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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.

Michael Parra, 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

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.

orcid_id14.png 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.

orcid_id14.png 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

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

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

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

Victor Rafael Bucheli, Department of Cardiovascular Surgery, Centro Medico Imbanaco, Cali, Colombia

orcid_id14.png 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.

orcid_id14.png 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.

orcid_id14.png 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.

orcid_id14.png 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.

orcid_id14.png 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.

orcid_id14.png 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.

orcid_id14.png 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

orcid_id14.png 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.

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

Parra, M., Ordoñez, C. A., Pino, L. F., Millan, M., Caicedo, Y., Bucheli, V. R., Garcia, A., Gonzalez-Hadad, A., Salcedo, A., Serna, J. J., Quintero, L., Herrera, M. A., 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 Medica, 52(2), e4054611. https://doi.org/10.25100/cm.v52i2.4611

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