SURGICAL TREATMENT OF THORACIC AORTA TRANSECTION BY CONTUSIVE TRAUMA: CASE REPORT

Authors

  • Augusto Campeão Rodrigues
  • Bruno Vaz de Melo
  • Rodrigo Andrade Vaz de Melo

DOI:

https://doi.org/10.56083/RCV4N2-002

Keywords:

Aortic Trauma, Aortic Transection, Vascular Prosthesis

Abstract

Traumatic injuries to the thoracic aorta are rare events with high mortality. Several treatment modalities are described, including: conservative treatment, endovascular techniques, and conventional surgery. The objective of this work is to report the conventional surgical treatment and its evolution of a thoracic aorta transection injury. Case Report: Patient, F.R. 25 years old, victim of blunt motor trauma x shield, was admitted to the unit with chest pain plus signs of shock, a chest CT scan was performed and a grade IV blunt injury to the thoracic aorta and fracture of the right femur were identified, evolving with hypotension, tachycardia and anemia. A posterolateral thoracotomy was performed and, after control and exploration of the hematoma, a lesion with aortic transection was found, with an interposition using a Dacron prosthesis, with a satisfactory clamping time followed by chest drainage. External fixation of the D femur fracture was performed during the same surgery. Red blood cell concentrates were used during the operative period. The patient was admitted to the ICU, on mechanical ventilation, sedated and with amines and blood drains. He developed AKI due to rhabdomyolysis, requiring hemodialysis. A new CT scan showed hemothorax on the right side, and a thoracostomy on the right side was performed on the second day after the first surgery. The patient progressed with weaning from sedation and extubation 5 days after the first surgical procedure, but maintained anemia and mild hypoxia. A new CT scan showed a left hemothorax associated with a small pneumothorax, and a videothoracoscopy was performed on left with evacuation of the clot plus drainage. a good evolution of the condition, with improvement in hematic parameters and renal insufficiency, with gradual removal of the drains. Discharged from hospital without further complications.

References

Mosquera V, Marini M, et al. Role of conservative management in traumatic aortic injury: comparison of long term results of conservative, surgical and endovascular treatment. J Thoracic Cardiovasc Surg. 2011:614–21. [PubMed] DOI: https://doi.org/10.1016/j.jtcvs.2010.10.044

Feczko JD, Lynch L, Pless JE, Clark MA, McClain J, Hawley DA. An autopsy case review of 142 non-penetrating (blunt) injuries of the aorta. J Trauma. 1992;33:846–849. doi: 10.1097/00005373-199212000-00009. [PubMed] [CrossRef] [Google Scholar] DOI: https://doi.org/10.1097/00005373-199212000-00009

Lundervall J. The mechanism of traumatic rupture of the aorta. Acta Pathol Microbiolog Scandinavia. 1964;62:34. doi: 10.1111/apm.1964.62.1.34. [PubMed] [CrossRef] [Google Scholar] DOI: https://doi.org/10.1111/apm.1964.62.1.34

Crass, JR. Cohen AM. Motta AO. A proposed new mechanism of aortic rupture: the osseous pinch. Radiology 1990. 176:645. [PubMed] DOI: https://doi.org/10.1148/radiology.176.3.2389022

Azizzadeh A. Keyhani K. Miller III, C.C. Coogan S.M. Safi H.J. Estrera A.L. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009; 49: 1403-1408 DOI: https://doi.org/10.1016/j.jvs.2009.02.234

Published

2024-02-09

How to Cite

Rodrigues, A. C., de Melo, B. V., & de Melo, R. A. V. (2024). SURGICAL TREATMENT OF THORACIC AORTA TRANSECTION BY CONTUSIVE TRAUMA: CASE REPORT. Revista Contemporânea, 4(2), e3266. https://doi.org/10.56083/RCV4N2-002

Issue

Section

Artigos