• Journal of Trauma and Injury
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• 제34권2호
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• pp.81-86
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• 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
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• 제29권4호
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• pp.146-150
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• 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
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• 제31권2호
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• pp.66-71
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• 2018

Patients with traumatic aortic rupture rarely reach the hospital alive. Even among those who arrive at the hospital alive, traumatic aortic rupture after high-speed motor vehicle accidents leads to a high in-hospital mortality rate and is associated with other major injuries. Here, we report a rare case of descending midthoracic aortic rupture with blunt diaphragmatic rupture. Successful management with emergency laparotomy after an immediate endovascular procedure resulted in a favorable prognosis in this case.

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

• Korean Journal of Radiology
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• 제22권4호
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• pp.577-583
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• 2021

Objective: To report the authors' experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI). Materials and Methods: This retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedure-related factors and post-procedure prognosis were compared between the groups. Results: There were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group. Conclusion: Delaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft.

• Journal of Chest Surgery
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• 제37권9호
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• pp.774-780
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• 2004

외상성 흉부대동맥 파열은 수술적 치료가 요구되는 치명적 손상이며 이외에 다른 부위에 복합손상이 동반되면 심폐 바이패스에 의한 위험도를 크게 증가시킬 수 있다. 여기서 저자들은 심한 동반손상을 먼저 치료한 후 대동맥수술을 하고 그 결과를 관찰하였다. 대상 및 방법: 1997년부터 2003년까지 외상성 흉부 대동맥질환으로 수술을 받은 24명의 환자를 대상으로 의무기록을 후향적으로 검토하여, 동반손상 여부, 수술방법, 수술 후 경과, 합병증 등을 분석하고 국내외 문헌들과 비교하였다. 수술은 초저온 심정지법하에서 심폐 바이패스를 이용한 개흉술로 하였는데 근위부 연결 후 곁가지를 통해 뇌관류를 시행하였고 요추 카테터를 통한 뇌척수액 배액으로 하반신 마비를 예방하였다. 결과： 대상환자 전원에서 83예의 동반손상이 발생하였는데, 흉부손상이 49예, 근골격계 손상 18예, 복부 손상 13예였고, 수상 후 12명의 환자에서 7.6$\pm$12.6일에 16예의 동반손상에 대한 수술이 행해졌다. 수상당시 18예에서만 대동맥 손상이 진단되었다. 중환자실에서 혈압을 약물투여로 조절하면서 안정시키고 수상 후 693 $\pm$ 1350일에 지연수술을 시행하였는데, 관찰기간 중 사망이나 대동맥 파열의 진행은 없었다. 수술 사망은 없었으며, 술 후 큰 합병증은 없었다. 결론： 외상성 흉부대동맥 파열에 있어서 다른 부위 손상이 동반되면 심한 동반손상을 먼저 치료한 후 수술하는 것이 수술 사망률이나 이병률 면에서 좋은 결과를 가져온다.

• Journal of Trauma and Injury
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• 제28권1호
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• pp.31-33
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• 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 Chest Surgery
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• 제33권9호
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• pp.756-760
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• 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
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• 제45권6호
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• pp.390-395
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• 2012

Background: Conventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option. Materials and Methods: From August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared. Results: Although not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed. Conclusion: Compared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1125-1131
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• 1992

Still a lethal injury, traumatic rupture of thoracic aorta occurs more frequently than we expect and comprises significant part of causes of deaths by blunt trauma. We recently experienced a thoracic aortic rupture accompanied by multiple injuries including pericardial and interatrial septal rupture and myocardial contusion in a patient who had been injured in a fall accident. Literatures are reviewed with the concern of early diagnosis, surgical technique and the result of operation.