Blunt Injury to the Proximal Descending Thoracic Aorta

[KMATTOX at aol.com]

Just so there is no confusion,   At the BTGH we follow the  following 
considerations
 
1.    We rarely operate on such an injury in the middle  of the night
2.    We consider injuries to the aortic root,  ascending aorta, and aortic 
arch, totally different lesions
3.    We place any patient with a suspicion of an  aortic injury on after 
load reduction, unless they are markedly  hypotensive
4.    We delay surgery several days to even weeks and  months in over 85% of 
our current cases
5.    Screening strategies include:  History,  Physical examination, plain 
chest x-ray and sometimes CT, (although the CT has  not really resulted in a 
positive screen any better than a seasoned eye viewing  the plain chest x-ray)
6.    We would never do an aortic intervention without  an AORTOGRAM,   for a 
long list of reasons
7.    Three DIAGNOSTIC studies exist to be definitive  for this injury:   
Aortogram, operation, autopsy
8.    We ALWAYS are concerned about the other areas of  the aorta, branch 
vessels and anomalies.   
9.    We use BOTH endografts and open operation, even  to this day and are 
impressed with the accumulated data regarding the low  incidence of paraplegia 
and death and complications with endografts
10.    We are very concerned about the small  aorta
11.    We are very concerned about the high rate of  device insertion site 
complications.    
12.    We have not had a stent migration or  enfolding
13.    Our recent results between open and stent graft  repairs are equal, 
but the stent grafts are much much more  expensive.    
 
k



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