BACKGROUND: The best time to intervene in traumatic aortic injuries has long been a matter of debate. While emergency surgery is characterized by high morbidity and mortality, initial medical management of uncomplicated aortic injury and subsequent delayed surgery resulted in better outcome. METHODS AND RESULTS: From analysis of medical literature of the last 10 years, major paradigm shift in management of traumatic injuries includes the use of different imaging methods for diagnosis, with a almost complete elimination of aortography and transesophageal echocardiography in favour of CT scan, and a significant change in method of definitive repair, shifting from exclusively open techniques in 1997 to predominantly endovascular repairs in 2007. At present several reports in literature provide data on comparative results of endovascular therapy with respect open surgery, supporting the use of stent-graft in traumatic injuries, both in acute and chronic cases. The authors' personal experience comprises 58 patients treated with endovascular stent-graft repair, with no mortality or treatment failure even during 11 years follow-up. CONCLUSIONS: For many years traumatic aortic injury has been considered a highly lethal lesion and a potential cause of death in blunt chest trauma. Because of the lower invasivity endovascular repair can be applied in traumatic aortic injury with very low risk and limited impact on trauma destabilization. Long term follow-up seems indicate a substantial durability of the procedure.
BACKGROUND: The best time to intervene in traumatic aortic injuries has long been a matter of debate. While emergency surgery is characterized by high morbidity and mortality, initial medical management of uncomplicated aortic injury and subsequent delayed surgery resulted in better outcome. METHODS AND RESULTS: From analysis of medical literature of the last 10 years, major paradigm shift in management of traumatic injuries includes the use of different imaging methods for diagnosis, with a almost complete elimination of aortography and transesophageal echocardiography in favour of CT scan, and a significant change in method of definitive repair, shifting from exclusively open techniques in 1997 to predominantly endovascular repairs in 2007. At present several reports in literature provide data on comparative results of endovascular therapy with respect open surgery, supporting the use of stent-graft in traumatic injuries, both in acute and chronic cases. The authors' personal experience comprises 58 patients treated with endovascular stent-graft repair, with no mortality or treatment failure even during 11 years follow-up. CONCLUSIONS: For many years traumatic aortic injury has been considered a highly lethal lesion and a potential cause of death in blunt chest trauma. Because of the lower invasivity endovascular repair can be applied in traumatic aortic injury with very low risk and limited impact on trauma destabilization. Long term follow-up seems indicate a substantial durability of the procedure.
Authors: Jan Trlica; Štěpánka Kučerová; Eva Kočová; Jaromír Kočí; Petr Habal; Jan Raupach; Igor Guňka; Lukáš Nechvátal; Jiří Páral; Jan Šimek; Karel Šmejkal; Martin Frank; Tomáš Dědek Journal: Eur J Trauma Emerg Surg Date: 2019-01-08 Impact factor: 3.693
Authors: Piotr Buczkowski; Mateusz Puslecki; Sebastian Stefaniak; Robert Juszkat; Jerzy Kulesza; Bartłomiej Perek; Marcin Misterski; Tomasz Urbanowicz; Marcin Ligowski; Bartosz Zabicki; Marek Dabrowski; Lukasz Szarpak; Marek Jemielity Journal: J Thorac Dis Date: 2017-11 Impact factor: 2.895
Authors: Miroslawa Mytsyk; Martin T R Grapow; Jasmin Shahinian; Markus Maurer; Lorenz Gurke; Friedrich S Eckstein Journal: J Cardiothorac Surg Date: 2016-07-16 Impact factor: 1.637