3.6%) aortic arch (n=8, 28.6%) aortic isthmus (n=18, 64.3%), and descending aorta (n=1, 3.6%). The severity of aortic injuries on chest CT was categorized as intramural hematoma (n=1, 3.6%), dissection (n=3, 10.7%), transection (n=9, 32.2%), pseudoaneurysm (n=12, 42.8%), and rupture (n=3, 10.7%). Endovascular repair was performed in 71.4% of patients (45% within 24 hours), and two patients received surgical management. The mortality rate was 25% (n=7). Conclusions: Traumatic thoracic aortic injuries are life-threatening. In our experience, however, if there is no rupture and extravasation from an aortic injury, resuscitation and stabilization of vital signs are more important than an intervention for an aortic injury in patients with multiple traumas. Further study is required to optimize the timing of the intervention and explore management strategies for blunt thoracic aortic injuries in severe trauma patients needing resuscitation.

• Journal of Trauma and Injury
• /
• 제28권1호
• /
• pp.31-33
• /
• 2015

Traumatic aortic injury is well recognized as a primary cause of instantaneous death in victims of thoracic blunt trauma presenting with an aortic rupture or dissection, particularly after a deceleration injury. However, a direct aortic injury caused by a fractured rib segment after blunt thoracic trauma is extremely rare. We report the case of a 43-year-old male patient who experienced an aortic injury caused by the sharp edge of a fractured rib after multiple rib fractures due to blunt thoracic trauma.

• Journal of Trauma and Injury
• /
• 제31권3호
• /
• pp.174-176
• /
• 2018

Most of aortic injuries after blunt chest trauma usually occur at the aortic isthmus and are identified in the emergency department soon after arrival. Delayed aortic injures by fractured posterior ribs, however, are relatively rare and have been reported only a few times. We recently experienced an iatrogenic descending aortic injury sustained as a result of a direct puncture by a sharp rib end after surgical stabilization of rib fractures.

• Journal of Trauma and Injury
• /
• 제31권1호
• /
• pp.24-28
• /
• 2018

Ascending aortic injury after blunt chest trauma is an emergency condition that requires urgent diagnosis and treatment. The authors report the case of a patient with traumatic ascending aortic injury who received ascending aorta replacement under cardiopulmonary bypass after failure of primary repair.

• Journal of Chest Surgery
• /
• 제42권1호
• /
• pp.100-103
• /
• 2009

흉부 대동맥의 외상성 파열은 두부 손상 다음으로 흔한 교통사고의 사망원인으로 약 85%의 환자가 병원 도착 전에 사망한다. 가장 흔한 기전은 고속의 차량이 충돌 등으로 인한 급작스런 감속에 의해 발생되며 대동맥 협부가 전체 대동맥 손상의 95%에 해당된다. 또 다른 기전으로는 흉부 압박 손상에 의해 골절되어 전위된 흉골병과 흉부 척추 사이에 대동맥이 끼이면서 나타날 수 있는데 이로 인해 흔하지 않은 위치의 대동맥벽의 내막이 파열된다. 저자들은 감속사고가 아닌 흉부 압박에 의해 대동맥궁이 파열되어 박리된 증례에 대해 집중적인 내과 치료 후에 지연 수술로 완전 순환정지 하에 뇌보호를 시행하면서 상행 대동맥의 일부와 대동맥궁을 인조혈관으로 치환하였기에 보고하는 바이다.

• Journal of Trauma and Injury
• /
• 제28권4호
• /
• pp.232-240
• /
• 2015

Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was $105.64{\pm}24.60mm\;Hg$, and the mean heart rate was $103.64{\pm}20.02per$ minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was $21.82{\pm}16.37hours$. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.

• Journal of Chest Surgery
• /
• 제33권9호
• /
• pp.756-760
• /
• 2000

Traumatic aortic transection after blunt chest injury is highly lethal and has high operative mortality. Recently, the diagnostic and therapeutic method of this injury is advanced, especially in spinal cord protection during aortic cross-clamping. We have experienced two cases of traumatic aortic transection with left hemothorax after blunt chest injury, which was diagnosed in operative field. The transected aorta was primarily repaired with clamp and sew method and postoperative paraplegia had not occured. The patients were dischraged without any significant complications. We report these cases with a review of literature.

• Journal of Chest Surgery
• /
• 제50권4호
• /
• pp.295-297
• /
• 2017

A 27-year-old man was admitted with a penetrating injury at the mid-manubrium. Computed tomographic (CT) angiography showed a f illing def ect in the aortic arch. This was evaluated as a sign of injury and the patient underwent an emergency operation. No active bleeding or clot was f ound in the mediastinum during the operation. The laceration point was between the innominate and the left carotid artery posteriorly. The injury was approached using hypothermic circulatory arrest. Aortotomy and exploration showed a 2-cm-long full-thickness aortic injury with an overlying clot. A filling defect on angiography as a sign of a penetrating arch injury has never been reported previously, but was the main pathological finding on CT angiography in our case. The aorta is a high-pressure system and injuries to it should be treated aggressively.

• Journal of Trauma and Injury
• /
• 제32권3호
• /
• pp.172-175
• /
• 2019

Although thoracic endovascular aortic repair (TEVAR) has grown to become the standard of care to treat blunt thoracic aortic injury (BTAI), the long-term effects of TEVAR are still unclear. We here present a 72-year-old man with BTAI due to a traffic accident. He successfully underwent TEVAR and was transferred to another rehabilitation hospital 2 months after the accident. However, 1 month later, he underwent gastroscopy with fever and hematemesis and was diagnosed with aorto-esophageal fistula (AEF). After being re-transferred to Niigata University Medical and Dental Hospital, we tried to convince him to undergo surgical treatment, but he strongly refused. He received palliative care and died due to rupture of the aortic pseudoaneurysm 3 days after the hospital transfer. Fatal complications like AEF may occur after TEVAR, so clinicians need to carefully follow patients who underwent TEVAR.