Trends in Clinical Presentation, Management, and Mortality of Blunt Aortic Traumatic Injury Over an 18-Year Period

Vascular and Endovascular Surgery (Impact Factor: 0.66). 12/2012; 47(1). DOI: 10.1177/1538574412469286
Source: PubMed


The purpose of our study was to assess whether the trends in management of blunt thoracic aortic injury (BTAI) have changed its outcomes over the years.

We reviewed data of 88 (0.3%) adult patients with BTAI from January 1993 to December 2010. Primary end points were trends in presentation and time to repair and early morbidity and mortality.

Of all, 63 (72%) patients with BTAI were male (age, 38 ± 17). The yearly distribution of cases and severity of associated injuries remain stable. Of all, 16 (21%) patients had no intervention, 47 (63%) underwent open repair, and 12 (16%) underwent endovascular treatment. The postoperative mortality has decreased from 29% to 9% and the time from presentation to repair has increased from 6 to 14 hours during the study period.

The incidence of BTAI remains stable with a reduction in postoperative mortality rate and an increasing number of delayed interventions over the past 18 years.

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    ABSTRACT: Thoracic trauma occurs in an estimated 25% of all trauma victims, with approximately 50% of trauma mortalities attributable to these injuries. Only 4% of thoracic traumas involve injuries to thoracic vessels, including the aorta, innominate veins and artery, left carotid artery, internal mammaries, and pulmonary hilar vessels. These vascular injuries can range from minor to major with advances in prehospital management increasing the number of patients surviving in the field and presenting to the hospital with life-threatening vascular injuries. Rapid assessment during the initial survey and interventions to maintain airway, breathing, and circulation of the patient can be life-saving. The patient's hemodynamic status will often dictate the extent of the initial workup or whether the patient requires emergent operation. Stable patients can undergo further assessment and detailed imaging, such as computed tomography and/or angiography. Treatment of thoracic vessel injuries may include advanced endovascular techniques, traditional open surgery, or non-operative management with observation. The following review systematically details the initial workup, evaluation and management techniques of thoracic vessel injuries.
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