Manejo del Trauma Aórtico Dra. Diana Patricia Cárdenas

1. Diana Patricia Cárdenas
Residente Medicina de Urgencias
U de A

2. • Vesalius: 1557
• 70% de lesiones torácicas: trauma contuso
vehicular
• 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

3. • 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
• 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

5. • Istmo 36-54%
• 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

6. • Ausentes o inespecíficos en 50% de las veces
• Marca de cinturón de seguridad
• Lesión de plexo braquial
• 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

8. • 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. Hematoma mediastinal
Disección de Subclavia izquierda
Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

16. Disección Braquiocefálica
Pseudoaneurismas
Ruptura aórtica
Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

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

18. 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

19. • Ligadura (ramas)
• Cirugía abierta
• Terapia endovascular
Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56

20. 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

21. 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

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