Encyclopedia of Intensive Care Medicine

2012 Edition
| Editors: Jean-Louis Vincent, Jesse B. Hall

Vascular, Intimal Flap

  • David V. FelicianoEmail author
Reference work entry
DOI: https://doi.org/10.1007/978-3-642-00418-6_536


An intimal flap in an artery can also be described as an intraluminal flap or wall defect in an artery


The wall of an artery is composed of a tunica intima, tunica media, and a tunica adventitia. The intima is the innermost layer of an artery (or vein) and is composed of endothelium (the cells lining the lumen), a subendothelial layer of connective tissue, and an elastica interna. Either blunt or penetrating trauma can lead to a tear in the endothelium and other layers of the intima. A piece of intima still attached to the media may result and will project into the lumen of the artery as an intimal flap.

Blunt trauma to a patient is a more common cause of a vascular intimal flap than penetrating trauma. Deceleration-type trauma or a side impact in a motor vehicle crash can lead to disruption of the intima alone or intima and media of the descending thoracic aorta just distal to the ligamentum arteriosum. With an intact media or media and adventitia, there will not...

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  1. 1.
    Dennis JW, Frykberg ER, Veldenz HC et al (1998) Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating extremity trauma: 5 to 10 year follow-up. J Trauma 44:243–253PubMedGoogle Scholar
  2. 2.
    Frykberg ER, Crump JM, Dennis JW et al (1991) Nonoperative observation of clinically occult arterial injuries: A prospective evaluation. Surgery 109:85–96PubMedGoogle Scholar
  3. 3.
    Frykberg ER, Schinco MA (2008) Peripheral vascular injury. In: Feliciano DV, Mattox KL, Moore EE (eds) Trauma, 6th edn. McGraw-Hill, New York, pp 941–970Google Scholar
  4. 4.
    Frykberg ER, Vines FS, Alexander RH (1989) The natural history of clinically occult arterial injuries: A prospective evaluation. J Trauma 29:577–583PubMedGoogle Scholar
  5. 5.
    Stain SC, Yellin AE, Weaver FA, Pentecost MJ (1989) Selective management of nonocclusive arterial injuries. Arch Surg 124:1136–1141PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of SurgeryEmory University School of Medicine, Grady Memorial HospitalAtlantaUSA