RT Book, Section
A1 Ruddy, Jean Marie
A1 Ikonomidis, John S.
A2 Cohn, Lawrence H.
SR Print(0)
ID 55927201
T1 Chapter 56. Trauma to the Great Vessels
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesssurgery.mhmedical.com/content.aspx?aid=55927201
RD 2024/04/25
AB Injury  to  the  aorta  and  great  vessels  of  the  thorax  may  occur  secondary  to  blunt  or  penetrating  trauma,  and  appropriate  management  of  immediate  hemorrhage  as  well  as  that  resulting  from  subsequent  pseudoaneurysm  rupture  should  be  the  primary  goal  of  the  treating  surgeon.1  Blunt  aortic  injury  is  the  most  common  thoracic  vascular  injury  following  blunt  trauma  and  the  second  leading  cause  of  death  from  motor  vehicle  collision,  accounting  for  15%  of  deaths.2–4  In  75  to  90%  of  cases,  death  occurs  at  the  accident  scene,  typically  in  those  with  four  or  more  serious  injuries  in  addition  to  their  aortic  transection.2–5  After  aortic  transection  at  the  isthmus,  aortic  disruption  at  the  base  of  the  innominate  artery  is  the  most  common  site  of  injury,  followed  by  the  base  of  the  left  subclavian  artery,  and  the  base  of  the  left  carotid.6  Central  venous  structures  are  rarely  injured  with  blunt  trauma,7  but  this  can  occur  with  penetrating  trauma.8  Traditionally,  open  surgical  repair  of  these  injuries  has  proved  effective,  but  recent  literature  has  demonstrated  the  safety  and  efficacy  of  endovascular  interventions.9  This  chapter  examines  trauma  to  each  of  the  thoracic  vessels  and  presents  diagnostic  modalities  as  well  as  treatment  options.