Endovascular Therapy for Overcoming Challenges Presented With Blunt Abdominal Aortic Injury

Abstract

Blunt abdominal aortic injury (BAAI) is a rare and lethal injury requiring surgical management. Injury patterns can be complex and surgical strategy should accommodate specific case circumstances. Endovascular solutions appear appropriate and preferred in certain cases of BAAI, which, however, may not be applicable due to device limitations in regard to patient anatomy and limited operating room capability. However, endovascular therapy can be pursued with limited fluoroscopy capability and consumable availability providing a solution that is expeditious and effective for select cases of BAAI.

Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature

“…Percutaneous deployment of EVARs for the treatment of traumatic aortic injuries has been reported. 40,43…”

“…Cuffs made by Gore, 27 Cook, 41 and Medtronic 33 have also been used. Large covered stents, such as the Fluency (Bard, Murray Hill, New Jersey) 42 and Corvita (Corvita Corporation, Miami, Florida), 34 and iliac limbs, such as the Cook iliac limb (Cook Medical), 43 have also been used for some patients. Bare devices, such as the Palmaz (Cordis, Milpitas, California), 44 WALLSTENT (Boston Scientific, Marlborough, Massachusetts), 44 Luminexx (Bard), 32 and Smartstent (Cordis) 32 have also been used.…”

Patients Who Underwent Surgery for Blunt Abdominal Aortic Injury Have Higher Risk of Perioperative Mortality, Pneumonia, and Longer Hospital Length of Stay

“…10 While minor contusions or intimal disruptions may be managed conservatively, 11 open repair has been the treatment of choice for more severe injury management in the past. 9 Most recently endovascular procedures have become available as an option for treatment.…”

“…5 The presentation of injury varies and may include intimal disruption with or without thrombosis, intramural hematoma, aortic pseudoaneurysm, and transection with exsanguinating hemorrhage. 9 Clinically, the most frequent presentation includes shock, abdominal pain, 10 acute arterial insufficiency, neuromuscular deficits, and abdominal wall defect. 9 Treatment options for BAAI are dependent on the nature of the injury.…”

“…9 Clinically, the most frequent presentation includes shock, abdominal pain, 10 acute arterial insufficiency, neuromuscular deficits, and abdominal wall defect. 9 Treatment options for BAAI are dependent on the nature of the injury. 11 Consideration of overall clinical status, injury severity, and presentation are of great importance when determining a course of treatment.…”