Outcome of Blunt Thoracic Aortic Injury in a Level I Trauma Center

Patients with blunt aortic injury often present to the emergency department in a relatively hypovolemic state. These patients undergo extensive inhospital resuscitation. The effect of posttraumatic resuscitation on aortic diameter has implications for stent graft sizing. The potential utility of repeat aortic imaging after resuscitation remains unclear. A retrospective chart review of all adult patients presenting to a Level I trauma center between the years 2007 and 2013 was performed. Fifty-three patients were identified with a diagnosis of traumatic aortic injury. Of those, 10 had 2 CT scans before aortic repair and were selected as the study population for analysis. After resuscitation, there was a significant increase in aortic diameter both proximal and distal to the aortic injury: proximal aortic diameter increase of 1.97 mm and distal aortic diameter increase of 1.48 mm. This retrospective study shows that after resuscitation, there is a significant increase in proximal and distal aortic diameter. Interval reimaging of the thoracic aorta may be beneficial after adequate stabilization of the patient's other injuries. In certain cases, more appropriate sizing may prevent a device-related complication.

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Association of Scapular Fractures and Blunt Thoracic Aortic Injury: Fact or Fiction?

The American Surgeon ◽

10.1177/000313480507100110 ◽

2005 ◽

Vol 71 (1) ◽

pp. 54-57 ◽

Cited By ~ 2

Author(s):

Carlos V.R. Brown ◽

George Velmahos ◽

Dennis Wang ◽

Susan Kennedy ◽

Demetrios Demetriades ◽

...

Keyword(s):

Los Angeles ◽

Blunt Trauma ◽

Medical Center ◽

Aortic Injury ◽

Trauma Patients ◽

Associated Injuries ◽

Blunt Thoracic Aortic Injury ◽

Scapular Fractures ◽

Thoracic Aortic Injury ◽

Level I

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.

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Blunt Thoracic Aortic Injury

The American Surgeon ◽

10.1177/000313480807401033 ◽

2008 ◽

Vol 74 (10) ◽

pp. 1033-1037 ◽

Cited By ~ 1

Author(s):

Elizabeth R. Benjamin ◽

Areti Tillou ◽

Jonathan R. Hiatt ◽

H. Gill Cryer

Keyword(s):

Injury Severity ◽

Aortic Injury ◽

Diagnosis And Treatment ◽

Successful Outcome ◽

Operative Repair ◽

Blunt Thoracic Aortic Injury ◽

Thoracic Aortic Injury ◽

Pelvic Embolization ◽

Life Threatening ◽

Level I

Blunt thoracic aortic injury (BAI) is a rare but often fatal injury that occurs with severe polytrauma. Immediate diagnosis and treatment of BAI are essential for a successful outcome. We reviewed our experience with 20 patients with BAI treated at a Level I trauma center between 1995 and 2006. The mean Injury Severity Score was 38 ± 14 and 14 patients had an abnormal Glasgow Coma Score; associated injuries included abdomen in 13 patients, extremity in 12, and head in six. Chest x-ray (CXR) findings were suggestive of aortic injury in 15 patients, equivocal in three, and showed no evidence of aortic injury in two. Diagnosis was made by CT angiography (CTA) in 17 patients, transesophageal echocardiography (TEE) in two, and formal angiography in one. Sixteen patients underwent operative repair of BAI. Of these, eight also underwent laparotomy, six had operative repair of extremity fractures, and three had pelvic embolization. Five patients died, three of whom were treated nonoperatively, and length of hospitalization in survivors was 32 ± 20 days. BAI is rare and often associated with multiple life-threatening injuries complicating diagnosis and treatment. Our data support the aggressive use of CTA even when classic CXR findings are not present. When CT must be delayed for abdominal exploration, intraoperative TEE is useful.

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Blunt Thoracic Aortic Injury: A 14-Year Experience at a Level 1 Trauma Center

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.08.088 ◽

2012 ◽

Vol 56 (5) ◽

pp. 1481

Author(s):

Jennifer Watson ◽

Jeffery Slaiby ◽

Manuel Garcia Toca ◽

Edward Marcaccio ◽

Tze Tec Chong

Keyword(s):

Trauma Center ◽

Aortic Injury ◽

Blunt Thoracic Aortic Injury ◽

Thoracic Aortic Injury ◽

Level 1 ◽

Level 1 Trauma Center

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Blunt Traumatic Aortic Injury: 10-Year Single-Center Experience

Aorta ◽

10.1055/s-0040-1715608 ◽

2021 ◽

Author(s):

Ahmet Can Topcu ◽

Kamile Ozeren-Topcu ◽

Ahmet Bolukcu ◽

Sinan Sahin ◽

Avni U. Seyhan ◽

...

Keyword(s):

Thoracic Aorta ◽

Subclavian Artery ◽

Open Repair ◽

Left Subclavian Artery ◽

Aortic Injury ◽

Blunt Thoracic Aortic Injury ◽

Phone Calls ◽

Primary Treatment Modality ◽

Thoracic Aortic Injury

Abstract Objective In blunt trauma patients, injury of the thoracic aorta is the second most common cause of death after head injury. In recent years, thoracic endovascular aortic repair (TEVAR) has largely replaced open repair as the primary treatment modality, and delayed repair of stable aortic injuries has been shown to improve mortality. In light of these major advancements, we present a 10-year institutional experience from a tertiary cardiovascular surgery center. Methods Records of patients who underwent endovascular or open repair of the ascending, arch or descending thoracic aorta between January 2009 and December 2018 were retrospectively analyzed. Patients without blunt traumatic etiology were excluded. Perioperative data were retrospectively collected from patient charts. Long-term follow-up was performed via data from follow-up visits and phone calls. Results A total of 1,667 patients underwent 1,740 thoracic aortic procedures (172 TEVAR and 1,568 open repair). There were 13 patients (12 males) with a diagnosis of blunt thoracic aortic injury. Mean patient age was 43.6 years (range, 16–80 years). Ten (77%) patients underwent TEVAR, two (15.4%) underwent open repair, and one (7.7%) was treated nonoperatively. Procedure-related stroke was observed in one (7.7%) case. Procedure-related paraplegia did not occur in any patients. Left subclavian artery origin was covered in seven patients. None developed arm ischemia. Hospital survivors were followed-up for an average of 60.2 months (range, 4–115 months) without any late mortality, endoleak, stent migration, arm ischemia, or reintervention. Conclusion Blunt thoracic aortic injury is a rare but highly fatal condition. TEVAR offers good early and midterm results. Left subclavian artery coverage can be performed without major complications.

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