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Journal of Long-Term Effects of Medical Implants
SJR: 0.332 SNIP: 0.491 CiteScore™: 0.89

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v13.i5.70
10 pages

Blunt Thoracic Aortic Injury: Old Problem and New Technology

L. D. Britt
Chairman, Brickhouse Professor of Surgery. Department of General Surgery, Eastern Virginia Medical School, Hofheimer Hall, 825 Fairfax Avenue, Norfolk VA 235001, USA

ABSTRACT

The lethal nature of transmural aortic injuries has remained constant; however, both the diagnostic and therapeutic interventional options have improved. Although aortography is still the "gold standard" against which all other diagnostic modalities are measured, contrast-enhanced spiral thoracic computed tomography has emerged as the diagnostic study that could potentially supplant aortography. The advent of the fast spiral computed tomography scanners offer several advantages, including being less affected by patient motion and volumeaveraging artifacts than the earlier generation CT scanners. The operative has broadened from primary repair and interposition prosthetic graft placement (with possible use of shunt or roller vs. centrifugal bypass) to the potential widespread use of endovascular stents. The Eastern Virginia Medical School (EVMS) experience during the first 10-year period (see table below) highlights the majority of patients undergoing interposition prosthetic graft placement. There was no use of shunts during this period. At the midpoint of the second 10-year period (1997-2007), the method of repair is exclusively interposition graft placement. The role of endovascular stent insertion in the management of these injuries is currently being debated.

        EVMS experience:       Primary repaire   23%
                               Graft             77%
        Mode of management:    Crossclamp        14%
                               Bypass            86%