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Therapeutic Plan for Traumatic Truncal Arterial Injury Associated with Truncal Organ Injury  

Jo, Choong Hyun (Department of Emergeny Medicine, Ajou University School of Medicine)
Jung, Yong Sik (Department of Surgery, Ajou University School of Medicine)
Kim, Wook Hwan (Department of Surgery, Ajou University School of Medicine)
Cho, Young Shin (Department of Emergeny Medicine, Ajou University School of Medicine)
Ahn, Jung Hwan (Department of Emergeny Medicine, Ajou University School of Medicine)
Min, Young Gi (Department of Emergeny Medicine, Ajou University School of Medicine)
Jung, Yoon Seok (Department of Emergeny Medicine, Ajou University School of Medicine)
Kim, Sung Hee (Department of Emergeny Medicine, Ajou University School of Medicine)
Lee, Kug Jong (Department of Emergeny Medicine, Ajou University School of Medicine)
Publication Information
Journal of Trauma and Injury / v.22, no.1, 2009 , pp. 77-86 More about this Journal
Abstract
Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.
Keywords
Aortic injuries; Aortic dissection; Blunt trauma; Stent;
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1 Antunes MJ. Acute traumatic rupture of the aorta: repair by simple aortic cross-clamping. Ann Thorac Surg. 1987;44:257-9   DOI   ScienceOn
2 Fabian TC, Davis KA, Gavant ML. Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg 1998;227:666-76   DOI   ScienceOn
3 Stemper BD, Yoganandan N, Pintar FA, Brasel KJ. Multiple subfailures characterize blunt aortic injury. J Trauma 2007;62:1171-4   DOI   ScienceOn
4 John M. Santaniello, MD, Preston R. Miller, et al. Blunt Aortic Injury with Concomitant Intra-abdominal Solid Organ Injury: Treatment Priorities Revisited. J Trauma. 2002;53:442-445   DOI
5 Berthet JP, Marty-Ane CH, Vecrapen R. Dissection of abdominal aorta in blunt trauma: endovascular or conventional surgical management? J Vasc Surg 2004;38:997-1004   DOI   ScienceOn
6 Pate JW. Traumatic rupture of the aorta: emergency operation. Ann Thorac Surg. 1985;39:531-7   DOI   ScienceOn
7 Kipfer B, Leupi F, Schuepbach P, Friedli D, Althaus U. Acute traumatic rupture of the thoracic aorta: immediate or delayed surgical repair? Eur J Cardiothorac Surg 1994;8:30-3   DOI   ScienceOn
8 Parmley LF, Colonel MC, Mattingly TW, Manion WC, Jahnke EJ. Nonpenetrating traumatic injury of the aorta. Circulation 1958;17:1086-101   DOI   ScienceOn
9 Amabile P, Collart F, Gariboldi V, Rollet G, Bartoli JM, Piquet P. Surgical versus endovascular treatment of traumatic thoracic aortic rupture. J Vasc Surg 2004;40:873-9   DOI   ScienceOn
10 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 Apr;31(4):305-9   DOI   ScienceOn
11 Fabian TC, Richardson JD, Croce MA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma. J Trauma 1997;42:374-80   DOI   ScienceOn
12 Neschis DG, Moaine S, Gutta R, Charles K, et al. Twenty consecutive cases of endograft repair of traumatic aortic disruption: lessons learned. J Vasc Surg. 2007 Mar;45(3):487-92   DOI   ScienceOn
13 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   DOI   ScienceOn
14 Svensson LG, Antunes MD, Kinsley RH. Traumatic rupture of the thoracic aorta. A report of 14 cases and a review of the literature. S Afr Med J. 1985 May 25;67(21):853-7
15 Merrill WH, Lee RB, Hammon JW Jr, Frist WH, Stewart JR, Bender HW Jr. Surgical treatment of acute traumatic tear of the thoracic aorta. Ann Surg. 1988;207:699-706   DOI   ScienceOn
16 Rousseau H, Dambrin C, Marcheix B, et al. Acute traumatic aortic rupture: a comparison of surgical and stent-graft repair. J Thorac Cardiovasc Surg 2005;129:1050-5   DOI   ScienceOn
17 Stewart RM, Myers JG, Dent DL, Ermis P, Gray GA. Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention. J Trauma. 2003 Jan;54(1):66-70   DOI   ScienceOn
18 Griffith GL, Mattingly WT Jr, Tood EP. Current diagnosis and management of blunt thoracic aortic trauma. J Ky Med Assoc. 1981 Sep;79(9):588-93
19 Croce MA, Fabian TC, Menke PG, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995 Jun;221(6):744-53   DOI   ScienceOn
20 Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003 Aug;138(8):844-51   DOI   ScienceOn
21 Von Oppell UO, Dunne TT, Degroot MK, et al. Traumatic aortic rupture: 20-year meta-analysis of mortality and risk of paraplegia. Ann Thorac Surg. 1994;58:585-93   DOI   ScienceOn
22 Greendyke RM. Traumatic rupture of aorta; special reference to automobile accidents. JAMA 1966;195:527-30   DOI   ScienceOn
23 Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency? World J Surg 1995;19:119-25   DOI   ScienceOn
24 David G. Neschis, Thomas M. Scalea, et al. Blunt aortic injury. N Engl J Med 2008;359:1708-16   DOI   ScienceOn
25 Kasirajan K, Heffernan D, Langsfeld M. Acute thoracic aortic trauma: a comparison of endoluminal stent grafts with open repair and nonoperative management. Ann Vasc Surg 2003;17:589-95   DOI   ScienceOn
26 Yanar H, Ertekin C, Taviloglu K. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma. 2008 Apr;64(4):943-8   DOI
27 Walker WA, Pate JW. Medical management of acute traumatic rupture of the aorta. Ann Thorac Surg. 1990;50:965-7   DOI   ScienceOn