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Initial Experiences in Management of Blunt Aortic Injury Taking Associated Brain Injury Into Consideration

2006; Japanese Circulation Society; Volume: 70; Issue: 2 Linguagem: Inglês

10.1253/circj.70.198

1347-4820

Yoshihiko Kurimoto, Kiyofumi Morishita, Nobuyoshi Kawaharada, Johji Fukada, Yoshikazu Hachiro, Yasuaki Fujisawa, Tatsuya Saitoh, Naoya Yama, Mamoru Hase, Eichi Narimatsu, Yasufumi Asai,

Cardiac Arrest and Resuscitation

Although endovascular stent-grafting (SG) has become acceptable for blunt aortic injury (BAI), open surgical repair (OR) does provide reliable, good long-term results. A current surgical strategy for BAI, taking account of associated brain injury, is presented and preferable initial management for BAI is proposed.The surgical strategy for BAI was established in 2001: SG is performed for patients with obvious brain injuries, but OR is performed for patients without brain injury, and conservative treatment should be used initially for patients with critical non-aortic injuries. Between 2001 and 2004 20 patients with BAI were admitted to hospital: 16 blunt aortic ruptures and 4 blunt aortic dissections. Of them 15 patients underwent surgery (SG, 9; OR, 6) and 5 patients were treated conservatively. One patient died from associated lung injury after SG, all patients treated conservatively died because of associated brain injuries or another rupture of BAI, and 2 elderly patients treated by OR died within 1 year from postoperative respiratory failure.This brain-injury conscious surgical strategy for BAI provided acceptable early results. OR should be chosen for young patients without brain injury, but endovascular SG seems to be a better initial treatment for elderly patients or patients with other comorbidities.