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 injury-9 required laparotomy (53%) and 2 underwent thoracotomy. There were 6 (35%) deaths, 2 attributable to aortic injury-1 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.
authors.affiliation: University of Maryland Medical Center, Baltimore, MD. Electronic address: dharris@smail.umaryland.edu.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.forename: Charles B
authors.initials: CB
authors.lastname: Drucker
authors.forename: Megan L
authors.initials: ML
authors.lastname: Brenner
authors.forename: Rajabrata
authors.initials: R
authors.lastname: Sarkar
authors.forename: Mayur
authors.initials: M
authors.lastname: Narayan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult