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Therapeutic Plan for Traumatic Truncal Arterial Injury Associated with Truncal Organ Injury

Other Title
체간부 장기 손상을 동반한 외상성 체간부 동맥 손상 환자의 치료 방침
Authors
조, 충현; 정, 용식; 김, 욱환; 조, 영신; 안, 정환; 민, 영기; 정, 윤석; 김, 성희; 이, 국종
Citation
Taehan Oesang Hakhoe chi, 22(1):77-86, 2009
Journal Title
Taehan Oesang Hakhoe chi; Journal of the Korean Association of Traumatology; Journal of the Korean Society of Traumatology; 대한외상학회지
ISSN
1738-87672287-1683
Abstract
Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study’s objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions.



Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed.



Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury.



Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional horacotomy.
Keywords
Aortic injuriesAortic dissectionBlunt traumaStent
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Emergency Medicine
AJOU Authors
정, 용식김, 욱환안, 정환민, 영기정, 윤석이, 국종
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