RESUMO
PURPOSE: This study aimed to elucidate the treatment approach for blunt splenic injuries concurrently involving the aorta. We hypothesized that non-operative management failure rates would be higher in such cases, necessitating increased hemorrhage control surgeries. METHODS: Data from the Trauma Quality Improvement Program spanning 2017 to 2019 were utilized. All patients with blunt splenic trauma were considered for inclusion. We conducted comparisons between blunt splenic trauma patients with and without thoracic or abdominal aortic injuries to identify any potential disparities in treatment. RESULTS: Among the 32,051 patients with blunt splenic injuries during the study period, 752 (2.3%) sustained concurrent aortic injuries. Following 2:1 propensity score matching, it was determined that the presence of aortic injuries did not significantly affect the utilization of splenic transarterial angioembolization (TAE) (7.2% vs. 8.7%, p = 0.243) or the necessity for splenectomy or splenorrhaphy (15.3% vs. 15.7%, p = 0.853). Moreover, aortic injuries were not a significant factor contributing to TAE failure, regardless of the location or severity of the injury. Patients with simultaneous splenic and aortic injuries required more red blood cell transfusion within first 4 hours (0 ml [0, 900] vs. 0 ml [0, 650], p = 0.001) and exhibited a higher mortality rate (10.6% vs. 7.9%, p = 0.038). CONCLUSION: This study demonstrated that patients with concurrent aortic and splenic injuries presented with more severe conditions, higher mortality rates, and extended hospital stays. The presence of aortic injuries did not substantially influence the utilization of TAE or the necessity for splenectomy or splenorrhaphy. Patients of this type can be managed in accordance with current treatment guidelines. Nonetheless, given their less favorable prognosis, they necessitate prompt and proactive intervention.
Assuntos
Estudos de Viabilidade , Baço , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/complicações , Masculino , Feminino , Baço/lesões , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenectomia/estatística & dados numéricos , Escala de Gravidade do Ferimento , Embolização Terapêutica/métodos , Aorta Abdominal/lesões , Traumatismos Abdominais/terapia , Traumatismos Abdominais/complicações , Pontuação de Propensão , Lesões do Sistema Vascular/terapia , Lesões do Sistema Vascular/mortalidade , Traumatismo Múltiplo/terapiaRESUMO
Abdominal aortic lacerations are very rare in closed trauma and are usually caused by high energy trauma. Aortic injuries should be assessed as a priority as they present an immediate life-threatening risk in the event of major haemorrhage. However, the clinical presentations are highly variable and often misleading. We -present a case of traumatic blunt abdominal aortic laceration following a fall down the stairs. The laceration involved the posterior part of the abdominal aorta secondary to a lumbar fracture with L1-L2 disc tear.
Les lacérations de l'aorte abdominale sont très rares dans les traumatismes fermés et sont généralement causées par des traumatismes à haute énergie. Les lésions aortiques doivent être évaluées en priorité car elles présentent un risque vital immédiat en cas d'hémorragie majeure. Cependant, les présentations cliniques sont très variables et souvent trompeuses. Nous présentons un cas de lacération aortique abdominale traumatique suite à une chute dans les escaliers. La lacération intéresse la partie postérieure de l'aorte abdominale sur une fracture lombaire avec déchirure du disque L1-L2.
Assuntos
Lacerações , Fraturas da Coluna Vertebral , Lesões do Sistema Vascular , Humanos , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Lacerações/complicações , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/complicações , Vértebras Lombares/diagnóstico por imagem , Lesões do Sistema Vascular/complicaçõesRESUMO
The patient is an 8 year-old male presenting to outside facility following high-speed motor vehicle collision in which he was a restrained passenger. CT imaging at that time demonstrated a traumatic infrarenal aortic pseudoaneurysm, extensive pneumoperitoneum and free fluid, and an unstable L2 vertebral body fracture. He underwent exploratory laparotomy with small bowel resection prior to transfer. The patient was left in discontinuity and temporary closed. Vascular surgery was consulted upon arrival to tertiary care children's hospital. The decision was made to proceed with emergent endovascular repair. An aortogram confirmed the location of the aortic disruption well below the renal arteries, superior to the bifurcation. An 11 mm × 5 cm Viabahn covered stent was placed across the injury with adequate proximal and distal seal. This is a case of seatbelt-related pediatric infrarenal aortic injury in the setting of polytrauma. Endovascular repair was pursued in this damage-control setting.
Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Masculino , Humanos , Criança , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aorta Abdominal/lesões , Artéria Renal , Stents , Resultado do Tratamento , Implante de Prótese Vascular/métodos , Aneurisma da Aorta Abdominal/cirurgia , Prótese VascularRESUMO
Traumatic aortic injuries in children and adolescents are rare, and even more rare are blunt traumatic injury to the abdominal aorta in this population. Therefore, there are few reports discussing the presentation and repair of such injuries, especially within the pediatric population. We report the successful repair of traumatic abdominal aortic transection in a 10-year-old female after a high speed MVC. She arrived in extremis with a seatbelt sign and was taken emergently for damage control laparotomy with subsequent postoperative CT findings of aortic transection/dissection at L3 with active extravasation. She immediately underwent open thrombectomy of the bilateral iliac arteries, and repair of her aortic injury with a 12 × 7 mm Hemashield interposition graft extending just distal to the IMA and 1 cm proximal to the aortic bifurcation. There are little data regarding long-term outcomes of pediatric patients undergoing different aortic repair techniques, and further research is needed.
Assuntos
Doenças da Aorta , Dissecção Aórtica , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Humanos , Criança , Feminino , Adolescente , Desaceleração , Cintos de Segurança/efeitos adversos , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aorta Abdominal/lesões , Doenças da Aorta/cirurgia , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgiaRESUMO
BACKGROUND: Studies on the mortality of blunt abdominal aortic injury (BAAI) are rare and have yielded inconsistent results. In the present study, we aimed to quantitatively analyse the retrieved data to more accurately determine the hospital mortality of BAAI. METHODS: The Excerpta Medica Database, PubMed, Web of Science and Cochrane Library databases were searched to identify relevant publications without date restrictions. The overall hospital mortality (OHM) of BAAI patients was set as the primary outcome measure. English publications with data that met the selection criteria were included. The quality of all included studies was assessed by the Joanna Briggs Institute checklist and the American Agency for Health Care Quality and Research's cross-sectional study quality evaluation items. After data extraction, a meta-analysis of the Freeman-Tukey double arcsine transformation of data was performed using the Metaprop command in Stata 16 software. Heterogeneity was assessed and reported as a percentage using the I2 index value and as a P value using the Cochrane Q test. Various methods were used to determine the sources of heterogeneity and to analyse the sensitivity of the computation model. RESULTS: Of the 2147 references screened, 5 studies that involved 1593 patients met the selection criteria and were included. There were no low-quality references after assessment. One study that only included 16 juvenile BAAI patients was excluded from the meta-analysis of the primary outcome measure due to high heterogeneity. Due to the low heterogeneity (I2 = 47.6%, P = 0.126 for Q test) that was observed after using the random effects model, the fixed model was subsequently used to pool the effect sizes of the remaining four studies, thus yielding an OHM of 28.8% [95% confidence interval (CI) 26.5-31.1%]. The stability of the model was verified by sensitivity analysis, and Egger's test (P = 0.339) indicated a low level of publication bias. In addition, we also performed meta-analyses and obtained a pooled hospital mortality of operation (13.5%, 95% CI 8.0-20.0%), a pooled hospital mortality of non-operation (28.4%, 95% CI 25.9-31.0%), and a pooled rate of aortic rupture (12.2%, 95% CI 7.0-18.5%) of BAAI. CONCLUSIONS: The present study indicated that BAAI has an OHM of 28.8%, indicating that this disease deserves more attention and research.
Assuntos
Aorta Abdominal , Ferimentos não Penetrantes , Humanos , Estados Unidos , Mortalidade Hospitalar , Estudos Transversais , Aorta Abdominal/lesõesRESUMO
OBJECTIVE: Blunt abdominal aortic injury in children is a rare clinical entity with which most vascular surgeons have minimal experience. The evidence for management recommendations is limited. We have reported a single institution's experience in the care of pediatric abdominal aortic injuries. METHODS: We performed a retrospective review of consecutive pediatric patients who had been diagnosed with blunt traumatic abdominal aortic injury at our institution from 2008 to 2019. RESULTS: A total of 16 pediatric patients (50% male) were identified. They ranged in age from 4 to 17 years. All had been involved in motor vehicle collisions and had been restrained passengers with a seatbelt in use. Five patients (31%) were hypotensive en route or on arrival. Seven patients (44%) had been transferred from another hospital. The median injury severity score was 34 (interquartile range, 19-35). The infrarenal aortic injuries were stratified using the aortic injury grading classification (five, two, seven, and two with grade 1, 2, 3, and 4, respectively). Concurrent nonaortic injuries included solid organ (63%; n = 10), hollow viscus (88%; n = 14), brain (25%; n = 4), hemothorax or pneumothorax (25%; n = 4), spine fractures (81%; n = 13), and nonspine fractures (75%; n = 12). Of the 16 patients, 9 (56%) had required aortic repair. Three had required immediate revascularization for distal ischemia. The remaining six patients (38%) had undergone delayed repair, with a median interval to repair of 52 days (range, 2-916 days). One half of the delayed repairs were performed during the index hospitalization. On repeat axial imaging, the three patients who had undergone delayed repair were found to have enlarging pseudoaneurysms or flow-limiting dissections and had subsequently undergone repair during the index hospitalization. Only one patient had undergone endovascular repair. No deaths occurred, and the median follow-up was 7 months (interquartile range, 3-28 months) for our study population. All postoperative patients demonstrated stable imaging findings without requiring further intervention. Seven patients, whose injury grades had ranged from 1 to 3, were observed. Their repeat imaging studies demonstrated either stability or resolution of their aortic injury. However, one half of the patients had been lost to follow-up after discharge or after their first postoperative clinic visit. CONCLUSIONS: Delayed aortic intervention can be safely performed for most pediatric patients with blunt abdominal aortic injuries with preserved distal perfusion to the lower extremities. This finding suggests that transfer to a tertiary center with vascular expertise is a safe and feasible management strategy. However, the progression of aortic injuries was seen as early as within 48 hours and as late as 30 months after injury, underscoring the importance of long-term surveillance. However, in our cohort, 50% of the children were lost to follow-up, highlighting the need for a more structured surveillance strategy.
Assuntos
Traumatismos Abdominais , Doenças da Aorta , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Adolescente , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Aorta Abdominal/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgiaAssuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Ferimentos Perfurantes/cirurgia , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagemAssuntos
Traumatismos Abdominais/complicações , Aorta Abdominal/lesões , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Stents , Lesões do Sistema Vascular/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/cirurgiaRESUMO
The Heimlich maneuver is a lifesaving bystander intervention to assist an individual with airway obstruction however, cholesterol embolization syndrome is a rare, but serious potential complication of the Heimlich maneuver. We present the case of the 56-year-old female presenting to the emergency department with acute right foot pain following performance of the Heimlich maneuver who was found to have distal arterial occlusion resulting from cholesterol embolization syndrome. The patient underwent right popliteal artery exploration, right popliteal and tibial thrombectomy, and popliteal patch angioplasty resulting in restoration of blood flow to her right foot.
Assuntos
Obstrução das Vias Respiratórias/terapia , Arteriopatias Oclusivas/etiologia , Embolia de Colesterol/etiologia , Manobra de Heimlich/efeitos adversos , Aorta Abdominal/lesões , Feminino , Humanos , Extremidade Inferior , Pessoa de Meia-IdadeRESUMO
Limb ischemia is a major complication associated with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The high velocity jet from arterial cannulae can cause "sandblasting" injuries to the arterial endothelium, with the potential risk of distal embolization and end organ damage. The aim of this study was to identify, for a range of clinically relevant VA-ECMO cannulae and flow rates, any regions of peak flow velocity on the aortic wall which may predispose to vascular injury, and any regions of low-velocity flow which may predispose to thrombus formation. A silicone model of the aortic and iliac vessels was sourced and the right external iliac artery was cannulated. Cannulae ranged from 15 to 21 Fr in size. Simulated steady state ECMO flow rates were instituted using a magnetically levitated pump (CentriMag pump). Adaptive particle image velocimetry was performed for each cannula at 3, 3.5, 4, and 4.5 L/min. For all cannulae, in both horizontal and vertical side hole orientations, the peak velocity on the aortic wall ranged from 0.3 to 0.45 m/s, and the regions of lowest velocity flow were 0.05 m/s. The magnitude of peak velocity flow on the aortic wall was not different between a single pair versus multiple pairs of side holes. Maximum velocity flow on the aortic wall occurred earlier at a lower pump flow rate in the vertical orientation of distal side holes compared to a horizontal position. The presence of multiple paired side holes was associated with fewer low-velocity flow regions, and some retrograde flow, in the distal abdominal aorta compared to cannulae with a single pair of side holes. From this in vitro visualization study, the selection of a cannula design with multiple versus single pairs of side holes did not change the magnitude of peak velocity flow delivered to the vessel wall. Cannulae with multiple side holes were associated with fewer regions of low-velocity flow in the distal abdominal aorta. Further in vivo studies, and ideally clinical data would be required to assess any correlation of peak velocity flows with incidence of vascular injury, and any low-velocity flow regions with incidence of thrombosis.
Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Extremidades/irrigação sanguínea , Isquemia/prevenção & controle , Modelos Cardiovasculares , Lesões do Sistema Vascular/prevenção & controle , Aorta Abdominal/lesões , Velocidade do Fluxo Sanguíneo , Cânula/efeitos adversos , Desenho de Equipamento , Oxigenação por Membrana Extracorpórea/instrumentação , Humanos , Artéria Ilíaca/lesões , Isquemia/etiologia , Isquemia/fisiopatologia , Reologia , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologiaRESUMO
We report the case of an anterior cage migration that was incarcerated between the abdominal aorta and inferior vena cava. Removal of the cage was favored over conservative treatment because of potential migration and vessel injury.
Assuntos
Aorta Abdominal/lesões , Migração de Corpo Estranho/etiologia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Lesões do Sistema Vascular/etiologia , Veia Cava Inferior/lesões , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Remoção de Dispositivo , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgiaRESUMO
Accurate quantification and characterization of atherosclerotic plaques with MRI requires high spatial resolution acquisitions with excellent image quality. The intrinsically better signal-to-noise ratio (SNR) at high-field clinical 7T compared to the widely employed lower field strengths of 1.5 and 3T may yield significant improvements to vascular MRI. However, 7T atherosclerosis imaging also presents specific challenges, related to local transmit coils and B1 field inhomogeneities, which may overshadow these theoretical gains. We present the development and evaluation of 3D, black-blood, ultra-high resolution vascular MRI on clinical high-field 7T in comparison lower-field 3T. These protocols were applied for in vivo imaging of atherosclerotic rabbits, which are often used for development, testing, and validation of translatable cardiovascular MR protocols. Eight atherosclerotic New Zealand White rabbits were imaged on clinical 7T and 3T MRI scanners using 3D, isotropic, high (0.63 mm3) and ultra-high (0.43 mm3) spatial resolution, black-blood MR sequences with extensive spatial coverage. Following imaging, rabbits were sacrificed for validation using fluorescence imaging and histology. Image quality parameters such as SNR and contrast-to-noise ratio (CNR), as well as morphological and functional plaque measurements (plaque area and permeability) were evaluated at both field strengths. Using the same or comparable imaging parameters, SNR and CNR were in general higher at 7T compared to 3T, with a median (interquartiles) SNR gain of +40.3 (35.3-80.1)%, and a median CNR gain of +68.1 (38.5-95.2)%. Morphological and functional parameters, such as vessel wall area and permeability, were reliably acquired at 7T and correlated significantly with corresponding, widely validated 3T vessel wall MRI measurements. In conclusion, we successfully developed 3D, black-blood, ultra-high spatial resolution vessel wall MRI protocols on a 7T clinical scanner. 7T imaging was in general superior to 3T with respect to image quality, and comparable in terms of plaque area and permeability measurements.
Assuntos
Aterosclerose/diagnóstico , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Placa Aterosclerótica/diagnóstico por imagem , Animais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Aorta Abdominal/patologia , Aterosclerose/etiologia , Aterosclerose/patologia , Dieta Hiperlipídica/efeitos adversos , Modelos Animais de Doenças , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética/instrumentação , Masculino , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/patologia , Coelhos , Reprodutibilidade dos Testes , Razão Sinal-RuídoRESUMO
BACKGROUND/PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative technique for traumatic hemorrhage control in the adult population. The purpose of this study is to describe the details of REBOA placement in adolescent trauma patients. METHODS: Patients 18â¯years of age or less who received REBOA for aortic occlusion (AO) from August 2013 to February 2017 at 2 urban tertiary care centers were included. RESULTS: 7 adolescent trauma patients received REBOA by trauma surgeons for both blunt (nâ¯=â¯4) and penetrating mechanisms (nâ¯=â¯3); mean age was 17â¯+â¯1.5â¯years, mean admission lactate 13.0â¯+â¯4.85â¯mmol/L, and mean Hgb 10.7â¯+â¯2.7â¯g/dL. 3 patients received REBOA through a 12Fr sheath and 4 through a 7Fr sheath. AO occurred mostly at the distal thoracic aorta (Zone I) (85.7%) and also in the distal abdominal aorta (Zone III) (14.3%). 57% of patients were in arrest with ongoing CPR at the time of REBOA. In-hospital mortality was 57%; all of these patients were in arrest at the time of REBOA, had return of spontaneous circulation (ROSC), and survived to the operating room. No complications from REBOA were identified. CONCLUSION: REBOA appears to be feasible for use in adolescents despite their smaller caliber vessels, even with use of a 12Fr sheath. REBOA results in improved physiology and can bridge adolescent trauma patients presenting in extremis to the operating room. TYPE OF STUDY: Treatment/therapeutic study LEVEL OF EVIDENCE: Level IV.
Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Choque Hemorrágico , Ferimentos e Lesões/terapia , Adolescente , Aorta Abdominal/lesões , Aorta Torácica/lesões , Mortalidade Hospitalar , Humanos , Ressuscitação , Retorno da Circulação Espontânea , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Ferimentos e Lesões/complicaçõesRESUMO
OBJECTIVES: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. METHODS: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. RESULTS: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). CONCLUSION: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.
Assuntos
Traumatismos Abdominais/cirurgia , Aorta Abdominal/cirurgia , Certificação/normas , Técnicas Hemostáticas/normas , Centros de Traumatologia/normas , Procedimentos Cirúrgicos Vasculares/normas , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Bases de Dados Factuais , Feminino , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/mortalidade , Adulto JovemRESUMO
BACKGROUND: "Seat belt-type" pediatric abdominal aortic trauma is uncommon but potentially lethal. During high speed motor vehicle collisions (MVCs), seat or lap belt restraints may concentrate forces in a band-like pattern across the abdomen, resulting in the triad of hollow viscus perforation, spine fracture, and aortoiliac injury. We report 4 cases of pediatric seat belt-type aortic trauma and review management strategies for the aortic disruption and the associated constellation of injuries. METHODS: -approved, retrospective review of all pediatric patients requiring surgical intervention for seat belt-type constellation of abdominal aortic/iliac and associated injuries over a 5-year period. Blunt thoracic aortic injuries were excluded. RESULTS: We identified 4 patients, ranging from 2 to 17 years of age, who required surgical correction of seat belt-type aortoiliac trauma and associated injuries: 3 abdominal aortas and 1 left common iliac artery. The majority (3/4 patients) were hemodynamically unstable at emergency room presentation, and all underwent computed tomography angiography of the chest/abdomen/pelvis during initial resuscitation. Injuries of the suprarenal and proximal infrarenal aorta were accompanied by unilateral renal artery avulsion requiring nephrectomy. Presumed or proven spinal instability mandated supine positioning and midline laparotomy, with medial visceral rotation utilized for proximal injuries. Aortoiliac injuries requiring repair were accompanied by significant distal intraluminal prolapse of dissected intima, with varying degrees of obstruction. Conduit selection was dictated by the presence of enteric contamination and the rapid availability of an autologous conduit. The sole neurologic deficit was irreparable at presentation. CONCLUSIONS: Seat belt aortoiliac injuries in pediatric patients require prompt multidisciplinary evaluation. Evidence of contained aortoiliac transection, major branch vessel avulsion, and bowel perforation mandates immediate exploration, which generally precedes spinal interventions. Lesser degrees of aortoiliac injuries have been managed with surveillance, but long-term follow-up is needed to fully validate this approach.
Assuntos
Traumatismos Abdominais/cirurgia , Acidentes de Trânsito , Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Contusões Miocárdicas/cirurgia , Cintos de Segurança/efeitos adversos , Lesões do Sistema Vascular/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Adolescente , Fatores Etários , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Bioprótese , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Criança , Pré-Escolar , Humanos , Contusões Miocárdicas/diagnóstico por imagem , Contusões Miocárdicas/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaAssuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Aortografia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler de Pulso , Lesões do Sistema Vascular/diagnóstico por imagem , Adolescente , Dissecção Aórtica/cirurgia , Aorta Abdominal/lesões , Aorta Abdominal/cirurgia , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Valor Preditivo dos Testes , Lesões do Sistema Vascular/cirurgiaRESUMO
Abdominal aortic injury secondary to blunt abdominal aortic trauma (BAAI) is rare in children but frequently occurs in association with other injuries, including bowel injury and vertebral fracture. We present a case of a 14-year-old boy who sustained a partial transection of the infrarenal aorta with a lumbar chance fracture and small bowel injury after a motor vehicle accident. Repair was performed with bowel resection followed by Dacron graft interposition. We reviewed the literature on BAAI in children with a focus on the method of repair of these injuries.
Assuntos
Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Aorta Abdominal/lesões , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/etiologia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Humanos , Masculino , Cintos de Segurança , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgiaRESUMO
OBJECTIVE: Seat belt aorta is rare and difficult to manage. The lack of data and follow-up increases the complexity of treating such patients. We aimed to create a decision algorithm by reviewing our current experience and analyzing the presentation and management of our patients. METHODS: We performed a descriptive case series based on retrospective analysis of all consecutive patients admitted with the diagnosis of seat belt aorta from 2008 to 2018. Seat belt aorta was defined as any blunt abdominal aortic lesion resulting from a seat belt compression mechanism after a car accident. RESULTS: Nine consecutive patients were admitted with the diagnosis of seat belt aorta, all of whom developed lesions in the infrarenal aorta. Eight patients were assessed in the acute phase and one patient presented with late-onset symptoms. Associated injuries were present in all acute patients, and seat belt sign and small bowel injury were present in 88%. One patient presented with a small intimal tear and was treated conservatively. All other patients diagnosed with large intimal flaps (seven patients) and pseudoaneurysm (one patient) underwent open repair in five cases and endovascular repair in three cases. In-hospital mortality for the acute cases was 38%, with no mortality seen during follow-up. Two patients submitted to endovascular repair required reinterventions. CONCLUSIONS: Seat belt aorta is a deadly condition, frequently associated with blunt thoracoabdominal trauma with concomitant injuries; the presence of a seat belt sign or lower limb ischemia must lead to a high diagnostic suspicion. Management must take into account the other concomitant injuries. Follow-up is crucial as most patients are young; they may develop complications and subsequently require further intervention.
Assuntos
Traumatismos Abdominais/terapia , Acidentes de Trânsito , Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Cintos de Segurança/efeitos adversos , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Adulto , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Implante de Prótese Vascular/mortalidade , Criança , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/mortalidade , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/mortalidade , Adulto JovemRESUMO
Trocar injury to abdominal aorta is uncommon and even rare with optical trocars. Such injury, resulting from umbilical trocar insertion, is potentially fatal. It often causes on-table death due to torrential life-threatening haemorrhage and unavailability of expert vascular help. We present a rare case of an injury to infra-renal abdominal aorta, caused by optical trocar insertion for bariatric surgery. Immediate recognition of the injury, deployment of life-saving manoeuvres, timely resuscitation, followed by definitive repair of aorta by vascular surgeon was life-saving for this patient. The recovery phase was uneventful and patient had no residual clinical problems during follow-up.
Assuntos
Aorta Abdominal/lesões , Gastrectomia/efeitos adversos , Gastrectomia/instrumentação , Complicações Intraoperatórias/etiologia , Lesões do Sistema Vascular/etiologia , Adulto , Evolução Fatal , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/cirurgiaRESUMO
Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.