Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (9): 19-25.doi: 10.6040/j.issn.1671-7554.0.2024.0295

• Advances in Basic and Clinical Research on Aortic Diseases-Research Progress • Previous Articles    

Advances in diagnosis and treatment of traumatic type B aortic dissection

WANG Lunchang1*, QIN Qi1*, SHU Chang1,2   

  1. 1. Department of Vascular Surgery, The Second Xiangya Hospital, Central South University/Insititute of Vascular Disease, Central South University/Clinical Research Center for Vascular Disease in Hunan Province, Changsha 410011, Hunan, China;
    2. Central of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science, Beijing 100037, China
  • Published:2024-10-10

PDF (PC)

3

Abstract: This article focuses on the clinical research advancements in traumatic type B aortic dissection(TTBAD), and summarized its pathogenesis, clinical features and diagnosis, severity classification, treatment modalities, and follow-up prognosis. TTBAD is commonly observed in patients with multiple trauma injuries, and making early and accurate diagnosis is imperative. The severity of the injury is a critical determinant in deciding the treatment strategy and prognosis for TTBAD patients. Treatment emphasizes a multidisciplinary approach, with pharmacotherapy and thoracic endovascular aortic repair(TEVAR)being the primary options. However, there remains some controversy regarding treatment strategies and the timing of surgery in patients with varying severities of TTBAD.

Key words: Aortic dissection, Trauma, Thoracic endovascular aortic repair, Timing of surgery

CLC Number: 

  • R654.3
[1] Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 146(24): e334-e482.
[2] Piffaretti G, Williams IM, Bailey DM, et al. Thoracic endovascular repair in patients with concomitant blunt aortic injuries and abdominal trauma: what are the risks and results?[J]. Eur J Cardiothorac Surg, 2022, 62(6): 531.
[3] Richens D, Field M, Neale M, et al. The mechanism of injury in blunt traumatic rupture of the aorta[J]. Eur J Cardiothorac Surg, 2002, 21(2): 288-293.
[4] Arthurs ZM, Starnes BW, Sohn VY, et al. Functional and survival outcomes in traumatic blunt thoracic aortic injuries: an analysis of the National Trauma Databank[J]. J Vasc Surg, 2009, 49(4): 988-994.
[5] Teixeira PG, Inaba K, Barmparas G, et al. Blunt thoracic aortic injuries: an autopsy study[J]. J Trauma, 2011, 70(1): 197-202.
[6] de Mestral C, Dueck A, Sharma SS, et al. Evolution of the incidence, management, and mortality of blunt thoracic aortic injury: a population-based analysis[J]. J Am Coll Surg, 2013, 216(6): 1110-1115.
[7] Cannon RM, Trivedi JR, Pagni S, et al. Open repair of blunt thoracic aortic injury remains relevant in the endovascular era[J]. J Am Coll Surg, 2012, 214(6): 943-949.
[8] Zeng W, Caudillo A, Mukherjee S, et al. Development and multi-level validation of a computational model to predict traumatic aortic injury[J]. Comput Biol Med, 2021, 136: 104700. doi:10.1016/j.compbiomed.2021.104700.
[9] Lundervall J. The mechanism of traumatic rupture of the aorta[J]. Acta Pathol Microbiol Scand, 1964, 62: 34-46. doi:10.1111/apm.1964.62.1.34.
[10] Feczko JD, Lynch L, Pless JE, et al. An autopsy case review of 142 nonpenetrating(blunt)injuries of the aorta[J]. J Trauma, 1992, 33(6): 846-849.
[11] Crass JR, Cohen AM, Motta AO, et al. A proposed new mechanism of traumatic aortic rupture: the osseous pinch[J]. Radiology, 1990, 176(3): 645-649.
[12] Parmley LF, Mattingly TW, Manion WC, et al. Nonpenetrating traumatic injury of the aorta[J]. Circulation, 1958, 17(6): 1086-1101.
[13] 刘昌伟, 郑月宏. 血管损伤的腔内治疗[J]. 中国实用外科杂志, 2007, 27(7): 521-523. LIU Changwei, ZHENG Yuehong. Endovascular treatment of vascular injury[J]. Chinese Journal of Practical Surgery, 2007, 27(7): 521-523.
[14] Buczkowski P, Puslecki M, Stefaniak S, et al. Post-traumatic acute thoracic aortic injury(TAI)-a single center experience[J]. J Thorac Dis, 2017, 9(11): 4477-4485.
[15] Arbabi CN, DuBose J, Starnes BW, et al. Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry[J]. J Vasc Surg, 2022, 75(3): 930-938.
[16] Ungar TC, Wolf SJ, Haukoos JS, et al. Derivation of a clinical decision rule to exclude thoracic aortic imaging in patients with blunt chest trauma after motor vehicle collisions[J]. J Trauma, 2006, 61(5): 1150-1155.
[17] Fabian TC, Davis KA, Gavant ML, et al. Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture[J]. Ann Surg, 1998, 227(5): 666-676.
[18] Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma[J]. J Trauma Nurs, 2015, 22(2): 99-110.
[19] Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
[20] Bansal RC, Chandrasekaran K, Ayala K, et al. Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography[J]. J Am Coll Cardiol, 1995, 25(6): 1393-1401.
[21] Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection[J]. J Am Coll Cardiol, 2015, 66(4): 350-358.
[22] Erbel R, Engberding R, Daniel W, et al. Echocardiography in diagnosis of aortic dissection[J]. Lancet, 1989, 1(8636): 457-461.
[23] Trust MD, Teixeira PGR. Blunt trauma of the aorta, current guidelines[J]. Cardiol Clin, 2017, 35(3): 441-451.
[24] Kim SH, Huh U, Song S, et al. Open repair versus thoracic endovascular aortic repair for treating traumatic aortic injury[J]. Asian J Surg, 2022, 45(11): 2224-2230.
[25] Moore EE, Malangoni MA, Cogbill TH, et al. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm[J]. J Trauma, 1994, 36(3): 299-300.
[26] Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery[J]. J Vasc Surg, 2011, 53(1): 187-192.
[27] Azizzadeh A, Keyhani K, Miller CC 3rd, et al. Blunt traumatic aortic injury: initial experience with endovascular repair[J]. J Vasc Surg, 2009, 49(6): 1403-1408.
[28] Starnes BW, Lundgren RS, Gunn M, et al. A new classification scheme for treating blunt aortic injury[J]. J Vasc Surg, 2012, 55(1): 47-54.
[29] Quiroga E, Starnes BW, Tran NT, et al. Implementation and results of a practical grading system for blunt thoracic aortic injury[J]. J Vasc Surg, 2019, 70(4): 1082-1088.
[30] Czerny M, Grabenwöger M, Berger T, et al. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ[J]. Eur J Cardiothorac Surg, 2024, 65(2): 426.
[31] Lozano R, DiLosa K, Schneck M, et al. Comparison of treatment and outcomes in blunt thoracic aortic injury based on different vascular surgery guidelines[J]. J Vasc Surg, 2023, 78(1): 48-52.
[32] Mohapatra A, Liang NL, Makaroun MS, et al. Risk factors for mortality after endovascular repair for blunt thoracic aortic injury[J]. J Vasc Surg, 2020, 71(3): 768-773.
[33] Zhang Y, Yang YY, Guo JH, et al. Risk factors for early death after surgery in patients with acute Stanford type A aortic dissection: a systematic review and meta-analysis[J]. Int J Cardiol, 2023, 377: 33-41. doi:10.1016/j.ijcard.2022.12.013.
[34] Lin CC, Liu KS, Chen HW, et al. Blunt aortic injury: risk factors and impact of surgical approaches[J]. Surg Today, 2016, 46(2): 188-196.
[35] Pu X, Huang XY, Huang LJ. Emergency percutaneous thoracic endovascular aortic repair for patients with traumatic thoracic aortic blunt injury: a single center experience[J]. Chin J Traumatol, 2020, 23(1): 15-19.
[36] Rabin J, Harris DG, Crews GA, et al. Early aortic repair worsens concurrent traumatic brain injury[J]. Ann Thorac Surg, 2014, 98(1): 46-51.
[37] Michetti CP, Hanna R, Crandall JR, et al. Contemporary analysis of thoracic aortic injury: importance of screening based on crash characteristics[J]. J Trauma, 2007, 63(1): 18-24.
[38] Sun JW, Ren K, Zhang LY, et al. Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis[J]. J Cardiothorac Surg, 2022, 17(1): 335.
[39] Rabin J, DuBose J, Sliker CW, et al. Parameters for successful nonoperative management of traumatic aortic injury[J]. J Thorac Cardiovasc Surg, 2014, 147(1): 143-149.
[40] Mosquera VX, Marini M, Lopez-Perez JM, et al. Role of conservative management in traumatic aortic injury: comparison of long-term results of conservative, surgical, and endovascular treatment[J]. J Thorac Cardiovasc Surg, 2011, 142(3): 614-621.
[41] Spencer SM, Safcsak K, Smith CP, et al. Nonoperative management rather than endovascular repair may be safe for grade II blunt traumatic aortic injuries: an 11-year retrospective analysis[J]. J Trauma Acute Care Surg, 2018, 84(1): 133-138.
[42] Gaffey AC, Zhang J, Saka E, et al. Natural history of nonoperative management of grade II blunt thoracic aortic injury[J]. Ann Vasc Surg, 2020, 65: 124-129. doi:10.1016/j.avsg.2019.10.084.
[43] Ultee KH, Soden PA, Chien V, et al. National trends in utilization and outcome of thoracic endovascular aortic repair for traumatic thoracic aortic injuries[J]. J Vasc Surg, 2016, 63(5): 1232-1239.
[44] Akhmerov A, DuBose J, Azizzadeh A. Blunt thoracic aortic injury: current therapies, outcomes, and challenges[J]. Ann Vasc Dis, 2019, 12(1): 1-5.
[45] Mouawad NJ, Paulisin J, Hofmeister S, et al. Blunt thoracic aortic injury-concepts and management[J]. J Cardiothorac Surg, 2020, 15(1): 62.
[46] Dahal R, Acharya Y, Tyroch AH, et al. Blunt thoracic aortic injury and contemporary management strategy[J]. Angiology, 2022, 73(6): 497-507.
[47] 方泽民, 魏翔, 刘立刚, 等. 创伤性主动脉破裂的外科治疗经验[J]. 华中科技大学学报(医学版), 2015, 44(5): 591-594. FANG Zemin, WEI Xiang, LIU Ligang, et al. Surgical experiences for traumatic aortic rupture[J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2015, 44(5): 591-594.
[48] Xenos ES, Abedi NN, Davenport DL, et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture[J]. J Vasc Surg, 2008, 48(5):1343-1351.
[49] Harky A, Bleetman D, Chan JSK, et al. A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta[J]. J Vasc Surg, 2020, 71(1): 270-282.
[50] Scalea TM, Feliciano DV, DuBose JJ, et al. Blunt thoracic aortic injury: endovascular repair is now the standard[J]. J Am Coll Surg, 2019, 228(4): 605-610.
[51] Kenel-Pierre S, Ramos Duran E, Abi-Chaker A, et al. The role of heparin in endovascular repair of blunt thoracic aortic injury[J]. J Vasc Surg, 2019, 70(6): 1809-1815.
[52] Nagy K, Fabian T, Rodman G, et al. Guidelines for the diagnosis and management of blunt aortic injury: an EAST Practice Management Guidelines Work Group[J]. J Trauma, 2000, 48(6): 1128-1143.
[53] Marcaccio CL, Dumas RP, Huang YL, et al. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury[J]. J Vasc Surg, 2018, 68(1): 64-73.
[54] Romijn AC, Rastogi V, Proaño-Zamudio JA, et al. Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis[J]. Ann Surg, 2023, 278(4): e848-e854.
[55] Alarhayem AQ, Rasmussen TE, Farivar B, et al. Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era[J]. J Vasc Surg, 2021, 73(3): 896-902.
[56] Smeds MR, Wright MP, Eidt JF, et al. Delayed management of Grade III blunt aortic injury: series from a Level I trauma center[J]. J Trauma Acute Care Surg, 2016, 80(6): 947-951.
[57] DuBose JJ, Leake SS, Brenner M, et al. Contemporary management and outcomes of blunt thoracic aortic injury: a multicenter retrospective study[J]. J Trauma Acute Care Surg, 2015, 78(2): 360-369.
[58] Topcu AC, Ozeren-Topcu K, Bolukcu A, et al. Blunt traumatic aortic injury: 10-year single-center experience[J]. Aorta, 2020, 8(6): 163-168.
[59] Charlton-Ouw KM, DuBose JJ, Leake SS, et al. Observation may be safe in selected cases of blunt traumatic abdominal aortic injury[J]. Ann Vasc Surg, 2016, 30: 34-39. doi:10.1016/j.avsg.2015.06.067.
[60] Shalhub S, Starnes BW, Brenner ML, et al. Blunt abdominal aortic injury: a Western Trauma Association multicenter study[J]. J Trauma Acute Care Surg, 2014, 77(6): 879-885.
[61] 谢永富, 陆清声. 单中心腔内治疗创伤性Stanford B型主动脉夹层远期随访结果[J]. 中华胸心血管外科杂志, 2019, 35(8): 458-461. XIE Yongfu, LU Qingsheng. The beneficial enlightenment of thoracic endovascular aortic repair for traumatic type B aortic dissection with long-term follow-up of single center[J]. Chinese Journal of Thoracic and Cardiovascular Surgery, 2019, 35(8): 458-461.
[62] Jacob-Brassard J, Salata K, Kayssi A, et al. A systematic review of nonoperative management in blunt thoracic aortic injury[J]. J Vasc Surg, 2019, 70(5): 1675-1681.
[1] CHEN Zhong, WANG Sheng. Current status and reflections on the treatment of aortic disease [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 1-6.
[2] LIN Changpo, FU Weiguo. Progress in diagnosis and treatment of Stanford type B aortic dissection [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 7-12.
[3] GAN Qiqing, LIU Xianhu, GOU Yuan, YANG Bin. Diagnosis and treatment of aortic dissection combined with paraplegia: a report of two cases and literature review [J]. Journal of Shandong University (Health Sciences), 2024, 62(8): 101-106.
[4] SONG Han, WANG Zhenhua, WEI Duoliang, XU Kai, LI Bowen, ZHAO Xin. Impacts of preoperative MELD grades on the postoperative early outcomes of 304 acute Standford type A aortic dissection patients [J]. Journal of Shandong University (Health Sciences), 2023, 61(5): 31-36.
[5] WANG Zhenhua, SONG Han,WEI Duoliang, LI Bowen, XU Kai, FANG Changcun, ZHAO Xin. Early remodeling of the proximal aorta after Castor single-branched stent-graft implantation for acute type B aortic dissection [J]. Journal of Shandong University (Health Sciences), 2023, 61(2): 36-42.
[6] REN Dazhuang, ZHOU Weiyan, ZHAO Bojun. A case report of corneoscleral iron filing-like foreign body [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 129-132.
[7] BAI Lu, ZHANG Yuqing, FANG Yuying. Infertility stress and posttraumatic stress disorder in infertile women: mindfulness as a mediator and moderator [J]. Journal of Shandong University (Health Sciences), 2021, 59(2): 83-87.
[8] YANG Bei, ZHANG Huihui, GUO Chunhong, CAO Fenglin. Association among child abuse, coping styles and negative emotions in college students: an observational analysis [J]. Journal of Shandong University (Health Sciences), 2018, 56(2): 68-73.
[9] LIN Pingzhen, XUE Jiaomei, YANG Bei, LI Meng, ZHOU Mailin, CAO Fenglin. Correlation between posttraumatic growth and psychological adjustment of cancer survivors based on Pearson correlation coefficient: a Meta-analysis [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(9): 110-121.
[10] LIU Wen, WANG Ximing, DUAN Yanhua, YANG Shifeng, JI Xiaopeng, KANG Rui. The value of multiphase dynamic reconstruction with CTA to the intimal flap motion of abdominal aortic dissection [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(3): 50-54.
[11] WANG Long, ZHAO Xin, LI Yuanyuan, WANG Ximing, LI Decai, SONG Guangmin. Effect of anticoagulation on the remodeling of residual false lumen after aortic valve replacement of DeBakey type I aortic dissection [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(12): 27-31.
[12] WANG Chunlai, XU Shujun, WANG Hongliang, SHANG Jingrui. Neuroendoscopic repair of traumatic cerebrospinal fluid rhinorrhea [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(3): 69-72.
[13] GAO Wen, CAO Fenglin, CUI Naixue. Association between childhood trauma, early adulthood executive functions and negative emotions in medical students [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(9): 95-98.
[14] ZHU Xide. Serum cortisol alterations after acute traumatic brain injury emergency operation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(6): 58-61.
[15] SONG Hui-ping1, WANG Zhi-qiang1, BI Ruo-jie1, LI Qi-jia2. Correlation of ATF4 and GPR48 expressions in the progression of traumatic necrosis of the femoral head in rats [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(1): 42-46.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd