Citation

Shalhub S, Starnes BW, Brenner ML, Biffl WL, Azizzadeh A, Inaba K, Skiada D, Zarzaur B, Nawaf C, Eriksson EA, Fakhry SM, Paul JS, Kaups KL, Ciesla DJ, Todd SR, Seamon MJ, Capano-Wehrle LM, Jurkovich GJ, Kozar RA. J. Trauma Acute Care Surg. 2014; 77(6): 879-85; discussion 885.

Affiliation

From the Division of Vascular Surgery (S.S., B.W.S.), Department of Surgery, University of Washington, Seattle, Washington; R. Adams Cowley Shock Trauma Center (M.L.B.), University of Maryland, Baltimore, Maryland; Department of Surgery (W.L.B., G.J.J.), Denver Health Medical Center and the University of Colorado School of Medicine, Denver, Colorado; Department of Cardiothoracic and Vascular Surgery (A.A.), University of Texas Medical School at Houston; and Department of Surgery (R.A.K.), University of Texas Health Science Center at Houston, Houston, Texas; Division of Trauma and Surgical Critical Care (K.I., D.S.), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles; and Community Regional Medical Center (K.L.K.), Department of Surgery, University of California, San Francisco-Fresno Campus, Fresno, California; Division of Trauma and Critical Care (B.Z., C.N.), Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Division of General Surgery (E.A.E., S.M.F.), Department of Surgery, Medical University of South Carolina, Charleston, South Carolina; Division of Trauma and Critical Care (J.S.P.), Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (D.J.C.), University of South Florida Colleges of Medicine, Tampa, Florida; Department of Surgery (S.R.T.), New York University Langone Medical Center, New York, New York; Division of Trauma and Surgical Critical Care (M.J.S., L.M.C.-W.), Department of Surgery, Cooper University Hospital, Camden, New Jersey.

Copyright

(Copyright © 2014, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000353

PMID

25248064

Abstract

BACKGROUND: Blunt abdominal aortic injury (BAAI) is a rare injury. The objective of the current study was to examine the presentation and management of BAAI at a multi-institutional level.

METHODS: The Western Trauma Association Multi-Center Trials conducted a study of BAAI from 1996 to 2011. Data collected included demographics, injury mechanism, associated injuries, interventions, and complications.

RESULTS: Of 392,315 blunt trauma patients, 113 (0.03%) presented with BAAI at 12 major trauma centers (67% male; median age, 38 years; range, 6-88; median Injury Severity Score [ISS], 34; range, 16-75). The leading cause of injury was motor vehicle collisions (60%). Hypotension was documented in 47% of the cases. The most commonly associated injuries were spine fractures (44%) and pneumothorax/hemothorax (42%). Solid organ, small bowel, and large bowel injuries occurred in 38%, 35%, and 28% respectively. BAAI presented as free aortic rupture (32%), pseudoaneurysm (16%), and injuries without aortic external contour abnormality on computed tomography such as large intimal flaps (34%) or intimal tears (18%). Open and endovascular repairs were undertaken as first-choice therapy in 43% and 15% of cases, respectively. Choice of management varied by type of BAAI: 89% of intimal tears were managed nonoperatively, and 96% of aortic ruptures were treated with open repair. Overall mortality was 39%, the majority (68%) occurring in the first 24 hours because of hemorrhage or cardiac arrest. The highest mortality was associated with Zone II aortic ruptures (92%). Follow-up was documented in 38% of live discharges.

CONCLUSION: This is the largest BAAI series reported to date. BAAI presents as a spectrum of injury ranging from minimal aortic injury to aortic rupture. Nonoperative management is successful in uncomplicated cases without external aortic contour abnormality on computed tomography. Highest mortality occurred in free aortic ruptures, suggesting that alternative measures of early noncompressible torso hemorrhage control are warranted. LEVEL OF EVIDENCE: Multicenter retrospective review, level IV.

Language: en