VESS Clinical ResearchObservation May Be Safe in Selected Cases of Blunt Traumatic Abdominal Aortic Injury
Section snippets
Background
Blunt traumatic abdominal aortic injury (BTAAI) is rare lesion, most commonly associated with high-speed motor vehicle collisions. It occurs in 0.03% of all blunt traumas1 and represents <5% of all aortic injuries. A significant portion of patients sustaining aortic injuries die in the field, with reported mortality among those patients reaching the hospital as high as 30%.2
Characteristic BTAAI-related physical examination findings, such as seat belt sign and abdominal wall contusions,3 have
Methods
The local institutional review board, the Committee for the Protection of Human Subjects, approved this study with a waiver of patient-informed consent. The institutional trauma and departmental databases were queried for patients with BTAAI admitted between January 1, 2000 and January 31, 2014. Patients with primarily thoracic aortic and isolated iliac artery injuries were excluded. Aortic injuries were considered primarily abdominal when occurring at or below the T12 vertebral body. The
Results
During the study period, there were 70,143 trauma admissions, of which 58,031 were for blunt trauma; 8,751 patients had blunt injury to the abdomen, with 16 (0.2%) BTAAI. Among these BTAAI patients, there were 11 males (69%) and 5 females (31%), with a median age of 47 years (range, 5–80; Table I). Mean ISS was 33.6 ± 12.9. One patient died soon after arrival, before initiation of treatment and ISS was not calculated. Three patients did not have admission CT scan because of hemodynamic
Discussion
After initial stabilization, much of the morbidity associated with BTAAI consists of acute arterial insufficiency of the lower extremities, neurologic deficits, and bowel injury.4 A significant portion of these injuries are diagnosed at the time of emergency exploratory laparotomy. Up to 60% of patients may present in stable condition,3 however, and have their aortic injury identified by subsequent CT imaging. Contrast-enhanced CT in this setting provides for improved characterization of injury
Conclusions
BTAAI is rare and is associated with high in-hospital mortality, mostly due to associated injuries. It appears that selected patients, even with large intimal flaps and pseudoaneurysms, can be safely observed. When needed, revascularization with in situ prosthetic graft may be safe, despite concomitant bowel injuries. Available short-term and midterm follow-up data suggest that survival after hospital discharge is excellent and aortic-related complications are rare. The optimal treatment of
References (9)
- et al.
Blunt abdominal aortic injury
J Vasc Surg
(2012) - et al.
Seat-belt aorta: a rare injury associated with blunt abdominal trauma
Ann Vasc Surg
(2006) - et al.
Technique of supraceliac balloon control of the aorta during endovascular repair of ruptured abdominal aortic aneurysms
J Vasc Surg
(2013) - et al.
Intravascular stenting of traumatic abdominal aortic dissection
J Vasc Surg
(1996)
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2021, International Journal of Surgery Case ReportsCitation Excerpt :BAAI can lead to death due to rupture or ischemia of organs if symptoms are overlooked or treatment is delayed. There are certain symptoms, such as abdominal pain and lower limb ischemia, that may be overlooked without contrast-enhanced CT at first diagnosis [8], or the patient may develop intermittent claudication in the chronic phase [9]. Therefore, care should be taken when making a diagnosis.
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2018, Annals of Vascular SurgeryCitation Excerpt :Frequently, the patient remains asymptomatic, and spontaneous resolution in the follow-up has been described.4 Charlton-Ouw et al.5 and Shalhub et al.6 reported successfully nonoperatively managed case series. They recommend a close image surveillance a few days after the trauma, with a CT or vascular ultrasound, maintaining an arterial pressure of <120 mm Hg.
Hospital mortality of blunt abdominal aortic injury (BAAI): a systematic review and meta-analysis
2023, World Journal of Emergency Surgery