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Minimal aortic injury after blunt trauma: selective nonoperative management is safe. J Trauma 2011 Dec;71(6):1519-23

Date

12/21/2011

Pubmed ID

22182862

DOI

10.1097/TA.0b013e31823b9811

Scopus ID

2-s2.0-84255170212   37 Citations

Abstract

BACKGROUND: An increasing number of minimal aortic injuries (MAIs) are being identified with modern computed tomography (CT) imaging techniques. The optimal management and natural history of these injuries are unknown. We have adopted a policy of selective multidisciplinary nonoperative management of MAI. This study examines our experience with these patients from July 2004 to June 2009.

METHODS: Retrospective chart review of all blunt trauma patients who underwent chest CT angiography to evaluate for blunt aortic injury (BAI) was undertaken. All patients deemed to have a MAI were managed nonoperatively, and those with a severe aortic injury underwent repair. Data collected included age, mechanism of injury, Injury Severity Score, type and location of aortic injury, intensive care unit length of stay (LOS), overall LOS, ventilator days, disposition, and mortality. In addition, all BAIs were graded according to the Presley Trauma Center CT Grading System of Aortic Injury.

RESULTS: Forty-seven patients with BAI were identified. Thirty-two were classified as severe injuries, and 15 were considered MAI (32%). Nineteen underwent operative repair, 13 underwent endovascular stent graft repair, and 15 were managed nonoperatively. The average Injury Severity Score was 31 ± 10, and the average age was 44 ± 20 with no significant difference across treatment groups. There was no difference in overall or intensive care unit LOS. The nonoperative group had a shorter duration of ventilator days (1.1 vs. 4.28, p = 0.02). There were five deaths, none in the nonoperative group. None of these patients required subsequent intervention. All nonoperative patients had follow-up imaging at median of 4 days; on CT chest angiography, five injuries had resolved, eight had stable intimal flaps or pseudoaneurysm, and two had no detectable injury on subsequent aortogram.

CONCLUSION: Almost one-third of our BAI were safely managed nonoperatively. Patients with MAI should be considered for selective nonoperative management in a multidisciplinary approach with close radiographic follow-up. We recommend that patients with MAIs should be considered for selective nonoperative management.

Author List

Paul JS, Neideen T, Tutton S, Milia D, Tolat P, Foley D, Brasel K

Authors

David J. Milia MD Associate Professor in the Surgery department at Medical College of Wisconsin
Todd A. Neideen MD Associate Professor in the Surgery department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Associate Professor in the Radiology department at Medical College of Wisconsin
Sean Tutton MD Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aorta, Thoracic
Aortography
Cohort Studies
Critical Care
Drug Therapy, Combination
Female
Follow-Up Studies
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Patient Selection
Retrospective Studies
Risk Assessment
Safety Management
Stents
Survival Rate
Thoracic Injuries
Tomography, X-Ray Computed
Trauma Centers
Treatment Outcome
Vascular Surgical Procedures
Wounds, Nonpenetrating
Young Adult
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280