PS76. Memory Decline following Carotid Interventions

Abstract

Objectives: Blunt abdominal aortic injury (BAAI) is very rare. Current literature is limited to case series of single center experience. Through an analysis of the National Trauma Databank (NTBD), the largest aggregation of United States trauma registry data, our aim was to more accurately characterize the injury patterns, management strategy and mortality of patients with BAAI.Methods: We used a nested case-control design. The cohort was patients ageϾ16 years, with injury severity score (ISS) Ն16, treated at a level 1 or 2 trauma center in years 2007-2009. Cases were patients with BAAI and were matched by age and mechanism to 1815 randomly selected controls without BAAI. Data collected included age, gender, comorbidities, ISS, associated injuries, type and timing of vascular interventions and hospital disposition.Results: We identified 363 patients with BAAI from 156 centers. The mean ISS was 34 Ϯ15 and the average age was 49 Ϯ21 years. Most patients were injured in motor vehicle crashes (84%). In comparison to controls, lumbar spine fractures, pelvic fractures as well as injuries to the kidneys, liver, spleen, pancreas, small bowel and colon were all more frequent in association with BAAI (pϽ0.001). Mortality was greater in patients with BAAI (32% vs. 10% in controls, pϽ0.001), with two thirds of deaths occurring in the first 24 hours.Of the 286 patients surviving beyond 24 hours, 249 (87%) were managed non-operatively, 26 (9%) underwent endovascular repair and 11 (4%) underwent open repair (9 with aortic interposition graft, 2 with extra-anatomic bypass). 81% of repairs were performed within 48 hours. 216 (86%) patients managed non-operatively survived to hospital discharge.Conclusions: The index of suspicion for BAAI should be raised in severely injured patients by the presence of lumbar and pelvic fractures as well as intra-abdominal injury. While endovascular repair is the most common intervention, most patients are managed non-operatively and survive to hospital discharge.