Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202200141
Jornal Vascular Brasileiro
Therapeutic Challenge

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

José Maciel Caldas dos Reis; Flávio Roberto Cavalleiro de Macêdo Ribeiro; Adib Koury Junior; Glauco dos Santos Melo; Murilo Vasconcelos de Oliveira; Vitor Hugo Guerreiro Américo Gomes; José Victor Figueiredo dos Santos; Sotero Gonçalves Sarquis Neto Segundo

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Resumo

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.

Palavras-chave

aorta, endovascular, pseudoaneurisma da aorta torácica, lesão traumática da aorta

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.

Keywords

aorta; endovascular; thoracic aortic pseudoaneurysm; traumatic aortic injury

References

1 Vargas TB, Lopes LA, Bergo R, Melo RF, Barroso LA, Starling SV. Lesão da aorta torácica por trauma fechado. Rev Med MG. 2016;26(4):20-3. http://dx.doi.org/10.5935/2238-3182.20160043.

2 Araujo PT, Lins NC, Proviett R, et al. Trauma de aorta torácica: experiência do Hospital Municipial Souza Aguiar. Rev SBACV-RJ. 2015;4:25-8.

3 Brown SR, Still SA, Eudailey KW, Beck AW, Gunn AJ. Acute traumatic injury of the aorta: presentation, diagnosis, and treatment. Ann Transl Med. 2021;9(14):1193. http://dx.doi.org/10.21037/atm-20-3172. PMid:34430634.

4 Benz RM, Makaloski V, Brönnimann M, Mertineit N, von Tengg-Kobligk H. Diagnostik und therapie traumatischer aortenverletzungen [Diagnostics and treatment of traumatic aortic injuries]. Unfallchirurg. 2021;124(8):601-9. http://dx.doi.org/10.1007/s00113-021-01044-0. PMid:34254152.

5 Mioto B No, Aun R, Estenssoro AEV, Puech-Leão P. Tratamento das lesões de aorta nos traumatismos torácicos fechados. J Vasc Bras. 2005;4(3):217-26. http://dx.doi.org/10.1590/S1677-54492005000300002.

6 Richens D, Field M, Neale M, Oakley C. The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardiothorac Surg. 2002;21(2):288-93. http://dx.doi.org/10.1016/S1010-7940(01)01095-8. PMid:11825737.

7 Alarhayem AQ, Rasmussen TE, Farivar B, et al. Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era. J Vasc Surg. 2021;73(3):896-902. http://dx.doi.org/10.1016/j.jvs.2020.05.079. PMid:32682070.

8 Riambau V, Böckler D, Brunkwall J, et al.; Esvs Guidelines Committee. Editor’s Choice - Management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(1):4-52. http://dx.doi.org/10.1016/j.ejvs.2016.06.005. PMid:28081802.

9 Starnes BW, Lundgren RS, Gunn M, et al. A new classi cation scheme for treating blunt aortic injury. J Vasc Surg. 2012;55(1):47-54. http://dx.doi.org/10.1016/j.jvs.2011.07.073. PMid:22130426.

10 Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracicaortic injury: clinical practice guidelines of the Society forvascular surgery. J Vasc Surg. 2011;53(1):187-92. http://dx.doi.org/10.1016/j.jvs.2010.08.027. PMid:20974523.

11 Steenburg SD, Ravenel JG, Ikonomidis JS, Schonholz C, Reeves S. Acute traumatic aortic injury: imaging evaluation and management. Radiology. 2008;248(3):748-62. http://dx.doi.org/10.1148/radiol.2483071416. PMid:18710974.

12 Pang D, Hildebrand D, Bachoo P. Thoracic endovascular repair (TEVAR) versus open surgery for blunt traumatic thoracic aortic injury. Cochrane Database Syst Rev. 2019;2(2):CD006642. http://dx.doi.org/10.1002/14651858.CD006642.pub3. PMid:30723895.

13 Ferreira MS, Marques G, Gonzalez A, Sousa G, Vieira J, Ferreira MJJ. Aneurisma da aorta torácica 29 anos após laceração e reparação primária. Angiol Cir Vasc. 2019;15(3):210-5.

14 Sarquis LM, Michaelis W, Santos AL Fo, et al. Abordagem endovascular de lesão de aorta torácica penetrante - relato de caso. J Vasc Bras. 2020;19:e20200132. http://dx.doi.org/10.1590/1677-5449.200132. PMid:34211531.

15 Tang GL, Tehrani HY, Usman A, et al. Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis. J Vasc Surg. 2008;47(3):671-5. http://dx.doi.org/10.1016/j.jvs.2007.08.031. PMid:17980541.

16 Demetriades D, Velmahos GC, Scalea TM, et al.; American Association for the Surgery of Trauma Thoracic Aortic Injury Study Group. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study. J Trauma. 2008;64(3):561-70, discussion 570-1. http://dx.doi.org/10.1097/TA.0b013e3181641bb3. PMid:18332794.

17 Hahn LD, Prabhakar AM, Zucker EJ. Cross-sectional imaging of thoracic traumatic aortic injury. Vasa. 2019;48(1):6-16. http://dx.doi.org/10.1024/0301-1526/a000741. PMid:30264668.

18 Plodr M, Safr M, Novak I. Thoracic aortic rupture due to airbag deployment. World J Emerg Med. 2021;12(4):327-9. http://dx.doi.org/10.5847/wjem.j.1920-8642.2021.04.014. PMid:34512833.

19 Lichtenberger JP 3rd, Franco DF, Kim JS, Carter BW. MR imaging of thoracic aortic disease. Top Magn Reson Imaging. 2018;27(2):95-102. http://dx.doi.org/10.1097/RMR.0000000000000165. PMid:29613964.

20 Renani AS, Pavlidis V, Morgan RA. Secondary endoleak management following TEVAR and EVAR. Cardiovasc Intervent Radiol. 2020;43(12):1839-54. http://dx.doi.org/10.1007/s00270-020-02572-9.

21 Patterson B, Holt P, Nienaber C, Cambria R, Fariman T, Thompson M. Aortic pathology determine midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation. 2013;127(1):24-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.112.110056. PMid:23283856.

22 Wiedmann D, Mahr S, Vadehra A, Schoder M, Funovics M, Lowe C. Thoracic endovascular aortic repair in 300 patientes: lont-term results. Ann Thorac Surg. 2013;95(5):1577-83. http://dx.doi.org/10.1016/j.athoracsur.2013.02.043. PMid:23566647.

23 Patel NH, Hahn D, Comess KA. Blunt chest trauma victims: role of intravascular ultrasound and transesophageal echo-cardiography in cases of abnormal thoracic aortogram. J Trauma. 2003;55(2):330-7. http://dx.doi.org/10.1097/01.TA.0000078696.27012.5C. PMid:12913645.

24 Volodos NL. Historical perspective: the first steps in endovascular aortic repair: how it all began. J Endovasc Ther. 2013;20(Suppl. 1):13. http://dx.doi.org/10.1583/1545-1550-20.sp1.I-3. PMid:23448181.

25 Hoffer EK, Forauer AR, Silas AM, Gemery JM. Endovascular stent-graft or open surgical repair for blunt thoracic aortic trauma: systematic review. J Vasc Interv Radiol. 2008;19(8):1153-64. http://dx.doi.org/10.1016/j.jvir.2008.05.012. PMid:18656007.
 


Submitted date:
02/06/2022

Accepted date:
02/05/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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