Blunt Aortic Injury with Dyspagiaand Surgical Treatment

ABSTRACTBlunt aortic injuries are mortal with %80 in the rst hour. It is second most common cause of death in the trauma patient a er head trauma. Blunt traumatic disruption of the aorta, can occur during motor vehicle collisions or falls from signi cant heights. is fatal condition is usually distal to the origin of the subclavian artery in the area known as the aortic isthmus. Sudden hemorrhage, hypovolemic shock and consequently death a ect 85% of victims. In the remainders self-limiting hematoma or pseudoaneurysm may develop. Computed tomography has replaced anjiography as the gold standard for the diagnosis of blunt aortic injuries and delivers sensitivity and negative predictive values up to 100%.CASE PRESENTATIONA 25-year-old man falls from 15 m while motocross activity. He has threated in a multitrauma center because of hemotorax and discharged. 1 mount later he has gone to the hospital with dysphagia. e pseudoaneurizm of the aorta is diagnosed with ct angiography. It has localized just distal to the origin of the le subclavian artery. He has dispatched to our hospital. His blood pressure was 129/85 mmHg in upper extremities and 91/70 in lower extremities. Femoral pulses was diminished. He has headache. His nutrition was only liquid food. In the ct angiograpy aort lumen was narrowed. e case was discussed with cardiovascular surgery team. e conlusion was to repair by open surgery because of serius dysphagia and coarctation. Dysphagia etiology was the pseudoaneuryzm of the aorta. e aneuryzm segment had been compressed to the eosophagus. Surgical implementation with posterolateral thoracotomy has applied. e standart open surgery technique with shunting and cross-clmaping was applied. Inside the aorta wasn’t appropriate to repair. e proximal and distal of the gre was sutured to the aortic wall with 4-0 polypropylene by continuous suture. e total operation time was 176 min. ere were no complications. Postoperatively, he was weaned from the ventilator 3 hour a er the surgery. He was discharged from the hospital on postoperative 5. Day with no dyspagia.RESULTS e densely adherent tissue to the aorta was dissected as meticulously as possible. Dissection and psodoaneurysm segment excluded and bypass applied with gre . Any neurological symtoms or another complications haven’t developed. e patient has’nt dysphagia. Postoperative control ct angiograpy has optimal lumen size.DISCUSSIONTEVAR was suggested for BTAI if approppriate. But TEVAR cannot secure enough landing zones in some cases. However, no gra s with an appropriate caliber are usually available for otherwise normal aortas in the trauma setting. e long-term e ects of endovascular stenting require further assessment in the predominantly younger population of patients who sustain BTAI. In the present case, cardiac surgery team decided to surgical treatment because of serius dysphagia. And this case was not appropriate for enough landing zone.KEY WORDSBlunt Aortic Injury, Aortic pseudoaneurysm, Trauma