Michael J. Osgood1, Stacey L. Doran1, Eric Rellinger1, Josh Heck2, Clifford L. Garrard1, Oscar Guillamondegui3, Raul Guzman1, Thomas Naslund1, Jeffery Dattilo1
1Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN; 2Radiology, Vanderbilt University Medical Center, Nashville, TN; 3Trauma Surgery, Vanderbilt University Medical Center, Nashville, TN.
OBJECTIVES: Endovascular aortic repair has revolutionized the management of blunt aortic trauma. However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients.
METHODS: We retrospectively reviewed all blunt traumatic aortic injuries at an academic Level I trauma center over a 10-year period (2001-2010). Images were reviewed by a radiologist and graded according to SVS guidelines (Grade I-IV). Demographics, injury severity and outcomes were recorded.
RESULTS: We identified 214 patients with blunt injuries to the thoracic or abdominal aorta. One hundred fifteen were deemed operative injuries at presentation and were excluded from analysis. The remaining 99 were observed. On presentation, 54 had minimal (Grade I or II) injury. Of these, 43 had follow-up imaging at a mean of 102 days post-injury and constitute our study cohort. Mean age was 39 years and mean length of stay was 16 days. Forty-one patients (95%) had Grade I injury (intimal flap) and 2 patients had Grade II injury (medial hematoma). Forty (93%) were thoracic aortic injuries and the remaining were abdominal. On follow-up imaging, 23 of 43 (54%) had complete resolution of injury, 18 (42%) had no change in aortic injury and 2 (5%) had progression (enlargement) of injury. Of the 2 patients with progression, 1 progressed from Grade I to Grade II and 1 progressed from Grade I to Grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention. No patients were operated on or died from a Grade I or II aortic injury.
CONCLUSIONS: Injury progression in Grade I-II blunt aortic injury is rare (~5%) and did not cause death in our study cohort. Since progression to Grade III injury is possible, follow-up with repeat aortic imaging is reasonable.
AUTHOR DISCLOSURES: J. Dattilo: Nothing to disclose; S. L. Doran: Nothing to disclose; C. L. Garrard: Nothing to disclose; O. Guillamondegui: Nothing to disclose; R. Guzman: Nothing to disclose; J. Heck: Nothing to disclose; T. Naslund: WL Gore, Consulting fees or other remuneration (payment); M. J. Osgood: Nothing to disclose; E. Rellinger: Nothing to disclose.
Posted April 2013