Journal article
Blunt aortic injuries in the new era: radiologic findings and polytrauma risk assessment dictates management strategy
European journal of trauma and emergency surgery (Munich : 2007), Vol.45(6), pp.951-957
12/2019
DOI: 10.1007/s00068-019-01163-9
PMID: 31227849
Abstract
Blunt aortic injuries (BAI) have historically been considered an indication for emergent surgical intervention. Nevertheless, the observation that the outcome of the concomitant traumatic injuries has a major impact on prognosis and the rise of thoracic endovascular aortic repair (TEVAR) as an effective therapy for BAI have significantly changed in recent years the treatment algorithm of this condition. Our objective was to identify findings associated with the aortic injury which would be the best predictor of prognosis, with the objective of guiding the decision-making process for selecting the optimal timing of aortic repair.
We reviewed blunt aortic injuries from 3 Level I Trauma Centers from July 2008 to December 2016. We analyzed overall and BAI-related 30-day mortality in relation to: hemodynamics, timing of treatment, TEVAR vs open repair, and aortic injury grade as defined by the Society for Vascular Surgery. Based on computed tomographic angiography (CT scan) imaging, we selected the radiologic aortic findings most indicative of high mortality risk, which we defined as "Radiographic Severe Injury" (RSI): (1) total/partial aortic transection, (2) active contrast extravasation, or (3) the association of 2 of more of the following: contained contrast extravasation > 10 mm, periaortic hematoma, and/or mediastinal hematoma with thickness > 10 mm, or significant left pleural effusion.
Of a total of 76 consecutive patients, 50 (66%) underwent immediate repair, 24 (31%) delayed aortic repair, and 2 (3%) died prior to repair. 58 patients (76%) had TEVAR, while 16 (24%) had open repair. Overall mortality was 18% and BAI-related mortality was 13%. In BAI-related mortalities, 70% of patients had RSI. Patients with high risk of overall mortality had hypotension and tachycardia (SBP < 100, HR ≥ 100), high ISS, and required vasopressors. Factors only associated with BAI-related mortality included RSI.
CT scan findings suggestive of RSI are predictive of mortality associated with BAI. Radiologic assessment of the severity of the aortic injury with characterization for the presence of RSI may represent the key factors to determine the optimal timing of treatment of the aortic injury and guide the overall treatment strategy.
IV.
Details
- Title: Subtitle
- Blunt aortic injuries in the new era: radiologic findings and polytrauma risk assessment dictates management strategy
- Creators
- Rachel Elizabeth Payne - University of MinnesotaRachel Michelle Nygaard - University of MinnesotaJoss Dean Fernandez - University of IowaPrateek Sahgal - Hennepin County Medical CenterChad John Richardson - University of MinnesotaMohammad Bashir - University of IowaKalpaj Parekh - University of IowaPanos Nicolas Vardas - Indiana UniversityYoshikazu Suzuki - University of IowaJoel Corvera - Indiana UniversityJon Christopher Krook - University of MinnesotaDomenico Calcaterra - University of Minnesota
- Resource Type
- Journal article
- Publication Details
- European journal of trauma and emergency surgery (Munich : 2007), Vol.45(6), pp.951-957
- DOI
- 10.1007/s00068-019-01163-9
- PMID
- 31227849
- ISSN
- 1863-9933
- eISSN
- 1863-9941
- Grant note
- name: Hitchcock Surgical Society
- Language
- English
- Date published
- 12/2019
- Academic Unit
- Anatomy and Cell Biology; Cardiothoracic Surgery
- Record Identifier
- 9984284344002771
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