Kristofer M. Charlton-Ouw1, Miguel Sanchez-Perez1, Samuel S. Leake1, David Hamilton2, John B. Holcomb2, Rosemary A. Kozar2, Ali Azizzadeh1, Anthony L. Estrera1, Hazim J. Safi1
1Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; 2Department of Surgery, University of Texas Medical School at Houston, Houston, TX.
OBJECTIVES: Blunt traumatic aortoiliac injury (BTAII) is unusual due to its protected location. When it does occur, BTAII is associated with extensive intraperitoneal injuries. Optimal management is unclear since few cases are reported in the modern literature. The purpose of this study is to evaluate our experience in management of BTAII.
METHODS: A review of a prospectively maintained database revealed 304 aortic injuries in 55,876 trauma admissions (0.03%) between Jan 2001 and Nov 2011. Among these, 15 patients had BTAII and comprise the study group.
RESULTS: Of the 15 patients with BTAII, 11 were male and the median age was 47 years (range 5-80). Four patients (27%) died after arrival to the hospital. Two patients (13%) with traumatic dissections without intraabdominal injury were medically managed. Thirteen (87%) patients required exploratory laparotomy; and 12 (80%) required repair of bowel injuries. Two patients died in the operating room, only one of whom died as a result of aortic injury. Two other patients died later as a result of multi-organ failure. Six patients (40%) required aortoiliac repair or revascularization: primary aortic repair (n=2), in situ aortoiliac prosthetic bypass (n=2), iliac artery bypass with autogenous vein (n=1) and iliac thrombectomy with femorofemoral bypass (n=1). All patients with aortoiliac repair or revascularization also had concomitant bowel injuries and all survived to hospital discharge. All repairs were patent and no patient with prosthetic graft had evidence of graft infection in follow-up (mean 26 months, range 5-80).
CONCLUSIONS: BTAII is rare and associated with moderate in-hospital mortality, usually due to associated injuries. Survival after aortoiliac repair is excellent. Revascularization with prosthetic graft appears safe despite concomitant bowel injuries.
AUTHOR DISCLOSURES: A. Azizzadeh, Nothing to disclose; K. M. Charlton-Ouw, Cook Medical, Research Grants; A. L. Estrera, Nothing to disclose; D. Hamilton, Nothing to disclose; J. B. Holcomb, Nothing to disclose; R. A. Kozar, Nothing to disclose; S. S. Leake, Nothing to disclose; H. J. Safi, Nothing to disclose; M. Sanchez-Perez, Nothing to disclose.
Posted April 2012