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Age affects vascular morphology and predictiveness of anatomical landmarks for aortic zones in trauma patients: implications for resuscitative endovascular balloon occlusion of the aorta

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Abstract

Purpose

Understanding the vascular morphology is fundamental for resuscitative endovascular balloon occlusion of the aorta. This study aimed to evaluate the effect of aging on length and diameter of aorta and iliac arteries in trauma patients, and to investigate the predictiveness of anatomical landmarks for aortic zones.

Methods

A total of 235 patients in a regional trauma center registry from September 1, 2018, to January 3, 2024, participated in the study. Reconstruction of computed tomography was applied to the torso area. The marginal diameter and length of aorta and iliac arteries were measured. Anatomical landmark distances and aortic marginal lengths were compared.

Results

The length and diameter of aorta and iliac arteries increased with age, and a tortuous and enlarged morphology was observed in older patients. There was a good regression between age and diameter of the aorta. Neither the jugular notch, the xiphisternal joint, nor the umbilicus could reliably represent specific margins of aortic zones. The distance between the mid-sternum and femoral artery (427 ± 25 to 442 ± 25 mm for right, and 425 ± 28 to 440 ± 26 mm for left) was predictive for zone 1 in all groups. The distance between the lower one-third junction of the xiphisternum to the umbilicus and femoral artery (232 ± 19 to 240 ± 17 mm for right, and 229 ± 20 to 237 ± 19 mm for left) was predictive for zone 3 aorta.

Conclusion

Aging increases the length and diameter of aorta and iliac arteries, with a tortuous and enlarged morphology in geriatric populations. The mid-sternum and the lower one-third junction of the xiphisternum to the umbilicus were predictive landmarks for zone 1 and zone 3, respectively.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, upon reasonable request.

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Funding

This study was funded by the Health Commission of Shenzhen Nanshan District (NS2022122).

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China

    Rui-fa Li, Hong-bo Xu, Jin-tuan Lin, Hai-gang Zhang, Zhi-jun Suo & Jing-lan Wu

  2. Department of Pulmonary and Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China

    Xue-fang Gong

Authors
  1. Rui-fa Li
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Contributions

R-F. L. designed the study protocol, collected data for all subjects, and wrote the main manuscript text. X-F. G. re-checked the measurements independently and contributed to the statistical analysis. H-B. X. set up the statistical analysis scheme and grouping method. J-T. L. and H-G. Z. prepared Figs. 1, 2, 3, and 4. Z-J. S. prepared Tables 4, 5, 6, and 7. All authors reviewed the manuscript.

Corresponding author

Correspondence to Jing-lan Wu.

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The authors declare no competing interests.

Appendix

Appendix

Tables 6 and 7

Table 6 Comparison of SCF between classes
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Table 7 Number of patients with values not favoring prediction of zone 3
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Li, Rf., Gong, Xf., Xu, Hb. et al. Age affects vascular morphology and predictiveness of anatomical landmarks for aortic zones in trauma patients: implications for resuscitative endovascular balloon occlusion of the aorta. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02512-z

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