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Vascular injuries after blunt chest trauma: diagnosis and management.

O'Connor JV, Byrne C, Scalea TM, Griffith BP, Neschis DG - Scand J Trauma Resusc Emerg Med (2009)

Bottom Line: Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries.More stable injuries can often be medically temporized in order to optimize definitive management.Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.

View Article: PubMed Central - HTML - PubMed

Affiliation: R. Adams Cowley Shock Trauma Center, Baltimore, USA. joconnor@umm.edu

ABSTRACT

Background: Although relatively rare, blunt injury to thoracic great vessels is the second most common cause of trauma related death after head injury. Over the last twenty years, the paradigm for management of these devastating injuries has changed drastically. The goal of this review is to update the reader on current concepts of diagnosis and management of blunt thoracic vascular trauma.

Methods: A review of the medical literature was performed to obtain articles pertaining to both blunt injuries of the thoracic aorta and of the non-aortic great vessels in the chest. Articles were chosen based on authors' preference and clinical expertise.

Discussion: Blunt thoracic vascular injury remains highly lethal, with most victims dying prior to reaching a hospital. Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries. More stable injuries can often be medically temporized in order to optimize definitive management. Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.

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Reconstructed computed tomography with contrast demonstrating a pseudoaneurysm at the junction of the right subclavian and common carotid arteries (arrow).
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Figure 2: Reconstructed computed tomography with contrast demonstrating a pseudoaneurysm at the junction of the right subclavian and common carotid arteries (arrow).

Mentions: This is the second most commonly injured great vessel, with the proximal descending aorta the most common. Most innominate artery injuries occur at the vessel origin [7,19,20,28]. These are surgically repaired by placing a graft end-to-side from the ascending aorta and end-to-end to the distal innominate. Only after the graft is in place is the proximal innominate artery closed with pledgeted polypropylene sutures. An interposition graft or stent placement may be employed if the injury is in the mid portion of the vessel. More distal injuries (Figure 2) may require more complex reconstruction [20]. Generally all these injuries can be repaired without cardiopulmonary bypass or shunts although some authors recommend monitoring stump pressure [19].


Vascular injuries after blunt chest trauma: diagnosis and management.

O'Connor JV, Byrne C, Scalea TM, Griffith BP, Neschis DG - Scand J Trauma Resusc Emerg Med (2009)

Reconstructed computed tomography with contrast demonstrating a pseudoaneurysm at the junction of the right subclavian and common carotid arteries (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749011&req=5

Figure 2: Reconstructed computed tomography with contrast demonstrating a pseudoaneurysm at the junction of the right subclavian and common carotid arteries (arrow).
Mentions: This is the second most commonly injured great vessel, with the proximal descending aorta the most common. Most innominate artery injuries occur at the vessel origin [7,19,20,28]. These are surgically repaired by placing a graft end-to-side from the ascending aorta and end-to-end to the distal innominate. Only after the graft is in place is the proximal innominate artery closed with pledgeted polypropylene sutures. An interposition graft or stent placement may be employed if the injury is in the mid portion of the vessel. More distal injuries (Figure 2) may require more complex reconstruction [20]. Generally all these injuries can be repaired without cardiopulmonary bypass or shunts although some authors recommend monitoring stump pressure [19].

Bottom Line: Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries.More stable injuries can often be medically temporized in order to optimize definitive management.Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.

View Article: PubMed Central - HTML - PubMed

Affiliation: R. Adams Cowley Shock Trauma Center, Baltimore, USA. joconnor@umm.edu

ABSTRACT

Background: Although relatively rare, blunt injury to thoracic great vessels is the second most common cause of trauma related death after head injury. Over the last twenty years, the paradigm for management of these devastating injuries has changed drastically. The goal of this review is to update the reader on current concepts of diagnosis and management of blunt thoracic vascular trauma.

Methods: A review of the medical literature was performed to obtain articles pertaining to both blunt injuries of the thoracic aorta and of the non-aortic great vessels in the chest. Articles were chosen based on authors' preference and clinical expertise.

Discussion: Blunt thoracic vascular injury remains highly lethal, with most victims dying prior to reaching a hospital. Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries. More stable injuries can often be medically temporized in order to optimize definitive management. Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.

Show MeSH
Related in: MedlinePlus