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JOURNAL ARTICLE
MULTICENTER STUDY

Blunt abdominal aortic injury: a Western Trauma Association multicenter study

Sherene Shalhub, Benjamin W Starnes, Megan L Brenner, Walter L Biffl, Ali Azizzadeh, Kenji Inaba, Dimitra Skiada, Ben Zarzaur, Cayce Nawaf, Evert A Eriksson, Samir M Fakhry, Jasmeet S Paul, Krista L Kaups, David J Ciesla, S Rob Todd, Mark J Seamon, Lisa M Capano-Wehrle, Gregory J Jurkovich, Rosemary A Kozar
Journal of Trauma and Acute Care Surgery 2014, 77 (6): 879-85; discussion 885
25248064

BACKGROUND: Blunt abdominal aortic injury (BAAI) is a rare injury. The objective of the current study was to examine the presentation and management of BAAI at a multi-institutional level.

METHODS: The Western Trauma Association Multi-Center Trials conducted a study of BAAI from 1996 to 2011. Data collected included demographics, injury mechanism, associated injuries, interventions, and complications.

RESULTS: Of 392,315 blunt trauma patients, 113 (0.03%) presented with BAAI at 12 major trauma centers (67% male; median age, 38 years; range, 6-88; median Injury Severity Score [ISS], 34; range, 16-75). The leading cause of injury was motor vehicle collisions (60%). Hypotension was documented in 47% of the cases. The most commonly associated injuries were spine fractures (44%) and pneumothorax/hemothorax (42%). Solid organ, small bowel, and large bowel injuries occurred in 38%, 35%, and 28% respectively. BAAI presented as free aortic rupture (32%), pseudoaneurysm (16%), and injuries without aortic external contour abnormality on computed tomography such as large intimal flaps (34%) or intimal tears (18%). Open and endovascular repairs were undertaken as first-choice therapy in 43% and 15% of cases, respectively. Choice of management varied by type of BAAI: 89% of intimal tears were managed nonoperatively, and 96% of aortic ruptures were treated with open repair. Overall mortality was 39%, the majority (68%) occurring in the first 24 hours because of hemorrhage or cardiac arrest. The highest mortality was associated with Zone II aortic ruptures (92%). Follow-up was documented in 38% of live discharges.

CONCLUSION: This is the largest BAAI series reported to date. BAAI presents as a spectrum of injury ranging from minimal aortic injury to aortic rupture. Nonoperative management is successful in uncomplicated cases without external aortic contour abnormality on computed tomography. Highest mortality occurred in free aortic ruptures, suggesting that alternative measures of early noncompressible torso hemorrhage control are warranted.

LEVEL OF EVIDENCE: Epidemiologic study, level III; therapeutic study, level IV.

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