Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (9): 36-41.doi: 10.6040/j.issn.1671-7554.0.2024.0319

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

Advances in diagnosis and treatment of blunt thoracic aortic injury

YANG Jianping, GUAN Sheng, FANG Qingbo, CI Hongbo, GE Xiaohu   

  1. Department of Vascular Surgery, Peoples Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang, China
  • Published:2024-10-10

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Abstract: Blunt thoracic aortic injury(BTAI)is the major cause of morbidity and mortality in trauma patients, with 80%-90% of patients dying immediately at the scene of the accident. Despite rapid advances in the detection and treatment of acute BTAI in recent years, the mortality rate remains high, with a mortality rate of 15%-40% of in-hospital deaths within 24 hours. The mechanism of aortic injury is related to physical impact and drastic changes in hemodynamics. For patients who survive the initial injury, maintaining hemodynamic stability in time may prevent injury exacerbation. For patients who can reach the hospital, rapid detection and timely and reasonable intervention are crucial. CT angiography can quickly and accurately evaluate the degree of aortic injury and guide the reasonable treatment measures. According to the latest guidelines, the time and method of treatment for grade Ⅰ, Ⅲ and Ⅳ patients have been clearly defined. But repair time in grade Ⅱ patients with BTAI combined with high-risk imaging features is still controversial. Thoracic endovascular aortic repair due to high clinical success rate and low complication rate has become the preferred method for BTAI, but there are still some unavoidable focal problems. This article mainly reviewed the injury mechanism, clinical manifestations, imaging diagnosis and treatment of BTAI.

Key words: Trauma, Aortic injury, Pseudoaneurysm, Thoracic endovascular aortic repair, Open repair

CLC Number: 

  • R543
[1] Stefanopoulos PK, Pinialidis DE, Hadjigeorgiou GF, et al. Wound ballistics 101: the mechanisms of soft tissue wounding by bullets[J]. Eur J Trauma Emerg Surg, 2017, 43(5): 579-586.
[2] Silaschi M, Byrne J, Wendler O. Aortic dissection: medical, interventional and surgical management[J]. Heart, 2017, 103(1): 78-87.
[3] Yu XJ, Suki B, Zhang YH. Avalanches and power law behavior in aortic dissection propagation[J]. Sci Adv, 2020, 6(21): eaaz1173. doi:10.1126/sciadv.aaz1173.
[4] 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): ezac531.
[5] 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 Acute Care Surg, 2015, 78(1): 136-146.
[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] 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.
[8] Omar A, Macke C, Winkelmann M, et al. Limited influence of blunt aortic injuries on the outcome of polytraumatized patients: a matched pair analysis[J]. Arch Orthop Trauma Surg, 2018, 138(2): 211-218.
[9] Gammie JS, Shah AS, Hattler BG, et al. Traumatic aortic rupture: diagnosis and management[J]. Ann Thorac Surg, 1998, 66(4): 1295-1300.
[10] Neschis DG, Scalea TM, Flinn WR, et al. Blunt aortic injury[J]. N Engl J Med, 2008, 359(16): 1708-1716.
[11] 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.
[12] Ait Ali Yahia D, Bouvier A, Nedelcu C, et al. Imaging of thoracic aortic injury[J]. Diagn Interv Imaging, 2015, 96(1): 79-88.
[13] Steenburg SD, Ravenel JG, Ikonomidis JS, et al. Acute traumatic aortic injury: imaging evaluation and management[J]. Radiology, 2008, 248(3): 748-762.
[14] Edwards R, Khan N. Traumatic aortic injury: Computed tomography angiography imaging and findings revisited in patients surviving major thoracic aorta injuries[J]. SA J Radiol, 2021, 25(1): 2044.
[15] Gupta S, Kumar A, Kaur T, et al. Current updates in acute traumatic aortic injury: radiologic diagnosis and management[J]. Clin Exp Emerg Med, 2022, 9(2): 73-83.
[16] Brown SR, Still SA, Eudailey KW, et al. Acute traumatic injury of the aorta: presentation, diagnosis, and treatment[J]. Ann Transl Med, 2021, 9(14): 1193.
[17] Nagpal P, Mullan BF, Sen I, et al. Advances in imaging and management trends of traumatic aortic injuries[J]. CardioVascular Interv Radiol, 2017, 40(5): 643-654.
[18] Steenburg SD, Ravenel JG. Acute traumatic thoracic aortic injuries: experience with 64-MDCT[J]. AJR Am J Roentgenol, 2008, 191(5): 1564-1569.
[19] Fishman JE, Nuñez D Jr, Kane A, et al. Direct versus indirect signs of traumatic aortic injury revealed by helical CT: performance characteristics and interobserver agreement[J]. AJR Am J Roentgenol, 1999, 172(4): 1027-1031.
[20] 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.
[21] Bottet B, Bouchard F, Peillon C, et al. When and how should we manage thoracic aortic injuries in the modern era?[J]. Interact CardioVasc Thorac Surg, 2016, 23(6): 970-975.
[22] Harris DG, Rabin J, Starnes BW, et al. Evolution of lesion-specific management of blunt thoracic aortic injury[J]. J Vasc Surg, 2016, 64(2): 500-505.
[23] De Freitas S, Joyce D, Yang Y, et al. Systematic review and meta-analysis of nonoperative management for SVS grade II blunt traumatic aortic injury[J]. Ann Vasc Surg, 2024, 98: 220-227. doi:10.1016/j.avsg.2023.07.106.
[24] DAlessio I, Domanin M, Bissacco D, et al. Thoracic endovascular aortic repair for traumatic aortic injuries: insight from literature and practical recommendations[J]. J Cardiovasc Surg, 2020, 61(6): 681-696.
[25] Arbabi CN, DuBose J, Charlton-Ouw K, et al. Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry[J]. J Vasc Surg, 2022, 75(2): 625-631.
[26] Dinh K, Limmer A, Ngai C, et al. Blunt thoracic aorta injuries, an Australian single centres perspective[J]. ANZ J Surg, 2021, 91(4): 662-667.
[27] Madigan MC, Lewis AJ, Liang NL, et al. Outcomes of operative and nonoperative management of blunt thoracic aortic injury[J]. J Vasc Surg, 2022, 76(1): 239-247.
[28] 中华医学会放射学分会介入学组. 中国Stanford B型主动脉夹层影像诊断和介入治疗临床指南[J]. 中华放射学杂志, 2023, 57(5): 457-473. Interventional Group of Chinese Society of Radiology Chinese Medical Association. Clinical guidelines for imaging diagnosis and interventional treatment of Stanford type B aortic dissection in China[J]. Chinese Journal of Radiology, 2023, 57(5): 457-473.
[29] Soong TK, Wee IJY, Tseng FS, et al. A systematic review and meta-regression analysis of nonoperative management of blunt traumatic thoracic aortic injury in 2897 patients[J]. J Vasc Surg, 2019, 70(3): 941-953.
[30] 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.
[31] Harris DG, Rabin J, Bhardwaj A, et al. Nonoperative management of traumatic aortic pseudoaneurysms[J]. Ann Vasc Surg, 2016, 35: 75-81. doi:10.1016/j.avsg.2016.02.021.
[32] Fortuna GR Jr, Perlick A, DuBose JJ, et al. Injury grade is a predictor of aortic-related death among patients with blunt thoracic aortic injury[J]. J Vasc Surg, 2016, 63(5): 1225-1231.
[33] 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.
[34] Romijn AS C, 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. doi:10.1097/SLA.0000000000005817.
[35] 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.
[36] Isselbacher EM, Preventza O, Black JH 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. doi:10.1161/CIR.0000000000001106.
[37] Rudra P, Cardoso R, Echevarria S, et al. Early versus delayed thoracic endovascular aortic repair for blunt traumatic aortic injury: a systematic review and meta-analysis[J]. Cureus, 2023, 15(6): e41078. doi:10.7759/cureus.41078.
[38] 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.
[39] 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.
[40] Manetta F, Newman J, Mattia A. Indications for thoracic EndoVascular aortic repair(TEVAR): a brief review[J]. Int J Angiol, 2018, 27(4): 177-184.
[41] Boutin L, Caballero MJ, Guarrigue D, et al. Blunt traumatic aortic injury management, a French TraumaBase analytic cohort[J]. Eur J Vasc Endovasc Surg, 2022, 63(3): 401-409.
[42] Yau PO, Lewis E, Shah A, et al. Blunt traumatic aortic injury in the elderly population[J]. J Vasc Surg, 2023, 77(1): 47-55.
[43] Gennai S, Leone N, Mezzetto L, et al. Systematic review and meta-analysis of long-term reintervention following thoracic endovascular repair for blunt traumatic aortic injury[J]. J Vasc Surg, 2023, 78(2): 540-547.
[44] Gang QW, Lun Y, Pang LW, et al. Traumatic aortic dissection as a unique clinical entity: a single-center retrospective study[J]. J Clin Med, 2023, 12(24): 7535.
[45] Sharafuddin MJ, Reece TB, Papia G, et al. Proposed classification of endoleaks after endovascular treatment of Stanford type-B aortic dissections[J]. Vascular, 2019, 27(6): 585-594.
[46] 王振华, 宋晗, 韦铎亮, 等. 急性B型主动脉夹层Castor单分支支架置入术后近端主动脉的早期重塑[J]. 山东大学学报(医学版), 2023, 61(2): 36-42. WANG Zhenhua, SONG Han, WEI Duoliang, et al. 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.
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