8 Comments

• 

  Muhammad AbdElhady Muhammad

  
  
  

  Q1 Traumatic type B aortic dissection
  Q2 either conserve if only intimal tear is present, if the patient is unstable then surgical repair if the endovascular device is not available or unsuitable or TEVAR
  Q3 the zone, the access vessels, the proximal landing zone, the aortic diameter

  August 17, 2025 at 1:26 am    Log in to Reply
• 

  Ahmed Said

  
  
  

  A1. Traumatic aortic dissection
  ..
  A2 resuscitation and permissive hypotension
  And TEVAR or open surgical
  According to case
  …
  A3
  In TEVAR
  Check
  Access vessel if small use iliac conduit
  Landing zone 2cm from Lt subclavian and intmal flab should be covered to avoid leak

  August 11, 2025 at 9:34 pm    Log in to Reply
• 

  Ahmed Nasr Mohammed Abdelfattah Ahmed Osman

  
  
  

  Q1:
  Traumatic aortic injury is usually more of a transection rather than a typical dissection. Most of the time, it happens around the isthmus, just after the left subclavian artery. On imaging, it might look like a dissection, but it’s not the same thing — different mechanism and different approach.

  ⸻

  Q2:
  We usually start with permissive hypotension to control the bleeding, especially if the patient has other injuries. After stabilization, the definitive treatment would be either TEVAR or open surgical repair, depending on the case. We follow EVES guidelines for the decision-making.

  ⸻

  Q3:
  Before doing TEVAR, we need to check a few things. First, the access vessels — if they’re small, we might go for an iliac conduit. Then we need good landing zones, especially proximally, like at least 2 cm from the left subclavian. Also, the intimal flap should be completely covered to avoid leaks or any future problems.

  July 23, 2025 at 11:38 am    Log in to Reply
• 

  Akram Ibrahim

  
  
  

  A1: Traumatic Aortic dissection

  A2: Immediate resuscitation with permissive hypotension and pain management.
  TEVAR according to EVES guidelines

  A3: Access vessels with possibility of iliac conduit having to be used due to smaller caliber vessel size
  Proximal landing zone 2 cms away from LSA
  Coverage of intimal flap

  July 6, 2025 at 2:17 pm    Log in to Reply
• 

  Malek Abdelraouf Moustafa Ahmed Eladawi

  
  
  

  Q1:
  traumatic aortic injury mostly type aortic dissection

  Q2:
  permissive hypotension then
  open surgical repair of the aorta or TEVAR according to EVES guidlines

  Q3:
  access vessel of appropriate size and as the patient may has small vessel size an iliac conduit may be used
  landing zones proximal and distal wit proximal landing zone 2 cm from left subclavian artery
  full coverage of the intimal flap

  July 5, 2025 at 11:45 pm    Log in to Reply
• 

  Ahmed Bedeer

  
  
  

  Q1: What is the most likely diagnosis?
  the most likely diagnosis is traumatic aortic injury (TAI), specifically a traumatic aortic dissection.
   
  Q2: What are the treatment options?

  1. Immediate Resuscitation & Stabilization: Airway, Breathing, Circulation (ABC) management: Secure airway, ensure adequate ventilation, and aggressive fluid resuscitation to address hypovolemic shock. Blood products (pRBCs, FFP, platelets, cryoprecipitate) will likely be needed.
  2. Damage Control Resuscitation: Permissive hypotension (maintaining a systolic BP of 90-100 mmHg) may be considered if there is no concurrent brain injury, to minimize further bleeding until definitive repair.
  3.  Pain management: Appropriate analgesia.
  4.  Definitive Repair of Traumatic Aortic Injury:

    * Thoracic Endovascular Aortic Repair (TEVAR)
    * Open Surgical Repair (Thoracotomy):

  Q3: What are the technical considerations in planning this case?
  Planning for the management of a traumatic aortic injury, especially with TEVAR, involves several critical technical considerations:

  1. Patient Stability and Urgency
  2.  Hemodynamic status and Associated Injuries: Identify and prioritize other life-threatening injuries (e.g., head injury, abdominal injury, pelvic fracture) that may influence the timing and approach to aortic repair.
  3. Imaging Assessment (CT Angiogram – CTA): Extent and Location of Injury + Aortic Dimensions + Proximal and Distal Landing Zones + Arch Anatomy + Access Vessels (diameter, tortuosity, calcification) +
  4.  Stent-Graft Selection: Size: + Type (e.g., flexibility, radial force, conformability) +
  5.  Surgical Access and Approach: Femoral Artery Access + Adjunctive Access
  6.  Neurological Protection: Spinal Cord Ischemia
  7.  Left Subclavian Artery Revascularization: If the injury is close to or involves the origin of the left subclavian artery, revascularization (e.g., by carotid-subclavian bypass or transposition) may be necessary if it’s covered by the stent-graft, to prevent left arm ischemia, vertebrobasilar insufficiency, or stroke, especially if the dominant vertebral artery arises from the left subclavian. This is often planned in elective cases or selectively in trauma depending on urgency.
  8. Intraoperative Imaging and Guidance: Angiography + Intravascular Ultrasound (IVUS)
  9.  Post-Procedure Management: Intensive Care Monitoring + Blood Pressure Control
  10.  Follow-up Imaging: Regular CTA follow-up to assess the repair and detect any late complications.

  June 30, 2025 at 10:41 pm    Log in to Reply
• 

  Reda Mansy

  
  
  

  A1:
  BTAI with acute type B AD of the DTA zone 3 to 4

  A2:
  Medical ttt with permissive hypotension syst bl pr not more than 80 HR less than 60 bpm
  OSR lat thoracotomy
  TEVAR is of choice according to EVES guidelines

  A3:
  Access site the ptn is young age with small vessels so he may need a conduit to deliver the system as the smallest delivery syst profile is 16 with a minimum fem diameter 6 mm
  Prox landing zone from the LSA at least 2 cm
  Entry site of the intimal flap
  Distal landing zone
  Diameter of the aorta in young ptn as long as the smallest device available in the market 21 can be used for aorta 16 mm

  June 26, 2025 at 2:30 am    Log in to Reply
• 

  mahmoud mahdy

  
  
  

  A1..
  The most likely diagnosis is traumatic aortic dissection acute type B complicated by shock

  A2..
  For this case
  Options of treatment are
  At first resuscitation with following the permissive hypotension protocol

  Once he is resuscitated optimum blood pressure control is a must so as not to deteriorate dissection from high blood pressure

  Repaire of tear by either TEVAR. Or OSR

  A3..
  For this young man with traumatic dissection of thoracic aorta it is important during planning for repaire to consider
  Landing zones cto be in a clear area from dissection with at least 2 cm landing zones

  Possibility of aortic branch vessel coverage and if there a need for pre or post operative revascularization

  If there is a malperfusion syndrome and a need for branch vessel revascularization

  Graft type and size to fit with such a small aortic diameter and the possibility for aortic growth later on

  June 25, 2025 at 10:06 pm    Log in to Reply