Survival trends after inferior vena cava and aortic injuries in the United States

Abstract

Objective: Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such as to the inferior vena cava (IVC) and aortic injuries remain responsible for a significant proportion of early trauma deaths in modern trauma care. The purpose of this study was to explore patterns in epidemiology and mortality after IVC and aortic injuries in the United States.Methods: A 13-year analysis of the National Trauma Databank (2002Databank ( -2014 was performed to extract all patients who sustained IVC, abdominal aortic, or thoracic aortic injuries. Demographics, clinical data, and outcomes were extracted.Patients were analyzed according to injury mechanism.Results: A total of 25,428 patients were included in this analysis. Overall, the mean age was 39.8 6 19.1 years, 70.3% were male, and 14.1% sustained a penetrating trauma. Although the incidence of all three injuries remained constant throughout the study period, for blunt trauma, mortality decreased over the study period (from 48.8% in 2002 to 28.7% in 2014; P < .001), in particular for thoracic aortic injuries (from 46.1% in 2002 to 23.7% in 2014; P < .001) and abdominal aortic injuries (from 58.3% in 2002 to 26.2% in 2014; P < .001). This decrease in mortality after blunt trauma was accompanied by an increase in endovascular procedures over the study period (from 1.0% in 2002 to 30.4% in 2014; P < .001), in particular for blunt thoracic aortic injuries (from 0.7% in 2002 to 41.4% in 2014; P < .001). When penetrating trauma patients were analyzed, overall there was an increase in mortality (from 43.8% in 2002 to 50.6% in 2014; P < .001), in particular after abdominal aortic injury (from 30.4% in 2002 to 66.0% in 2014; P < .001). Similar trends were observed for IVC injuries. No increase in endovascular use in penetrating trauma was identified (from 0.1% in 2002 to 3.4% in 2014; P < .001).Conclusions: The present study demonstrates an overall decrease in mortality after blunt aortic injuries in the United States. This decrease was accompanied by an increase in the use of endovascular procedures. After penetrating trauma, however, despite contemporary advances in trauma care, mortality has increased over the study period, in particular after abdominal aortic injury. No increase in endovascular use in penetrating trauma was demonstrated.

Blunt Aortic / Inferior Vena Cava Injury: Are We Consistently Providing the Same Level of Care?

“…Parallel to these findings, the overall mortality from aortic and IVC blunt trauma decreased from 48.8% in 2002 to 28.7% in 2014, with a more significant reduction in the BTAI group [1]. The use of endovascular techniques has decreased morbidity and mortality from traumatic blunt vascular trauma [1,5]. The aim of this article is to provide an updated literature review of the diagnosis, classification and current management of both BTAI and blunt traumatic inferior vena cava injury (BTIVCI).…”

“…However, in the last two decades, endovascular management for blunt trauma vascular injuries has significantly increased from 0.4% in 2002 to 13.2% in 2010. Parallel to these findings, the overall mortality from aortic and IVC blunt trauma decreased from 48.8% in 2002 to 28.7% in 2014, with a more significant reduction in the BTAI group [1]. The use of endovascular techniques has decreased morbidity and mortality from traumatic blunt vascular trauma [1,5].…”

“…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.…”

“…Trauma-related injuries are a leading cause of death worldwide that have increased over the last two decades [1]. Major vascular trauma such as injuries to the aorta or the inferior vena cava (IVC) has a high rate of pre-hospital mortality [2].…”

“…Blunt traumatic aortic injury (BTAI) is the second most common post-traumatic cause of death following traumatic brain injury as the first cause. According to the National Trauma Databank of the American College of Surgeons, from 2002-2014 the incidence of combined injuries to the IVC and the thoracic aorta was 1.1%, thoracic and abdominal aorta was 0.8% and IVC and abdominal aorta was 2.1% [1].…”