Ahsan T. Ali, Mark Wright, J. Greg Modrall, Mohammad Moursi, John F. Eidt
Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
OBJECTIVES: Blunt aortic injury (BAI) has been traditionally treated as an emergency. The mortality for early repair has been reported up to 30-40%. Delayed repair has shown better outcome. This study is a single center review in the management of BAI where early repair <48 hr. was compared to delayed >48 hr.
METHODS: BAI admitted at a tertiary hospital over a 8-year period (2004-2011). The patients were divided in to early repair vs. delayed repair. Outcome variables included survival, injury severity score (ISS), ICU and hospital length of stay.
RESULTS: A total of 26 patients (male=22; mean age 42±16.3 yr.) presented with a BAI on CTA. There were no deaths from blunt aortic injury or repair. No difference was found between ISS, survival or non-vascular procedures between groups. The mean BAI grade was 3.0 in the early group and 2.9 in the delayed group. Mean follow up (months) was 46.2 for early group and 30.4±27.3 (mean ± STDEV). Three patients with intimal flaps (Grade-I) were managed non-operatively and were successfully discharged. One patient underwent open repair in the early group (n=12). In this group there was one death from non-vascular injuries despite endograft repair. There were no deaths in the delayed group (n=11). The time from arrival to surgery was 23.5±32 days (range 2-91). Two patients underwent endograft repair electively after serial CT scans. One patient in the early group had an endograft collapse due to bird beak. A second endograft had to be placed to salvage the first, 17 days later. In the early group one patient had a traumatic aortic dissection which was urgently repaired for hemorrhage in the chest.
CONCLUSIONS: Patients with blunt aortic injuries that survive, may not require emergent repair. Delayed repair of BAI may be preferred in selected patients with serial imaging and aggressive negative inotropic therapy. Long term follow up is warranted and may be difficult to achieve this this population.
AUTHOR DISCLOSURES: A. T. Ali, Nothing to disclose; J. F. Eidt, Nothing to disclose; J. Modrall, Nothing to disclose; M. Moursi, Nothing to disclose; M. Wright, Nothing to disclose.
Posted April 2012