manejo del trauma aórtico
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Manejo del Trauma AórticoDra. Diana Patricia CárdenasTRANSCRIPT
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Diana Patricia CárdenasResidente Medicina de Urgencias
U de A
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• 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
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• 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
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• 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
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• 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
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• 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
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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
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H. H. LIEN. The Thoracic Paraspinal Shadow: A Review of the Appearances in Pathological Conditions. ClinicalRadiology (1984) 35, 215-221
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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
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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
![Page 13: Manejo del Trauma Aórtico](https://reader033.vdocuments.net/reader033/viewer/2022052508/559c6e771a28ab41358b471e/html5/thumbnails/13.jpg)
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
![Page 14: Manejo del Trauma Aórtico](https://reader033.vdocuments.net/reader033/viewer/2022052508/559c6e771a28ab41358b471e/html5/thumbnails/14.jpg)
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
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Hematoma mediastinal
Disección de Subclavia izquierda
Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56
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Disección Braquiocefálica
Pseudoaneurismas
Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56
Ruptura aórtica
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Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56
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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
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• Ligadura (ramas)
• Cirugía abierta
• Terapia endovascular
Anna Holdgate. Review of branch aortic injuries in blunt chest trauma. Emergency Medicine Australasia (2005) 17 , 49–56
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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
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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
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Complicaciones
Eleftherios S. Xenos. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 2008;48:1343-51