Anatomical considerations in the surgical management of blunt thoracic aortic injury

Yvonne Carter, Mark Meissner, Eileen Bulger, Seher Demirer, Susan Brundage, Gregory Jurkovich, John Borsa, Michael S. Mulligan, Riyad Karmy-Jones

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: Blunt aortic injury (BAI) involving the thoracic aorta is usually described as occurring at the isthmus. We hypothesized that injuries 1 cm or less from the inferior border of the left subclavian artery (LSCA) are associated with an increased mortality rate compared with injuries that are more distal. Methods: A retrospective review of patients admitted with the diagnosis of BAI was performed. Injuries were divided into two groups: group I, injuries that were 1 cm or less from the junction of the LSCA and the thoracic aorta; group II, injuries that were more than 1 cm from the LSCA. Primary outcome measures included cross-clamp time, rupture, and death. Results: In a 14-year period, 122 patients were admitted with BAI. The anatomy relative to the LSCA could be determined in 91 patients who underwent operative repair. Forty-two injuries (46%) were classified as group I, and 49 injuries were classified as group II. Group I injuries were characterized by an increased mortality rate (18/42 or 43% in group I vs 11/49 or 22% in group II, P = .04), intraoperative rupture rate (7/42 or 17% in group I vs 1/49 or 2% in group II, P = .003), and cross-clamp time (39.5 ± 21.9 minutes in group I vs 28.4 ± 13 minutes in group II, P = .04). Three ruptures occurred while proximal control was being obtained. Conclusion: Increased technical difficulty and risk of rupture characterize injuries that occur proximally in the descending thoracic aorta, 1 cm from the LSCA. These injuries may be better managed by instituting bypass before attempting to obtain proximal control and by routinely clamping proximal to the LSCA.

Original languageEnglish (US)
Pages (from-to)628-633
Number of pages6
JournalJournal of Vascular Surgery
Volume34
Issue number4
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

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Thoracic Injuries
Nonpenetrating Wounds
Subclavian Artery
Wounds and Injuries
Thoracic Aorta
Rupture
Mortality
Constriction
Anatomy
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Carter, Y., Meissner, M., Bulger, E., Demirer, S., Brundage, S., Jurkovich, G., ... Karmy-Jones, R. (2001). Anatomical considerations in the surgical management of blunt thoracic aortic injury. Journal of Vascular Surgery, 34(4), 628-633. https://doi.org/10.1067/mva.2001.117143

Anatomical considerations in the surgical management of blunt thoracic aortic injury. / Carter, Yvonne; Meissner, Mark; Bulger, Eileen; Demirer, Seher; Brundage, Susan; Jurkovich, Gregory; Borsa, John; Mulligan, Michael S.; Karmy-Jones, Riyad.

In: Journal of Vascular Surgery, Vol. 34, No. 4, 01.01.2001, p. 628-633.

Research output: Contribution to journalArticle

Carter, Y, Meissner, M, Bulger, E, Demirer, S, Brundage, S, Jurkovich, G, Borsa, J, Mulligan, MS & Karmy-Jones, R 2001, 'Anatomical considerations in the surgical management of blunt thoracic aortic injury', Journal of Vascular Surgery, vol. 34, no. 4, pp. 628-633. https://doi.org/10.1067/mva.2001.117143
Carter, Yvonne ; Meissner, Mark ; Bulger, Eileen ; Demirer, Seher ; Brundage, Susan ; Jurkovich, Gregory ; Borsa, John ; Mulligan, Michael S. ; Karmy-Jones, Riyad. / Anatomical considerations in the surgical management of blunt thoracic aortic injury. In: Journal of Vascular Surgery. 2001 ; Vol. 34, No. 4. pp. 628-633.
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abstract = "Purpose: Blunt aortic injury (BAI) involving the thoracic aorta is usually described as occurring at the isthmus. We hypothesized that injuries 1 cm or less from the inferior border of the left subclavian artery (LSCA) are associated with an increased mortality rate compared with injuries that are more distal. Methods: A retrospective review of patients admitted with the diagnosis of BAI was performed. Injuries were divided into two groups: group I, injuries that were 1 cm or less from the junction of the LSCA and the thoracic aorta; group II, injuries that were more than 1 cm from the LSCA. Primary outcome measures included cross-clamp time, rupture, and death. Results: In a 14-year period, 122 patients were admitted with BAI. The anatomy relative to the LSCA could be determined in 91 patients who underwent operative repair. Forty-two injuries (46{\%}) were classified as group I, and 49 injuries were classified as group II. Group I injuries were characterized by an increased mortality rate (18/42 or 43{\%} in group I vs 11/49 or 22{\%} in group II, P = .04), intraoperative rupture rate (7/42 or 17{\%} in group I vs 1/49 or 2{\%} in group II, P = .003), and cross-clamp time (39.5 ± 21.9 minutes in group I vs 28.4 ± 13 minutes in group II, P = .04). Three ruptures occurred while proximal control was being obtained. Conclusion: Increased technical difficulty and risk of rupture characterize injuries that occur proximally in the descending thoracic aorta, 1 cm from the LSCA. These injuries may be better managed by instituting bypass before attempting to obtain proximal control and by routinely clamping proximal to the LSCA.",
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AU - Jurkovich, Gregory

AU - Borsa, John

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