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Traumatic Injuries to the Aorta

Traumatic Injuries to the Aorta. Amanda Law. Anatomy. Supplies body with oxygenated blood Three layers Tunica Intima Tunica Media Tunica Adventitia Three major branches Ascending Aorta Aortic Arch Descending Aorta Composed of connective tissue and elastic fibers.

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Traumatic Injuries to the Aorta

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  1. Traumatic Injuries to the Aorta Amanda Law

  2. Anatomy • Supplies body with oxygenated blood • Three layers • Tunica Intima • Tunica Media • Tunica Adventitia • Three major branches • Ascending Aorta • Aortic Arch • Descending Aorta • Composed of connective tissue and elastic fibers http://www.vcu.edu/hearts/images/aorta_anatomy.jpg

  3. Different Forms of Injury • Incomplete Aortic Rupture • Severe Aortic Injury • Traumatic Aortic Dissection • Traumatic and Iatrogenic Aortic Dissection Incomplete Rupture Severe Aortic Injury Traumatic Aortic Dissection

  4. Mechanism of Injury • Hardy, Shah, Kopacz, and Yang studied mechanisms in 2006 • In situ cadavers to test TRA mechanisms • Main Goal: further study potential TRA mechanisms and discover which movements might cause TRA

  5. Procedure • 5 tests • Two tests pulled aortic arch in anterior direction • One test displaced the arch toward the right side • Two tests displaced the arch superiorly

  6. Categories • Side Impact • Frontal Impact • Both Side and Frontal Impact http://www1.istockphoto.com/file_thumbview_approve/2427726/2/istockphoto_2427726_car_crash.jpg

  7. Results • Aortic tear in all situations • Transverse • 3 complete, 1 incomplete, and 1 circumferential tear through intima • Peri-isthmic region

  8. Results

  9. 56% of all clinical TRA occurs within the peri-isthmic region. 94% of all car accident-related injuries occur within this region, and 93% of those tears are complete. Intimal tears were along the circumference and were 6.9mm in length and 33mm from the subclavian artery Conclusions http://www.jvascbr.com.br/03-02-03/03-02-03-197/fig02.jpg

  10. Mechanisms • Straightening of the inferior arch • Abnormal movement of the aortic arch • Thoracic deformation • Stretch deformation • Traction of superior vasculature • “Shoveling” • Motion of the sternum

  11. Tests • Chest x-ray • MRI • CT scan • TEE

  12. MRI http://hcd2.bupa.co.uk/images/factsheets/MRI_scan.gif

  13. CT Scan http://www.pennhealth.com/health_info/allergy/images/1088.jpg

  14. TEE http://content.answers.com/main/content/img/medTest/f005007b.jpg

  15. Surgical Interventions • Stent-graft Repair • Aortic repair using a “clamp and sew” approach or some form of bypass • Antihypertensive Therapy

  16. Stent-graft Repair http://www.medtronic.com/physician/aneurx/images/AAAdvantage3.jpg

  17. Stent Grafts • Talent • Excluder • Vanguard

  18. Aortic cross clamping and single lung ventilation is avoided Minimal anticoagulation Less invasive Minimal blood loss Annual CT scans Advantages/Disadvantages

  19. Direct aortic repair using a “clamp and sew” approach or some form of bypass http://www.jvascbr.com.br/02-01-03/02-01-03-207/Fig5.jpg

  20. Antihypertensive Therapy http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/8693.jpg

  21. Complications • Paraplegia • Hemorrhage • Transfusion • Organ Dysfunction • Long ICU stays • Extensive Rehabilitation

  22. Predisposition • Genetics • Connective Tissue Disorders • Marfan Syndrome http://www.cafamily.org.uk/pics/m15i1.jpg

  23. Marfan Syndrome • Connective Tissue Disorder • Connective Tissue is abnormal causing weakened tendons, ligaments, blood vessel walls, cartilage, and heart valves • Characteristics: slender, tapering fingers, long arms and legs, curvature of the spine, eye problems, mitral valve prolapse, aortic root dilation, and aortic dissection • Fibrin-1 gene

  24. A Case Study • 20-year female involved in motor vehicle accident • Sustained multi-system trauma • Unresponsive • Slight bruise to left chest with no instability • Pulse was 60-70 range (equal bilaterally) • Systolic Blood Pressure was in 120s • GCS - 3

  25. Tests • Chest x-ray • Fractured ribs 4-8 • Possible mid-sternal fracture • Wide mediastinum • CT scan • Mediastinal hematoma • Left-pulmonary contusion • Collapse lung

  26. Red Blood Cell Count – 4.25 x 10^12 cells/L Hemoglobin – 12.7 gm/dl Hematocrit – 36.7% Glucose – 179 Creatinine – 0.6 mg/dl Na – 134 mEq/L K – 3.2 mEq/L pH – 7.41 pO2 – 456 mmHg pCO2 – 36 mmHg Labs

  27. Treatment • Stent Graft Procedure • AneuRx graft http://content.answers.com/main/content/wp/en/thumb/3/33/200px-Covered_Stent_Graft.jpg

  28. Statistics • An estimated 15 to 20% of patients make it to the hospital alive and of those 75% will die within 24 hours if they do not receive surgical intervention.

  29. Conclusions • Aortic injuries are of serious concern to medical professionals. There is a high mortality rate among patients who sustain injuries to their aorta. • The statistics make it apparent that researchers must pay extra attention to this problem so that the most effective treatments may be developed.

  30. References • Unknown. {caraccidents.com website} 2007 Available at www.car-accidents.com/pages/stats.html Accessed November 21, 2007 • Marieb, Elaine N. Human Anatomy & Physiology. 6th Edition. San Francisco, CA: Pearson Education, Inc.; 2004: 712-714 • Hardy, Warren N., Shah, Chirag S., Kopacz, James M., Yang, King H. et al. Study of Potential Mechanisms of Traumatic Rupture of the Aorta using InSitu Experiments. Stapp Car Crash Journal. 2006; Volume 50: 247 • Alkadhi, Hatem; Wildermuth, Simon; Desbiolles, Lotus et al. Vascular Emergencies of the Thorax after Blunt and Iatrogenic Trauma: Multi-Detector Row CT and Three-dimensional Imaging. RadioGraphics. March 8, 2004 • Khalil, Ahmed; Tarik, Tari; Poremnka, David T. Aortic pathology: Aortic trauma, debris, dissection, and aneurysm. Critical Care Medicine. 2007; 35(8): 392-400 • Unknown. {Heartsite.com website} 2007 Available at http://www.heartsite.com/html/tee.html Accessed November 21, 2007 • Simeone, Alan; Freitas, Marilee; Frankel, Heidi L. Management Options in Blunt Aortic Injury: A Case Series and Literature Review. The American Surgeon. 2006; 72(1): 25 • Neuhauser, B; Czermak, B; Jaschke, W. et al Stent-Graft Repair for Acute Traumatic Thoracic Aortic Rupture. The American Surgeon. 2004; 70(12): 1039 • Svensson, L.G. Paralysis after aortic surgery: In search of lost cord function. TheSurgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 2005; 3(6): 396-405 • Cardarelli, Marcelo G.; McLaughlin, Joseph S.; Downing, Stephen W.; Brown, James M.; Attar, Safuh; Griffith, Bartley P. Management of Traumatic Aortic Rupture: A 30-year Experience. Analysis of Surgery. 2002; 236(4): 465-470 • Chen, Harold. {eMedicine from WebMD} 2007 Available at http://www.emedicine.com/ped/topic1372.htm Accessed December 9, 2007

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