背景:钝性创伤性主动脉损伤(BTAI)是年轻患者因创伤导致死亡的第二大原因。主要表现可能是胸部或肩胛骨间疼痛,呼吸困难,and,在严重的情况下,低血压。考虑到这些患者的临床状况迅速恶化,及时诊断和开始治疗至关重要。在这些伤害中,主动脉受累最多的部分是峡部(左锁骨下动脉远端)和胸腔的降部。因此,主要的诊断策略包括经胸超声心动图,CT血管造影,和血管内诊断方法。病例介绍患者是一名19岁男性,有胸痛症状,呼吸困难,汽车周转后四肢极度疼痛。初步评估显示,除了双侧血胸,没有异常的心血管发现。用胸管处理。十二小时后,当病人接受骨科手术观察时,他开始胸痛和呼吸困难,TTE和CTA显示主动脉瓣三降动脉瘤。患者立即接受了支架植入的血管内手术治疗。还进行了延迟脱支手术,这导致了理想的结果和顺利的后续行动。
结论:尽管开胸手术是治疗血流动力学不稳定患者主动脉瘤的主要且几乎是唯一的选择,在具有适当解剖结构的选定患者中,血管内手术显示出优异的结局。脱支手术,可以在初始程序之后同时或延迟进行,已证明对血栓栓塞性脑事件有保护作用。
■主动脉瘤患者应与多学科小组一起送往医疗中心进行紧急评估和治疗。最初的复苏和诊断具有挑战性,考虑到这些伤害的致命性质,治疗方法的选择是基于患者的临床状况和心血管影像学的解剖学评估。
BACKGROUND: Blunt traumatic aortic injury (BTAI) is the second leading cause of death due to traumas in young patients. The primary presentation might be chest or interscapular pain, difficulty in breathing, and, in severe cases, hypotension. Considering the rapid deterioration of these patients\' clinical conditions, prompt diagnosis and treatment initiation are crucial. In these injuries, the most involved parts of the aorta are the isthmus (distal to the left subclavian artery) and the descending part in the thorax. Therefore, the main diagnostic strategies include transthoracic echocardiography, CT angiography, and endovascular diagnostic approaches. Case presentation The patient was a 19-year-old male presenting with the symptoms of chest pain, dyspnea, and extremities excruciating pain after a car turnover. The initial evaluation showed no abnormal cardiovascular finding except bilateral hemothorax, addressed with chest tubes. Twelve hours later, when the patient was under observation for orthopedic surgeries, his chest pain and dyspnea started, and TTE and CTA showed a grade three descending aneurysm of the aorta. The patient was treated immediately with an endovascular procedure of stent implantation. A delayed debranching surgery was also performed, which resulted in desirable outcomes and uneventful follow-up.
CONCLUSIONS: Although open thoracic surgery is the main and almost the only option for treating aneurysms of the aorta in hemodynamically unstable patients, the endovascular procedure has shown superior outcomes in selected patients with appropriate anatomy. Debranching surgery, which can be done simultaneously or with delay after the initial procedure, has proven protective against thromboembolic cerebral events.
UNASSIGNED: Patients with an aneurysm of the aorta should be transported to a medical center with a multidisciplinary team for an urgent evaluation and treatment. The initial resuscitation and diagnosis are challenging, considering the fatal nature of these injuries, and the selection of the treatment is based on the patient\'s clinical condition and evaluated anatomy in cardiovascular imaging.