Non-Operative Safety, Healing of Aortic Injuries Studied

Select patients with blunt aortic injury (BAI) can be safely managed non-operatively with beta-blockade to lower the heart rate and blood pressure, according to a new study from the 64th Vascular Annual Meeting presented by the Society for Vascular Surgery®.

Researchers reported that during the 10-year study period from Jan. 1, 1999 to Dec. 31, 2008, a total of 141 patients with BAI were treated at the University of Washington Medical Center in Seattle. Fifty-five had open repair and 49 had endovascular repair. Survival in those who received an open repair was 69 percent (31 percent mortality) when compared to those who had an endovascular procedure at 84 percent (16 percent). The remaining 36 patients were treated non-operatively with a mortality of 28 percent, however, of significance is that NONE died from their blunt aortic injury.

Patients were analyzed based on type and location of aortic injury (determined by imaging), method of repair, injury severity score, morbidity, and mortality,” said Rachel Lundgren, vascular fellow from the Center’s Division of Vascular Surgery.

“The injuries were categorized radiographically into Intimal Ter: with the absence of external aortic contour abnormality (EACA) and a small intimal injury o of less than 10 mm (23 patients); Large Intimal Flap (LIF) with absence of EACA, and an intimal injury of more than 10 mm (8 patients); Pseudoaneurysm (PSA) with positive EACA and no extravasation (99 patients); and Rupture (RUPT) with positive EACA and extravasation (9 patients).”

Patients who were treated non-operatively principally had intimal tears (56 percent) and PSA (39 percent) with a small proportion of patients having large intimal flaps (5 percent). Follow-up imaging was available in 88 percent of survivors treated non-operatively with 35 percent of the injuries remaining stable and a majority (65 percent) completely healing. Most intimal tears healed (14 healed, 2 stable); whereas the LIF and PSA remained stable (LIF 2 stable; PSA 1 healed, 4 stable).

“At this point in time, CT angiography(CTA) has become the new ‘gold standard’ for diagnosing BAI’s and increased utilization of CTA in the work-up of trauma patients has led to increasing diagnosis of MAI,” said Dr. Lundgren. “At our Center a CTA of the chest is obtained in most high-mechanism or unstable trauma patients and in those with a widened mediastinum on initial chest x-ray, however some patients are transferred from other hospitals with the CT already done.

Dr. Lundgren added that this study is one of the largest single-center experiences describing the management of patients with BAI. The results from both those treated operatively and non-operatively show that additional research is needed to determine long-term outcomes blunt aortic injuries regardless of the modality of repair. It is clear, however, that there are some injuries that can be safely observed.

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