Traumatic blunt aortic injury: experience in one hospital

Abstract

Background: Traumatic blunt aortic injury (TBAI) is a rare event with an incidence rate of approximately 2.6 patients per year at a medical center. However, high rates of early mortality render it the second leading cause of mortality among traumatic injuries. The optimal management and long-term outcomes after intervention therapy remain unclear. We reviewed TBAI cases in our hospital and discussed the surgical strategy. Materials and Methods: We retrospectively analyzed ten patients diagnosed with TBAI between 2006 and 2019 in our Health insurance database. We used the grading system of the Society of Vascular Surgery. Patients who were classified as Grade 1 or 2 injuries received nonoperative treatment. Patients who were classified as Grade 3 or 4 injuries underwent surgical intervention. Follow-up computed tomography angiography was arranged within 1 year of discharge. Results: Two and seven patients presented with Grade 2 and 3 aortic injuries, respectively. One patient incidentally found chronic Type B aortic dissection after trauma. For one early case, open aortic replacement was performed. Four (including one brain dead) patients received nonoperative treatment. Five patients underwent percutaneous thoracic endovascular aortic repair. Nine patients survived after treatment. Three of the five patients who underwent endovascular repair developed postoperative complications, including endoleak and paraplegia. Two patients who underwent nonoperative treatment showed complete resolution within 2 months. Conclusion: In selected cases with Grade 2 injury, nonoperative treatment may be appropriate and complete resolution of intramural hematoma may occur.

Keywords

• endovascular repair
• management
• traumatic aortic blunt injury