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Clinical aspects and present challenges of the seat belt aorta.

Authors
  • Gouveia E Melo, Ryan1
  • Amorim, Pedro2
  • Soares, Tony Ramos3
  • Fernandes E Fernandes, Ruy2
  • Ministro, Augusto2
  • Garrido, Pedro3
  • Fernandes E Fernandes, José2
  • Pedro, Luís Mendes2
  • 1 Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal. Electronic address: [email protected] , (Portugal)
  • 2 Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal. , (Portugal)
  • 3 Vascular Surgery Service, Heart and Vessels Department, Hospital Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal. , (Portugal)
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
Sep 01, 2020
Volume
72
Issue
3
Pages
995–1004
Identifiers
DOI: 10.1016/j.jvs.2019.11.038
PMID: 32081481
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Seat belt aorta is rare and difficult to manage. The lack of data and follow-up increases the complexity of treating such patients. We aimed to create a decision algorithm by reviewing our current experience and analyzing the presentation and management of our patients. We performed a descriptive case series based on retrospective analysis of all consecutive patients admitted with the diagnosis of seat belt aorta from 2008 to 2018. Seat belt aorta was defined as any blunt abdominal aortic lesion resulting from a seat belt compression mechanism after a car accident. Nine consecutive patients were admitted with the diagnosis of seat belt aorta, all of whom developed lesions in the infrarenal aorta. Eight patients were assessed in the acute phase and one patient presented with late-onset symptoms. Associated injuries were present in all acute patients, and seat belt sign and small bowel injury were present in 88%. One patient presented with a small intimal tear and was treated conservatively. All other patients diagnosed with large intimal flaps (seven patients) and pseudoaneurysm (one patient) underwent open repair in five cases and endovascular repair in three cases. In-hospital mortality for the acute cases was 38%, with no mortality seen during follow-up. Two patients submitted to endovascular repair required reinterventions. Seat belt aorta is a deadly condition, frequently associated with blunt thoracoabdominal trauma with concomitant injuries; the presence of a seat belt sign or lower limb ischemia must lead to a high diagnostic suspicion. Management must take into account the other concomitant injuries. Follow-up is crucial as most patients are young; they may develop complications and subsequently require further intervention. Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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