Penetrating thoracic great vessel injury: impact of admission hemodynamics and preoperative imaging.

摘要: BACKGROUND The management of penetrating great vessel (PGV) injury is challenging. Patients in shock require rapid evaluation, whereas stable patients, imaging studies may optimize the surgical approach. We reviewed our experience with PGV to determine impact admission blood pressure and accuracy studies, both angiography computed tomographic (CTA). METHODS Retrospective review trauma registry from 2001 2007 identifying patients injury. Demographics, systolic pressure, specific injuries, incision, methods repair, hospital intensive care length stay, complications, mortality were recorded. Shock was defined as <90 mm Hg. RESULTS Thirty-six consecutive identified, average age 28 (+/-10) years, whom 20 (56%) presented shock. Those had more combined arterial-venous injuries (60% vs. 25%), concomitant thoracic requiring resection (45% 19%), units packed red cells (5.8 +/- 2 2.7 1.5), p < 0.01. For those shock, mean time operating room 27 minutes 9 75% sternotomy. Among 56% a periclavicular approach 31% partial All 16 imaging; 3 CTA 7 patients. In six who CTA, results concordant; therefore, accurately diagnosed arterial all 13 Imaging changed choice incision 4 (25%). Intensive stay significantly longer group 3.1 (+/-2.1) days versus 1.4 (+/-1.6) (p = 0.01). There 5 (14%) complications no deaths. CONCLUSION evaluation. Sternotomy affords excellent exposure sternotomy useful can be valuable defining influence Surgical are surprisingly good, even unstable related transport operation.