Skip to main content Skip to main navigation menu Skip to site footer
Page Header Logo
  • ABOUT THE JOURNAL
    • Focus and scope
    • Editorial Management Process
  • EDITORIAL POLICY
    • Ethical Publication Standards
    • Open Access Policy
    • Anti-plagiarism Policy
    • Copyright
    • Policy for Journal Archiving
    • Claim Policy
  • AUTHORS
    • Guidelines to Authors
    • Sending and Receiving Papers
    • Structure and Content of Articles
    • Article Evaluation Process
    • ORCID
    • coi_disclosure Colombia Médica ICMJE
    • Copyright Transfer Statement Colombia Médica
  • PEER REVIEW
    • Peer Review Process
    • Evaluation Forms
  • EDITORIAL TEAM
    • Editorial team
    • Contact
  • ARTICLES
    • Current
    • Archives
  • COLLECTIONS
Search
  • Register
  • Login
  1. Home /
  2. Archives /
  3. Vol 52 No 2 (2021): Damage Control Surgery (II) /
  4. Reviews

Damage Control Surgery for Thoracic Outlet Vascular Injuries: The New Resuscitative Median Sternotomy Plus Endovascular Aortic Balloon Occlusion of the Aorta Approach

  • Abstract
  • Keywords
  • Author Biographies
  • References

Abstract

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% of these 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. The aim of this article is 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 Zone I 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.

Authors

  • Michael Parra Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA https://orcid.org/0000-0001-6496-6275
  • Carlos Alberto Ordoñez Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. https://orcid.org/0000-0003-4495-7405
  • Luis Fernando Pino Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-1179-2854
  • Mauricio Millan Universidad Icesi, Cali, Colombia. Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0002-5502-5745
  • Yaset Caicedo Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0002-6128-0128
  • Victor Rafael Bucheli Department of Cardiovascular Surgery, Centro Medico Imbanaco, Cali, Colombia https://orcid.org/0000-0001-8467-291X
  • Alberto Garcia Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. https://orcid.org/0000-0002-4096-1434
  • Adolfo Gonzalez-Hadad Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia. https://orcid.org/0000-0001-5862-4906
  • Alexander Salcedo Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0001-8187-0638
  • Jose Julian Serna Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0001-9829-8930
  • Laureano Quintero Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia. https://orcid.org/0000-0001-8730-2447
  • Mario Alain Herrera Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-4526-7636
  • Fabian Hernandez Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia https://orcid.org/0000-0002-2974-0649
  • Fernando Rodriguez Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. https://orcid.org/0000-0002-5326-2317

Downloads

Download data is not yet available.

Keywords

  • REBOA
  • resuscitative median sternotom
  • thoracic outlet vascular injury
  • damage control surgery
  • hemothorax
  • angiography
  • carotid arteries
  • subclavian artery
  • sternotomy

Author Biographies


, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA

orcid_id14.png https://orcid.org/0000-0001-6496-6275


, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405


, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1179-2854


, Universidad Icesi, Cali, Colombia. Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5502-5745


, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6128-0128


, Department of Cardiovascular Surgery, Centro Medico Imbanaco, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-8467-291X


, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4096-1434


, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-5862-4906


, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8187-0638


, Universidad Icesi, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-9829-8930


, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8730-2447


, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4526-7636


, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-2974-0649


, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-5326-2317

References

Richens D, Field M, Neale M, Oakley C. The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardio-Thoracic Surg 2002;21:288-93. https://doi.org/10.1016/S1010-7940(01)01095-8

Clancy T V., Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level i and ii trauma centers for patients with major injuries. J Trauma 2001;51:346-51. https://doi.org/10.1097/00005373-200108000-00021

Jamieson WRE, Janusz MT, Gudas VM, Burr LH, Fradet GJ, Henderson C. Traumatic rupture of the thoracic aorta: Third decade of experience. Am. J. Surg., vol. 183, Am J Surg; 2002, p. 571-5. https://doi.org/10.1016/S0002-9610(02)00851-6

Callcut RA, Mell MW. Modern advances in vascular trauma. Surg Clin North Am 2013;93:941-61. https://doi.org/10.1016/j.suc.2013.04.010

Friend J, Rao S, Sieunarine K, Woodroof P. Vascular trauma in Western Australia: A comparison of two study periods over 15 years. ANZ J Surg 2016;86:173-8. https://doi.org/10.1111/ans.12309

Mattox KL, Feliciano D V., Burch J, Beall AC, Jordan GL, Debakey ME. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients: Epidemiologic evolution 1958 to 1987. Ann Surg 1989;209:698-707. https://doi.org/10.1097/00000658-198906000-00007

Wall J, Hirshberg A, Lemaire SA, Holcomb J, Mattox K. Thoracic aortic and thoracic vascular injuries. Surg Clin North Am 2001;81:1375-93. https://doi.org/10.1016/S0039-6109(01)80013-X

Ordoñez CA, Rodríguez F, Parra M, Herrera JP, Guzmán-Rodríguez M, Orlas C, et al. Resuscitative endovascular balloon of the aorta is feasible in penetrating chest trauma with major hemorrhage: Proposal of a new institutional deployment algorithm. J Trauma Acute Care Surg 2020;89:311-9. https://doi.org/10.1097/TA.0000000000002773

Bulger EM, Perina DG, Qasim Z, Beldowicz B, Brenner M, Guyette F, et al. Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians. Trauma Surg Acute Care Open 2019;4:e000376 https://doi.org/10.1136/tsaco-2019-000376

Glaser JJ, Neidert LE, Morgan CG, Brenner M, Stigall KS, Cardin S. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Thoracic Trauma: A Translational Swine Study. J Trauma Acute Care Surg 2020. https://doi.org/10.1097/TA.0000000000002749

Beyer CA, Hoareau GL, Kashtan HW, Wishy AM, Caples C, Spruce M, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury. Eur J Trauma Emerg Surg 2019. https://doi.org/10.1007/s00068-019-01185-3

Ordoñez CA, Rodríguez F, Orlas CP, Parra MW, Caicedo Y, Guzmán M, et al. The critical threshold value of systolic blood pressure for aortic occlusion in trauma patients in profound hemorrhagic shock. J Trauma Acute Care Surg 2020;89:1107-13. https://doi.org/10.1097/TA.0000000000002935

Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, et al. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm. J Trauma 1994;36:299-300. https://doi.org/10.1097/00005373-199403000-00002

Branney SW, Moore EE, Feldhaus KM, Wolfe RE. Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma - Inj Infect Crit Care 1998;45:87-95. https://doi.org/10.1097/00005373-199807000-00019

Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: Review of published data from the past 25 years. J Am Coll Surg 2000;190:288-98. https://doi.org/10.1016/S1072-7515(99)00233-1

Seamon MJ, Haut ER, Van Arendonk K, Barbosa RR, Chiu WC, Dente CJ, et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2015;79:159-73. https://doi.org/10.1097/TA.0000000000000648

Sanchez GP, Peng EWK, Marks R, Sarkar PK. "Scoop and run" strategy for a resuscitative sternotomy following unstable penetrating chest injury. Interact Cardiovasc Thorac Surg 2010;10:467-8. https://doi.org/10.1510/icvts.2009.219865

O'Connor J V., Scalea TM. Penetrating thoracic great vessel injury: Impact of admission hemodynamics and preoperative imaging. J Trauma - Inj Infect Crit Care 2010;68:834-7. https://doi.org/10.1097/TA.0b013e3181b250df

  • PDF
  • PDF (Español (España))
  • Full Text
  • Texto (Español (España))
Published
2021-08-18
Submitted
2020-11-03
| 841 |
How to Cite
Parra, M., Ordoñez, C. A., Pino, L., Millan, M., Caicedo, Y., Bucheli, V., Garcia, A., Gonzalez-Hadad, A., Salcedo, A., Serna, J., Quintero, L., Herrera, M., Hernandez, F., & Rodriguez, F. (2021). Damage Control Surgery for Thoracic Outlet Vascular Injuries: The New Resuscitative Median Sternotomy Plus Endovascular Aortic Balloon Occlusion of the Aorta Approach. Colombia Médica, 52(2), e4054611. https://doi.org/10.25100/cm.v52i2.4611
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
Download Citation
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX
Issue
Vol 52 No 2 (2021): Damage Control Surgery (II)
Section
Reviews

Copyright (c) 2021 Universidad del Valle

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use

Most read articles by the same author(s)

  • Carlos Alberto Ordoñez, Michael Parra, Jose Julian Serna, Fernando Rodriguez, Alberto Garcia, Alexander Salcedo, Yaset Caicedo, Natalia Padilla, Luis Fernando Pino, Adolfo González Hadad, Mario Alain Herrera, Mauricio Millán Lozano, Laureano Quintero, Fabian Hernandez, Ricardo Ferrada, Megan Brenner, Todd Rasmussen, Thomas Scalea, Rao Ivatury, John Holcomb, Damage control resuscitation: REBOA as the new fourth pillar , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Carlos Alberto Ordoñez, Michael Parra, Mauricio Millan, Yaset Caicedo, Natalia Padilla, Alberto Garcia, Adolfo Gonzalez Hadad, Luis Fernando Pino, Fernando Rodríguez-Holguín, Jose Julian Serna, Alexander Salcedo, Ricardo Ferrada, Fernando Miñan-Arana, Rao Ivatury, Mónica Guzmán, Pancreatic Damage Control: The Pancreas is Simple Don’t Complicate It , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Carlos Alberto Ordoñez, Michael Parra, Alfonso Holguín, Carlos Garcia, Monica Guzmán-Rodríguez, Natalia Padilla, Yaset Caicedo, Claudia Patricia Orlas, Alberto Garcia, Fernando Rodríguez-Holguín, Jose Julian Serna, Whole-body computed tomography is safe, effective and efficient in the severely injured hemodynamically unstable trauma patient , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Carlos Alberto Ordoñez, Michael Parra, Yaset Caicedo, Natalia Padilla, Edison Angamarca, Jose Julian Serna, Fernando Rodriguez, Alberto Garcia, Alexander Salcedo, Luis Fernando Pino, Adolfo Gonzalez Hadad, Mario Alain Herrera, Laureano Quintero, Fabian Hernandez, Maria Josefa Franco, Gonzalo Aristizabal, Luis Eduardo Toro, Monica Guzman, Federico Coccolini, Ricardo Ferrada, Rao Ivatury, Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent? , Colombia Médica: Vol 52 No 2 (2021): Damage Control Surgery (II)
  • Juan Jose Melendez, Yaset Caicedo, Monica Guzman, Jose Julian Serna, Juliana Ordoñez, Edison Angamarca, Alberto Garcia, Luis Fernando Pino, Laureano Quintero, Michael Parra, Carlos Alberto Ordoñez, Prehospital Damage Control: The Management of Volume, Temperature…and Bleeding! , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Carlos Alberto Ordoñez, Michael Parra, Yaset Caicedo, Natalia Padilla, Fernando Rodriguez, Jose Julian Serna, Alexander Salcedo, Alberto Garcia, Claudia Patricia Orlas, Luis Fernando Pino, Ana Milena del Valle, David Alejandro Mejia, Juan Carlos Salamea, Megan Brenner, Tal Hörer, REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Carlos Alberto Ordoñez, Michael Parra, Mauricio Millan, Yaset Caicedo, Natalia Padilla, Alberto Garcia, Maria Josefa Franco, Gonzalo Aristizabal, Luis Eduardo Toro, Luis Fernando Pino, Adolfo Gonzalez-Hadad, Mario Alain Herrera, Jose Julian Serna, Fernando Rodriguez, Alexander Salcedo, Claudia Patricia Orlas, Monica Guzman, Fabian Hernandez, Ricardo Ferrada, Rao Ivatury, Damage control in penetrating duodenal trauma: less is better , Colombia Médica: Vol 52 No 2 (2021): Damage Control Surgery (II)
  • David Alejandro Mejia, Michael Parra, Carlos Alberto Ordoñez, Natalia Padilla, Yaset Caicedo, Salin Pereira-Warr, Paula Andrea Jurado, Mauricio Torres, Alfredo Martinez, Jose Julian Serna, Fernando Rodriguez, Alexander Salcedo, Alberto Garcia, Mauricio Millan, Luis Fernando Pino, Adolfo Gonzalez Hadad, Mario Alain Herrera, Ernest Moore, Hemodynamically Unstable Pelvic Fracture: A Damage Control Surgical Algorithm that Fits your Reality , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Juan Carlos Salamea, Amber Himmler, Laura Isabel Valencia-Angel, Carlos Alberto Ordoñez, Michael Parra, Yaset Caicedo, Monica Guzman, Claudia Patricia Orlas, Marcela Granados, Carmenza Macia, Alberto Garcia, Jose Julian Serna, Marsol Badiel, Juan Carlos Puyana, Whole Blood for Blood Loss: Hemostatic Resuscitation in Damage Control , Colombia Médica: Vol 51 No 4 (2020): Damage Control Surgery (I)
  • Adolfo Gonzalez-Hadad, Carlos Alberto Ordoñez, Michael Parra, Yaset Caicedo, Natalia Padilla, Mauricio Millan, Alberto Garcia, Jenny Marcela Vidal-Carpio, Luis Fernando Pino, Mario Alain Herrera, Laureano Quintero, Fabian Hernandez, Guillermo Florez, Fernando Rodriguez-Holguín, Alexander Salcedo, Jose Julian Serna, Maria Josefa Franco, Ricardo Ferrada, Pradeep H. Navsaria, Damage control in penetrating cardiac trauma , Colombia Médica: Vol 52 No 2 (2021): Damage Control Surgery (II)
1 2 3 > >> 
Online ISSN: 1657-9534
Make a Submission

Bibliographics database

Full-text database

Citation Index

Bibliographical information system

Memberships

Licencia Creative Commons
This work is under License Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) .

Indexed

.
0.82
2018CiteScore
 
 
68th percentile
Powered by  Scopus
.
Information
  • For Authors
Universidad del Valle
Universidad del Valle
  • Cali - Colombia
  • © 1994 - 2020
Dirección:
  • Ciudad Universitaria Meléndez
  • Calle 13 # 100-00
  •  
  • Sede San Fernando
  • Calle 4B N° 36-00
PBX:
  • +57 2 3212100
  • Línea gratuita: 018000 22 00 21
  • A.A.25360
Redes Sociales:

2020 Universidad del Valle - Vigilada MinEducación

//Go to www.addthis.com/dashboard to customize your tools