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Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA
Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic tr...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Universidad del Valle
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634276/ https://www.ncbi.nlm.nih.gov/pubmed/34908619 http://dx.doi.org/10.25100/cm.v52i2.4611 |
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author | Parra, Michael W. Ordoñez, Carlos A. Pino, Luis Fernando Millán, Mauricio Caicedo, Yaset Buchelli, Víctor Rafael García, Alberto González-Hadad, Adolfo Salcedo, Alexander Serna, José Julián Quintero, Laureano Herrera, Mario Alain Hernández, Fabian Rodríguez-Holguín, Fernando |
author_facet | Parra, Michael W. Ordoñez, Carlos A. Pino, Luis Fernando Millán, Mauricio Caicedo, Yaset Buchelli, Víctor Rafael García, Alberto González-Hadad, Adolfo Salcedo, Alexander Serna, José Julián Quintero, Laureano Herrera, Mario Alain Hernández, Fabian Rodríguez-Holguín, Fernando |
author_sort | Parra, Michael W. |
collection | PubMed |
description | Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification. |
format | Online Article Text |
id | pubmed-8634276 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Universidad del Valle |
record_format | MEDLINE/PubMed |
spelling | pubmed-86342762021-12-13 Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA Parra, Michael W. Ordoñez, Carlos A. Pino, Luis Fernando Millán, Mauricio Caicedo, Yaset Buchelli, Víctor Rafael García, Alberto González-Hadad, Adolfo Salcedo, Alexander Serna, José Julián Quintero, Laureano Herrera, Mario Alain Hernández, Fabian Rodríguez-Holguín, Fernando Colomb Med (Cali) Review Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification. Universidad del Valle 2021-06-30 /pmc/articles/PMC8634276/ /pubmed/34908619 http://dx.doi.org/10.25100/cm.v52i2.4611 Text en Copyright © 2021 Colombia Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits unrestricted use and redistribution provided that the original author and source are credited. |
spellingShingle | Review Parra, Michael W. Ordoñez, Carlos A. Pino, Luis Fernando Millán, Mauricio Caicedo, Yaset Buchelli, Víctor Rafael García, Alberto González-Hadad, Adolfo Salcedo, Alexander Serna, José Julián Quintero, Laureano Herrera, Mario Alain Hernández, Fabian Rodríguez-Holguín, Fernando Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA |
title | Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA |
title_full | Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA |
title_fullStr | Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA |
title_full_unstemmed | Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA |
title_short | Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA |
title_sort | damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus reboa |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634276/ https://www.ncbi.nlm.nih.gov/pubmed/34908619 http://dx.doi.org/10.25100/cm.v52i2.4611 |
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