Aorta by Dr Roxanne Wu
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This document discusses aortic trauma from blunt force injuries. It notes that aortic trauma most commonly results from rapid deceleration in motor vehicle or motorcycle accidents, falls from heights, air crashes, or heavy objects falling on the chest. It outlines different zones of the thoracic aorta that can be injured and discusses techniques for diagnosing and treating aortic injuries, including open surgery, endovascular stenting, and a resuscitative endovascular balloon occlusion of the aorta (REBOA) technique to control hemorrhaging. REBOA involves inserting a large sheath and balloon catheter into the femoral or axillary artery under ultrasound guidance to occlude blood flow to the damaged area of the aorta.
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Aorta by Dr Roxanne Wu
- 1. Fast and Furious CICM 2019 Dr Roxanne Wu,Vascular Surgeon Cairns Hospital AORTIC TRAUMA
- 3. Mechanism • Rapid deceleration in MVA and MBA • Falls from a height • Air crash • Weight falling on chest ZONES OF THORACIC AORTA 95%
- 4. SVS grade of injury
- 6. TREATMENT • NO INTERVENTION • OPEN SURGERY • ENDOVASCULAR STENT
- 8. MINIMAL INJURY At injury At 3 months
- 9. 20 YRS POST AORTIC RUPTURE 45 YRS POST AORTIC RUPTURE
- 10. OPEN REPAIR +/- LV to aortic shunt
- 15. REBOA TECHNIQUE • CUTDOWN or ACCESS BY SELDINGER TECHNIQUE on COMMON FEMORAL/AXILLARY ARTERY, USING ULTRASOUND GUIDANCE • Difficulties: • Swelling in #pelvis • High puncture • Small arteries in women and children • Diseased arteries and previous vascular surgery Inguinal ligament Groin Crease INFRARENAL AORTA ✔ SUPRA COELIAC AORTA ✔ VISCERAL BRANCHES ✖
- 16. INSERT 12 FR SHEATH(4mm) • Initial sheath with be 6Fr X 13cm length • Insert 0.35” J-wire slowly and steadily (safe to do without screening if no resistance) a distance of 60cm. • SCREEN • Exchange for stiff wire (eg Cook Amplatz 190cm) • Insert 12Fr X 40cm sheath • Do angio to locate renal arteries( L1-L2) and bifurcation of aorta (L4-L5)
- 17. Place balloon/ inflate under fluoro guidance • Prepare half strength contrast (contrast is thick like honey) • Insert balloon through large sheath over the wire to desired position under fluoroscopy • Inflate under fluoroscopy • Position sheath to keep balloon from moving down WIR SYRINGE
- 18. HAZARDS OF REBOA • Requires X ray screening for safety. • Like clamping the aorta, can cause sudden increase in afterload and BP • Inflation time Mortality. • Maximum recommended time = 40 minutes