manejo del trauma aórtico

Diana Patricia CárdenasResidente Medicina de Urgencias

U de A

• Vesalius: 1557

• 70% de lesiones torácicas: trauma contuso

vehicularvehicular

• Incidencia de lesión aórtica: 1.5 -1.9%

• Mínimo 2 lesiones más, asociadas.

Forozan Navid. Great Vessel and Cardiac Trauma: Diagnostic and Management Strategies. Semin Thorac Cardiovasc Surg 20:31-38 © 2008

• Mortalidad 70-90%

– 20% de las muertes relacionadas con trauma

– 40-70% sobrevivirán si se diagnostican

– Mortalidad del 90% a los que no se tratan– Mortalidad del 90% a los que no se tratan

• 45% : lesiones de ramas

– 30%: lesiones de ramas aisladas

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

• Istmo 36-54%

• Aorta ascendente 8-27%• Aorta ascendente 8-27%

• Arco aórtico 8-18%

• Aorta descendente 11-21%

• Aorta abdominal

Eleftherios S. Xenos. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008;48:1343-51

• Ausentes o inespecíficos en 50% de las veces

• Marca de cinturón de seguridad

• Lesión de plexo braquial

• Diferencias de pulsos• Diferencias de pulsos

• Sindrome de vena cava superior

• Disfagia, masas supraesternales pulsátiles

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

• Rx tórax

– Sensibilidad 85-100%

– Especificidad 10-45%

• Ensanchamiento mediastinal

• Pérdida del contorno del arco aórtico

• Ecocardio TE

– S/E > 90%

• TC

• Arteriografía

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

Todd C. Ungar. Derivation of a Clinical Decision Rule to Exclude Thoracic Aortic Imaging in Patients With Blunt Chest Trauma After Motor Vehicle Collisions.

The Journal of TRAUMA Injury, Infection, and Critical Care. Volume 61 • Number 5

H. H. LIEN. The Thoracic Paraspinal Shadow: A Review of the Appearances in Pathological Conditions. ClinicalRadiology (1984) 35, 215-221

Todd C. Ungar. Derivation of a Clinical Decision Rule to Exclude Thoracic Aortic Imaging in Patients With Blunt Chest Trauma After Motor Vehicle Collisions.

The Journal of TRAUMA Injury, Infection, and Critical Care. Volume 61 • Number 5

Todd C. Ungar. Derivation of a Clinical Decision Rule to Exclude Thoracic Aortic Imaging in Patients With Blunt Chest Trauma After Motor Vehicle Collisions.

The Journal of TRAUMA Injury, Infection, and Critical Care. Volume 61 • Number 5

Todd C. Ungar. Derivation of a Clinical Decision Rule to Exclude Thoracic Aortic Imaging in Patients With Blunt Chest Trauma After Motor Vehicle Collisions.

The Journal of TRAUMA Injury, Infection, and Critical Care. Volume 61 • Number 5

Todd C. Ungar. Derivation of a Clinical Decision Rule to Exclude Thoracic Aortic Imaging in Patients With Blunt Chest Trauma After Motor Vehicle Collisions.

The Journal of TRAUMA Injury, Infection, and Critical Care. Volume 61 • Number 5

Hematoma mediastinal

Disección de Subclavia izquierda

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

Disección Braquiocefálica

Pseudoaneurismas

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

Ruptura aórtica

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

Enoch Akowuah. Emergency repair of traumatic aortic rupture: Endovascular versus conventional open repair. The Journal of Thoracic and Cardiovascular

Surgery ● Volume 134, Number 4 897 ACD

• Ligadura (ramas)

• Cirugía abierta

• Terapia endovascular

Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

Mortalidad en el

procedimiento

Eleftherios S. Xenos. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008;48:1343-51

Mortalidad a los 30

días

Eleftherios S. Xenos. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008;48:1343-51

Complicaciones

Eleftherios S. Xenos. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008;48:1343-51