Lesões traumáticas de aorta em zona rural: série de casos com manifestações tardias e revisão dos aspectos terapêuticos / Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

Resumo As lesões traumáticas da aorta (LTA) torácica estão associadas a altas taxas de morbimortalidade. São classificadas de acordo com a extensão do dano, e a angiotomografia computadorizada tem as maiores sensibilidade e especificidade para identificar o grau de lesão e potenciais lesões associadas. As estratégias terapêuticas para LTA são baseadas no tipo de lesão, na extensão e nas lesões associadas. Pode auxiliar na definição de conduta também o grau de estabilidade do paciente, podendo ser manejo cirúrgico convencional, endovascular (TEVAR) ou conservador em casos selecionados. Entre os pacientes com anatomia vascular adequada, a cirurgia endovascular está associada a melhor sobrevida e a menos riscos. O objetivo deste artigo foi descrever uma série de quatro casos acompanhados em serviço terciário, em um estado com poucos serviços de alta complexidade. A terapêutica endovascular foi empregada como método preferencial. Os pacientes apresentaram evolução favorável sem complicações até a alta e encontram-se em acompanhamento ambulatorial.

Abstract Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

An Operative Case of Traumatic Aortic Regurgitation / 日本心臓血管外科学会雑誌

Case reports of traumatic aortic regurgitation are rare. We report a case of a 62-year-old man injured by falling from a paraglider. After recovering from multiple injuries and discharge, he began to suffer from dyspnea. Severe aortic regurgitation and pseudoaneurysm of the sinus of Valsalva were diagnosed by ultrasound cardio graphy (UCG) and multi-detector-row computer tomography (MDCT). After cardiac failure was controlled, we operated. The commissure between the left and the right coronary cusps was detached from the aortic wall, and a modified Bentall operation was performed. The patient recovered well and was discharged uneventfully.

A Case of Abdominal Aortic Pseudoaneurysm That Was Treated with Inserting an Endovascular Stent Graft in a Patient with Behcet's Disease / 대한류마티스학회지

Behcet's disease is a chronic inflammatory disease of an unknown etiology, and it is characterized by recurrent oral and genital ulcerations, eye lesions skin lesions, and other involvement such as gastrointestinal ulcerations and lesions of the central nervous system and major vessels. The vascular lesions include deep vein thrombosis, superficial thrombophlebitis, arterial aneurysm and arterial occlusion. Aortic aneurysm or pseudoaneurysm is a rare complication, but it is one of the most common causes of death in Behcet's disease. We report here on a case of a 43 year old female with Behcet's disease that was complicated by an abdominal aortic pseudoaneurysm, and this was all successfully treated with percutaneous endovascular stent graft insertion, steroid pulse therapy and azathioprine.

An Experience of Abdominal Aortic Pseudoaneurysm in a Patient Having Abdominal Aortic Aneurysmal Disease after Extracorporeal Shock Wave Lithotripsy

A case of leaking abdominal aortic pseudoaneurysm following treatment of bilateral renal stones by extracopored shock wave lithotripsy(ESWL) is presented. Screening of the abdominal aortic pathology is recommended for a patient who needs ESWL for treatment of renal stones. Ultrasonography may be the diagnostic procedure of choice for pre- and post-ESWL evaluation of abdominal aortic pathology.

A Case of Descending Thoracic Aortic Pseudoaneurysm Associated with Thoracolumbar Pedicle Screw Removal

Vascular injuries after spine surgery may result in acute life-threatening hemorrhage, chronic arteriovenous fistula, or pseudoaneurysm formation. The interval between injury and rupture may range from seconds to years, and accordingly, a high index of suspicion is needed to make the diagnosis. Although acute and delayed vascular injury caused by placement of posterior pedicle screw fixation has been reported, the potential for large vessel disruption during posterior pedicle screw removal has been rarely reported. This case report concerns a 50-year-old man who developed an descending thoracic aortic pseudoaneurysm after posterior pedicle screw removal, diagnosed by chest computed tomography(CT) scan and transesophageal echocardiography(TEE).

Pseudoaneurysm of Thoracic Aorta / 대한흉부외과학회지

Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four csaes of thoracic aortic pseudoaneurysm who underwent surgical repair. The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.

Pseudoaneurysm of Thoracic Aorta / 대한흉부외과학회지

Pseudoaneurysm of the thoracic aorta is potentially fatal. However, reports of such cases are rare even in large series. We report four csaes of thoracic aortic pseudoaneurysm who underwent surgical repair. The causes were considered as infection in two cases (VSD repair, descending thoracic aortic aneurysm resection) and blunt chest trauma by traffic accident in two patients. The pseudoaneurysms developed on ascending aorta suspected as sites of arterial and cardiolplegic needle insertion in one patient. The others were located at descending thoracic aorta immediatly below the left subclavian artery. One patient died of sepsis associated with bile peritonitis and others were followed up from 10 to 18 months with specific morbidity. This study suggest that the incidence of pseudoaneurysm of the thoracic aorta followed by open heart or aorctic surgery can be repaired succesfuly and careful inspection of associated injury is very important in cases of traumatic thoracic pseudoaneurysm.