Stable Penetrating Chest Trauma
Annotation for Point K
The emergence of endovascular technologies has allowed for more options for the management of intrathoracic great vessel injury detected by CTA. The majority of endovascular repairs that have been described have been used following blunt trauma. To use an endovascular approach, the patient must be clinically stable. There are two settings in which an endovascular approach may be considered, both requiring that the interventional and operative skill set is available for the patient. In the more common scenario, a branch of the vessel has been injured, and embolization is a less morbid procedure than open repair. Rarely, anatomically appropriate areas of the thoracic aorta or great vessels have been injured, and the team feels that an endovascular approach is safer. The planning and technique are beyond the scope of this article. In short, rapid consideration of possible impairment of critical branch vessels, appropriate sizing for degree of shock, and determination of true landing zones are required. As true ‘‘hybrid’ operating suites become more commonplace, the role of endovascular approaches may expand, although the basic principles stated earlier will remain valid.