Patterns and management of blunt abdominal aortic injury

Donald G. Harris, Charles B. Drucker, Megan L. Brenner, Rajabrata Sarkar, Mayur Narayan, Robert S. Crawford

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Blunt abdominal aortic injury (BAAI) is historically associated with significant morbidity and mortality. Our institutional experience was analyzed to define current patterns of injury and to help guide management. Methods: Adult patients with BAAI between January 2000 and July 2011 were identified from our trauma registry. Medical, radiographic, and autopsy records were reviewed for relevant clinical data. Management and outcomes were compared between patients with minimal aortic injury limited to the intima (MAI) compared to more significant aortic injury (SAI). Results: Nine patients had MAI and 8 had SAI, including 2 dissections, 2 pseudoaneurysms, 2 branch avulsions, 1 thrombosis, and 1 transection. The MAI and SAI groups had similar demographics and patterns of injury, and all patients had significant polytrauma, with a mean injury severity score of 42. More MAI than SAI patients were managed nonoperatively (100% vs. 38%; P = 0.01). All observed patients underwent repeat imaging during the index admission, 85% within 72 hours, and no observed lesions led to malperfusion, death, or progression during the index admission. One MAI progressed to a pseudoaneurysm within 8 months. Five SAI patients underwent aortic-related repairs, including 2 endovascular stent grafts, 2 open primary repairs, and 1 axillobifemoral bypass. Overall, 15 (88%) patients underwent procedures for any injuryd9 required laparotomy (53%) and 2 underwent thoracotomy. There were 6 (35%) deaths, 2 attributable to aortic injuryd1 from hemorrhage and 1 from hyperkalemic cardiac arrest after prolonged ischemia from infrarenal aortic occlusion. Among patients who survived the initial resuscitation, SAI was associated with a significantly higher mortality rate compared to MAI (50% vs. 0%; P = 0.03). Conclusions: Patients with MAI are at low risk of complications and may be considered for observation. Patients with SAI requiring intervention manifest clinically and/or radiographically at presentation. Those not associated with bleeding, malperfusion, or thromboembolism may be observed with interval imaging. For all observed patients, long-term surveillance is required to document complete resolution or stability, because even MAI can progress to a more complex lesion.

Original languageEnglish (US)
Pages (from-to)1074-1080
Number of pages7
JournalAnnals of Vascular Surgery
Volume27
Issue number8
DOIs
StatePublished - Jan 1 2013

Fingerprint

Abdominal Injuries
Nonpenetrating Wounds
Wounds and Injuries
False Aneurysm
Hemorrhage
Injury Severity Score
Mortality
Multiple Trauma
Thromboembolism
Thoracotomy
Heart Arrest
Resuscitation
Laparotomy
Stents
Registries
Dissection
Autopsy
Thrombosis
Ischemia

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Harris, D. G., Drucker, C. B., Brenner, M. L., Sarkar, R., Narayan, M., & Crawford, R. S. (2013). Patterns and management of blunt abdominal aortic injury. Annals of Vascular Surgery, 27(8), 1074-1080. https://doi.org/10.1016/j.avsg.2012.09.019

Patterns and management of blunt abdominal aortic injury. / Harris, Donald G.; Drucker, Charles B.; Brenner, Megan L.; Sarkar, Rajabrata; Narayan, Mayur; Crawford, Robert S.

In: Annals of Vascular Surgery, Vol. 27, No. 8, 01.01.2013, p. 1074-1080.

Research output: Contribution to journalArticle

Harris, DG, Drucker, CB, Brenner, ML, Sarkar, R, Narayan, M & Crawford, RS 2013, 'Patterns and management of blunt abdominal aortic injury', Annals of Vascular Surgery, vol. 27, no. 8, pp. 1074-1080. https://doi.org/10.1016/j.avsg.2012.09.019
Harris DG, Drucker CB, Brenner ML, Sarkar R, Narayan M, Crawford RS. Patterns and management of blunt abdominal aortic injury. Annals of Vascular Surgery. 2013 Jan 1;27(8):1074-1080. https://doi.org/10.1016/j.avsg.2012.09.019
Harris, Donald G. ; Drucker, Charles B. ; Brenner, Megan L. ; Sarkar, Rajabrata ; Narayan, Mayur ; Crawford, Robert S. / Patterns and management of blunt abdominal aortic injury. In: Annals of Vascular Surgery. 2013 ; Vol. 27, No. 8. pp. 1074-1080.
@article{f0d19164140e4332805486559dfe6710,
title = "Patterns and management of blunt abdominal aortic injury",
abstract = "Background: Blunt abdominal aortic injury (BAAI) is historically associated with significant morbidity and mortality. Our institutional experience was analyzed to define current patterns of injury and to help guide management. Methods: Adult patients with BAAI between January 2000 and July 2011 were identified from our trauma registry. Medical, radiographic, and autopsy records were reviewed for relevant clinical data. Management and outcomes were compared between patients with minimal aortic injury limited to the intima (MAI) compared to more significant aortic injury (SAI). Results: Nine patients had MAI and 8 had SAI, including 2 dissections, 2 pseudoaneurysms, 2 branch avulsions, 1 thrombosis, and 1 transection. The MAI and SAI groups had similar demographics and patterns of injury, and all patients had significant polytrauma, with a mean injury severity score of 42. More MAI than SAI patients were managed nonoperatively (100{\%} vs. 38{\%}; P = 0.01). All observed patients underwent repeat imaging during the index admission, 85{\%} within 72 hours, and no observed lesions led to malperfusion, death, or progression during the index admission. One MAI progressed to a pseudoaneurysm within 8 months. Five SAI patients underwent aortic-related repairs, including 2 endovascular stent grafts, 2 open primary repairs, and 1 axillobifemoral bypass. Overall, 15 (88{\%}) patients underwent procedures for any injuryd9 required laparotomy (53{\%}) and 2 underwent thoracotomy. There were 6 (35{\%}) deaths, 2 attributable to aortic injuryd1 from hemorrhage and 1 from hyperkalemic cardiac arrest after prolonged ischemia from infrarenal aortic occlusion. Among patients who survived the initial resuscitation, SAI was associated with a significantly higher mortality rate compared to MAI (50{\%} vs. 0{\%}; P = 0.03). Conclusions: Patients with MAI are at low risk of complications and may be considered for observation. Patients with SAI requiring intervention manifest clinically and/or radiographically at presentation. Those not associated with bleeding, malperfusion, or thromboembolism may be observed with interval imaging. For all observed patients, long-term surveillance is required to document complete resolution or stability, because even MAI can progress to a more complex lesion.",
author = "Harris, {Donald G.} and Drucker, {Charles B.} and Brenner, {Megan L.} and Rajabrata Sarkar and Mayur Narayan and Crawford, {Robert S.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.avsg.2012.09.019",
language = "English (US)",
volume = "27",
pages = "1074--1080",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "8",

}

TY - JOUR

T1 - Patterns and management of blunt abdominal aortic injury

AU - Harris, Donald G.

AU - Drucker, Charles B.

AU - Brenner, Megan L.

AU - Sarkar, Rajabrata

AU - Narayan, Mayur

AU - Crawford, Robert S.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Blunt abdominal aortic injury (BAAI) is historically associated with significant morbidity and mortality. Our institutional experience was analyzed to define current patterns of injury and to help guide management. Methods: Adult patients with BAAI between January 2000 and July 2011 were identified from our trauma registry. Medical, radiographic, and autopsy records were reviewed for relevant clinical data. Management and outcomes were compared between patients with minimal aortic injury limited to the intima (MAI) compared to more significant aortic injury (SAI). Results: Nine patients had MAI and 8 had SAI, including 2 dissections, 2 pseudoaneurysms, 2 branch avulsions, 1 thrombosis, and 1 transection. The MAI and SAI groups had similar demographics and patterns of injury, and all patients had significant polytrauma, with a mean injury severity score of 42. More MAI than SAI patients were managed nonoperatively (100% vs. 38%; P = 0.01). All observed patients underwent repeat imaging during the index admission, 85% within 72 hours, and no observed lesions led to malperfusion, death, or progression during the index admission. One MAI progressed to a pseudoaneurysm within 8 months. Five SAI patients underwent aortic-related repairs, including 2 endovascular stent grafts, 2 open primary repairs, and 1 axillobifemoral bypass. Overall, 15 (88%) patients underwent procedures for any injuryd9 required laparotomy (53%) and 2 underwent thoracotomy. There were 6 (35%) deaths, 2 attributable to aortic injuryd1 from hemorrhage and 1 from hyperkalemic cardiac arrest after prolonged ischemia from infrarenal aortic occlusion. Among patients who survived the initial resuscitation, SAI was associated with a significantly higher mortality rate compared to MAI (50% vs. 0%; P = 0.03). Conclusions: Patients with MAI are at low risk of complications and may be considered for observation. Patients with SAI requiring intervention manifest clinically and/or radiographically at presentation. Those not associated with bleeding, malperfusion, or thromboembolism may be observed with interval imaging. For all observed patients, long-term surveillance is required to document complete resolution or stability, because even MAI can progress to a more complex lesion.

AB - Background: Blunt abdominal aortic injury (BAAI) is historically associated with significant morbidity and mortality. Our institutional experience was analyzed to define current patterns of injury and to help guide management. Methods: Adult patients with BAAI between January 2000 and July 2011 were identified from our trauma registry. Medical, radiographic, and autopsy records were reviewed for relevant clinical data. Management and outcomes were compared between patients with minimal aortic injury limited to the intima (MAI) compared to more significant aortic injury (SAI). Results: Nine patients had MAI and 8 had SAI, including 2 dissections, 2 pseudoaneurysms, 2 branch avulsions, 1 thrombosis, and 1 transection. The MAI and SAI groups had similar demographics and patterns of injury, and all patients had significant polytrauma, with a mean injury severity score of 42. More MAI than SAI patients were managed nonoperatively (100% vs. 38%; P = 0.01). All observed patients underwent repeat imaging during the index admission, 85% within 72 hours, and no observed lesions led to malperfusion, death, or progression during the index admission. One MAI progressed to a pseudoaneurysm within 8 months. Five SAI patients underwent aortic-related repairs, including 2 endovascular stent grafts, 2 open primary repairs, and 1 axillobifemoral bypass. Overall, 15 (88%) patients underwent procedures for any injuryd9 required laparotomy (53%) and 2 underwent thoracotomy. There were 6 (35%) deaths, 2 attributable to aortic injuryd1 from hemorrhage and 1 from hyperkalemic cardiac arrest after prolonged ischemia from infrarenal aortic occlusion. Among patients who survived the initial resuscitation, SAI was associated with a significantly higher mortality rate compared to MAI (50% vs. 0%; P = 0.03). Conclusions: Patients with MAI are at low risk of complications and may be considered for observation. Patients with SAI requiring intervention manifest clinically and/or radiographically at presentation. Those not associated with bleeding, malperfusion, or thromboembolism may be observed with interval imaging. For all observed patients, long-term surveillance is required to document complete resolution or stability, because even MAI can progress to a more complex lesion.

UR - http://www.scopus.com/inward/record.url?scp=84886094937&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886094937&partnerID=8YFLogxK

U2 - 10.1016/j.avsg.2012.09.019

DO - 10.1016/j.avsg.2012.09.019

M3 - Article

C2 - 23790766

AN - SCOPUS:84886094937

VL - 27

SP - 1074

EP - 1080

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

IS - 8

ER -