Ascending Aortic Arch Injury

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Dear Karim,
We recently treated 2 multiple injured patients with similar injuries
in our center. After initial stabilization (ex fix) of pelvic and
extremity injuries and 2-4 days of controlled hypotension on ICU, both
were operated on cardiopulmonary bypass during which the intimal tear
was repaired (see attached some low-resolution pictures).
Both are doing fine with 6-12 months follow up.
Good luck,
kind regards,
Carel Goslings and Kees Jan Ponsen,
Trauma Unit dept Surgery
Acadmic Medical Center Amsterdam


----- Original Message ----- 
From: "Karim Brohi" <karim at trauma.org>
To: <trauma-list at trauma.org>
Sent: Monday, January 08, 2007 11:10 PM
Subject: Ascending Aortic Arch Injury


> Dear All
>
> 36yo male motocycle injury admitted 36 hours ago.
> Haemodynamically normal.
>
> Injury complex:
> ---------------
> GCS15, No head injury
> Fracture C7 through foramen transversarium (stable)
> Bilateral first rib fractures & multiple left sided fractures.
> Bilateral small haemothoraces and left lung contusion.
> Open fracture left femur - externally fixated at present.
>
> Initial CT showed some upper mediastinal haematoma, thought initially to 
> be
> related to the first rib fractures.
> Repeat CT today shows dissection flap in ascending aorta.  Starts above 
> left
> coronary.  No extension into neck vasculature (yet).
> Not visible on initial CT.
>
> BP = 160 systolic -> controlled with labetalol.
>
> Now what?
> Conservative management?
> Stent?
> Open repair? Technique?
>
> Karim
>
> --
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> 
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