Traumatic Injuries Traumatic Injuries to the Aorta to the Aorta Amanda Law Amanda Law
Jan 21, 2016
Traumatic Injuries to Traumatic Injuries to the Aortathe Aorta
Amanda LawAmanda Law
AnatomyAnatomy Supplies body with oxygenated bloodSupplies body with oxygenated blood Three layersThree layers
– Tunica IntimaTunica Intima– Tunica MediaTunica Media– Tunica Adventitia Tunica Adventitia
Three major branchesThree major branches– Ascending AortaAscending Aorta– Aortic ArchAortic Arch– Descending Aorta Descending Aorta
Composed of connective tissue and elastic Composed of connective tissue and elastic fibersfibers
http://www.vcu.edu/hearts/images/aorta_anatomy.jpg
Different Forms of InjuryDifferent Forms of Injury
Incomplete Aortic RuptureIncomplete Aortic Rupture Severe Aortic InjurySevere Aortic Injury Traumatic Aortic DissectionTraumatic Aortic Dissection Traumatic and Iatrogenic Aortic Traumatic and Iatrogenic Aortic
DissectionDissection
Incomplete Rupture
Severe Aortic Injury
Traumatic Aortic Dissection
Mechanism of InjuryMechanism of Injury
Hardy, Shah, Kopacz, and Yang Hardy, Shah, Kopacz, and Yang studied mechanisms in 2006studied mechanisms in 2006
In situIn situ cadavers to test TRA cadavers to test TRA mechanismsmechanisms
Main Goal: further study potential Main Goal: further study potential TRA mechanisms and discover which TRA mechanisms and discover which movements might cause TRAmovements might cause TRA
ProcedureProcedure
5 tests5 tests Two tests pulled aortic arch in Two tests pulled aortic arch in
anterior directionanterior direction One test displaced the arch toward One test displaced the arch toward
the right sidethe right side Two tests displaced the arch Two tests displaced the arch
superiorly superiorly
Categories Categories
Side Impact Side Impact Frontal ImpactFrontal Impact Both Side and Frontal ImpactBoth Side and Frontal Impact
http://www1.istockphoto.com/file_thumbview_approve/2427726/2/istockphoto_2427726_car_crash.jpg
ResultsResults
Aortic tear in all situationsAortic tear in all situations TransverseTransverse 3 complete, 1 incomplete, and 1 3 complete, 1 incomplete, and 1
circumferential tear through intimacircumferential tear through intima Peri-isthmic regionPeri-isthmic region
Results Results
ConclusionsConclusions 56% of all clinical TRA 56% of all clinical TRA
occurs within the peri-occurs within the peri-isthmic region. isthmic region.
94% of all car accident-94% of all car accident-related injuries occur related injuries occur within this region, and within this region, and 93% of those tears are 93% of those tears are complete. complete.
Intimal tears were along Intimal tears were along the circumference and the circumference and were 6.9mm in length were 6.9mm in length and 33mm from the and 33mm from the subclavian arterysubclavian artery
http://www.jvascbr.com.br/03-02-03/03-02-03-197/fig02.jpg
MechanismsMechanisms
Straightening of the inferior archStraightening of the inferior arch Abnormal movement of the aortic Abnormal movement of the aortic
archarch Thoracic deformationThoracic deformation Stretch deformationStretch deformation Traction of superior vasculatureTraction of superior vasculature ““Shoveling”Shoveling” Motion of the sternumMotion of the sternum
TestsTests
Chest x-rayChest x-ray MRIMRI CT scanCT scan TEETEE
MRIMRI
http://hcd2.bupa.co.uk/images/factsheets/MRI_scan.gif
CT ScanCT Scan
http://www.pennhealth.com/health_info/allergy/images/1088.jpg
TEETEE
http://content.answers.com/main/content/img/medTest/f005007b.jpg
Surgical InterventionsSurgical Interventions
Stent-graft RepairStent-graft Repair Aortic repair using a “clamp and Aortic repair using a “clamp and
sew” approach or some form of sew” approach or some form of bypass bypass
Antihypertensive Therapy Antihypertensive Therapy
Stent-graft Repair Stent-graft Repair
http://www.medtronic.com/physician/aneurx/images/AAAdvantage3.jpg
Stent GraftsStent Grafts
Talent Talent Excluder Excluder Vanguard Vanguard
Advantages/DisadvantagesAdvantages/Disadvantages
Aortic cross Aortic cross clamping and clamping and single lung single lung ventilation is ventilation is avoidedavoided
Minimal Minimal anticoagulationanticoagulation
Less invasiveLess invasive Minimal blood lossMinimal blood loss
Annual CT scansAnnual CT scans
Direct aortic repair using a “clamp Direct aortic repair using a “clamp and sew” approach or some form and sew” approach or some form
of bypassof bypass
http://www.jvascbr.com.br/02-01-03/02-01-03-207/Fig5.jpg
Antihypertensive Therapy Antihypertensive Therapy
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/8693.jpg
ComplicationsComplications
ParaplegiaParaplegia HemorrhageHemorrhage TransfusionTransfusion Organ DysfunctionOrgan Dysfunction Long ICU staysLong ICU stays Extensive RehabilitationExtensive Rehabilitation
PredispositionPredisposition
GeneticsGenetics Connective Tissue DisordersConnective Tissue Disorders
– Marfan SyndromeMarfan Syndrome
http://www.cafamily.org.uk/pics/m15i1.jpg
Marfan SyndromeMarfan Syndrome
Connective Tissue DisorderConnective Tissue Disorder Connective Tissue is abnormal causing Connective Tissue is abnormal causing
weakened tendons, ligaments, blood weakened tendons, ligaments, blood vessel walls, cartilage, and heart valvesvessel walls, cartilage, and heart valves
Characteristics: slender, tapering Characteristics: slender, tapering fingers, long arms and legs, curvature fingers, long arms and legs, curvature of the spine, eye problems, mitral valve of the spine, eye problems, mitral valve prolapse, aortic root dilation, and aortic prolapse, aortic root dilation, and aortic dissection dissection
Fibrin-1 geneFibrin-1 gene
A Case StudyA Case Study
20-year female involved in motor vehicle 20-year female involved in motor vehicle accidentaccident
Sustained multi-system trauma Sustained multi-system trauma Unresponsive Unresponsive Slight bruise to left chest with no Slight bruise to left chest with no
instabilityinstability Pulse was 60-70 range (equal bilaterally)Pulse was 60-70 range (equal bilaterally) Systolic Blood Pressure was in 120sSystolic Blood Pressure was in 120s GCS - 3GCS - 3
TestsTests
Chest x-rayChest x-ray– Fractured ribs 4-8Fractured ribs 4-8– Possible mid-sternal fracturePossible mid-sternal fracture– Wide mediastinumWide mediastinum
CT scanCT scan– Mediastinal hematomaMediastinal hematoma– Left-pulmonary contusionLeft-pulmonary contusion– Collapse lungCollapse lung
LabsLabs Red Blood Cell Count – 4.25 x 10^12 cells/LRed Blood Cell Count – 4.25 x 10^12 cells/L Hemoglobin – 12.7 gm/dlHemoglobin – 12.7 gm/dl Hematocrit – 36.7%Hematocrit – 36.7% Glucose – 179Glucose – 179 Creatinine – 0.6 mg/dlCreatinine – 0.6 mg/dl
Na – 134 mEq/LNa – 134 mEq/L K – 3.2 mEq/LK – 3.2 mEq/L pH – 7.41pH – 7.41 pO2 – 456 mmHgpO2 – 456 mmHg pCO2 – 36 mmHgpCO2 – 36 mmHg
TreatmentTreatment
Stent Graft ProcedureStent Graft Procedure– AneuRx graftAneuRx graft
http://content.answers.com/main/content/wp/en/thumb/3/33/200px-Covered_Stent_Graft.jpg
Statistics Statistics
An estimated 15 to 20% of patients An estimated 15 to 20% of patients make it to the hospital alive and of make it to the hospital alive and of those 75% will die within 24 hours if those 75% will die within 24 hours if they do not receive surgical they do not receive surgical intervention. intervention.
ConclusionsConclusions
Aortic injuries are of serious concern Aortic injuries are of serious concern to medical professionals. There is a to medical professionals. There is a high mortality rate among patients high mortality rate among patients who sustain injuries to their aorta. who sustain injuries to their aorta.
The statistics make it apparent that The statistics make it apparent that researchers must pay extra attention researchers must pay extra attention to this problem so that the most to this problem so that the most effective treatments may be effective treatments may be developed. developed.
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