Blunt abdominal aortic injury

Shalhub, Sherene; Starnes, Benjamin W.; Tran, Nam; Hatsukami, Thomas S.; Lundgren, Rachel; Davis, Chelsea S.; Quade, Samantha; Gunn, Martin L.

doi:10.1016/j.jvs.2011.10.132

Cited by 88 publications

(48 citation statements)

References 45 publications

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“…Based on our results, it appears that these injuries behave similar to aortic injuries in other locations, albeit our sample size was very small. The largest series of nonoperatively managed grade I–II abdominal BAI reported by Shalhub et al (Table V), 14 reported similar findings. Combining these authors’ experience with abdominal BAI and ours, no patients were noted to have injury progression; all patients developed injury regression or have stable injuries on repeat imaging.…”

Section: Discussionsupporting

confidence: 57%

Natural history of grade I-II blunt traumatic aortic injury

Osgood

Heck

Rellinger

et al. 2014

Journal of Vascular Surgery

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Introduction Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury (MAI). Therefore, we conducted a retrospective observational analysis of our experience with these patients. Methods We retrospectively reviewed all BAI presenting to an academic Level I trauma center over a ten-year period (2000–2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery (SVS) guidelines (Grade I–IV). Demographics, injury severity, and outcomes were recorded. Results We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries, or aortic dissection and were excluded from this analysis. The remaining 49 patients had 50 grade I–II injuries. We managed 46 grade I injuries (intimal tear or flap, 95%), and 4 grade II injuries (intramural hematoma, 5%) nonopertively. Of these, 41 patients had follow-up imaging at a mean of 86 days post-injury and constitute our study cohort. Mean age was 41 years and mean length of stay was 14 days. The majority (48 of 50, 96%) were thoracic aortic injuries and the remaining 2 (4%) were abdominal. On follow-up imaging, 23 of 43 (55%) had complete resolution of injury, 17 (40%) had no change in aortic injury, and 2 (5%) had progression of injury. Of the 2 patients with progression, one progressed from grade I to grade II and the other 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 or died during follow-up. Conclusions Injury progression in grade I–II BAI 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.

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Section: Discussionsupporting

confidence: 57%

Natural history of grade I-II blunt traumatic aortic injury

Osgood

Heck

Rellinger

et al. 2014

Journal of Vascular Surgery

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“…However, abdominal aortic injury has been associated with a mortality rate of 32%. 9,10 Incidence in the pediatric population is even lower and the condition has only been reported in small series and cases. This study is the 22nd case to be reported of blunt abdominal aortic trauma in children less than 16 years of age and just the fourth report of a case of aortic bifurcation rupture found in the literature reviewed.…”

Section: Discussionmentioning

confidence: 99%

A case study involving a blunt abdominal trauma leading to disruption of the aortic bifurcation in an infant

et al. 2014

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The incidence of aortic disruption secondary to blunt abdominal trauma is rarely reported in the pediatric population. In general, most of the cases described are the result of motor vehicle accidents. We report on the treatment and outcomes of a 5-year-old child with aortic bifurcation disruption secondary to an unusual case of blunt abdominal trauma who was admitted to the emergency room in hypovolemic shock and subjected to immediate exploratory laparotomy and vascular repair. The mechanical forces involved in aortic disruption and the management options for repair and treatment of this injury will be discussed.Keywords: child; wounds and injuries; multiple trauma; abdominal aorta; abdominal injuries; vascular system injuries. ResumoA incidência de ruptura aórtica secundária a um trauma abdominal contuso é uma condição extremamente rara e pouco relatada na população pediátrica. Em geral, a maioria dos casos descritos é devida a acidentes automobilísticos. Descrevemos o caso de uma criança de cinco anos de idade, vítima de trauma abdominal contuso de etiologia incomum, a qual foi admitida em sala de emergência em choque hipovolêmico e submetida a laparotomia exploradora, com o reparo de uma laceração da bifurcação aórtica. Serão discutidas as forças mecânicas envolvidas e as opções de tratamento para esse tipo de lesão.Palavras-chave: criança; ferimentos e lesões; traumatismo múltiplo; aorta abdominal; traumatismos abdominais; traumatismos do sistema vascular.

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“…Abdominal BTAI accounts for only 2.5-5% of blunt aortic trauma [1,15,16]. The abdominal aorta extends from the diaphragmatic hiatus to the aortic bifurcation.…”

Section: Abdominal Aortamentioning

confidence: 99%

“…Although aortic injury classifications are initially based on thoracic injuries, abdominal injuries can be described with the same classification. Intimal flaps <10mm are safely managed with blood pressure control (B-blockers) and antiplatelet therapy (aspirin) [16,18]. Large intimal flaps, not complicated with thrombosis or arterial insufficiency, are treated with medical management and follow-up CT imaging in 48-72 hours.…”

Section: Abdominal Aortamentioning

confidence: 99%