Thoracic Vascular Injuries
Before the development of modern trauma centers, most individuals with thoracic vascular trauma died before reaching the hospital. With the advent of rapid-response trauma systems, the incidence of thoracic vascular injury that survives to the hospital is increasing and the complexity of the injuries is becoming more challenging - Anesthesia Key
HWN Suggests
Overview of blunt and penetrating thoracic vascular injury in adults
Major vascular injury is suggested on plain chest radiograph by the presence of hemothorax, foreign body in proximity to a major vessel, widened mediastinum, and loss of aortic knob contour. In hemodynamically unstable patients, the extended focused assessment with sonography for trauma (eFAST) examination provides a rapid and sensitive evaluation for hemothorax and identifies cardiac effusion or tamponade.
Articles of Interest
An Emergency Radiologist’s Perspective on Traumatic Vascular Injuries
Most deaths from traumatic aortic injuries still occur at the scene or before the patient reaches the hospital. However, those who reach the emergency department and undergo imaging can now be treated with a high rate of success. The majority of traumatic thoracic aortic injuries (TTAI) are found at the aortic isthmus. Injuries are found less commonly at the aortic root, ascending aorta, distal descending aorta, or at branch vessel origins, with multifocal injuries in up to 18% of patients.
Heart and Thoracic Vascular Injuries
The heart and its tributaries are encased in the chest cavity, composed of the manubrium, sternum, clavicle, rib cage, and vertebral bodies. This rigid chassis, for the most part, provides adequate protection against small impacts/injuries. Severe trauma requiring intervention occurs by penetrating or blunt mechanisms. Firearms often result in direct injury to the heart and great vessels, in the path of destruction. The bony structures, interestingly, can also provide unique forms of injuries as they cause a ricocheting of bullets or alter vectors of the original direction of penetration. Blunt forces can lead to crushing, traction, and torsion injuries to the heart from deceleration forces. Penetrating trauma to the great vessels can lead to immediate exsanguination or pattern of injury similar to blunt trauma including pseudoaneurysm, partial transection with intimal flap, thrombosis, and propagation.
Thoracic Vascular Trauma
Traumatic injuries to the thoracic vasculature – the aorta and its brachiocephalic branches, the pulmonary arteries and veins, the superior vena cava and intrathoracic inferior vena cava, and the innominate and thoracic veins – occurs following both blunt and penetrating trauma. The primary cause of mortality remains acute exsanguinating hemorrhage. A high clinical index of suspicion along with prompt recognition and resuscitation are necessary components in the surgeon’s armamentarium for dealing effectively with thoracic vascular trauma.
Resources
Anesthesia Key
Vascular injuries of the chest often include named vessels such as aorta, innominate artery, and proximal common carotid and subclavian arteries... The great vessel that is the most commonly injured in blunt thoracic trauma is the descending aorta. These injuries usually involve the proximal descending aorta near the isthmus.
