title: Management of simultaneous traumatic brain injury and aortic injury.
abstract: OBJECTIVE
  Simultaneous traumatic brain injury (TBI) and aortic injury has been considered unsurvivable for many years because treatments such as sedation and blood pressure goals conflict for these 2 conditions. Additionally, surgical interventions for aortic injury often require full anticoagulation, which is contraindicated in patients with TBI. For these reasons, and due to the relative rarity of aortic injury/TBI, little data are available to guide treating physicians.
  
  
  METHODS
  A retrospective review was performed on all simultaneous TBI and aortic injury cases from 2000 to 2012 at a university-affiliated, Level I trauma center. Patient demographics, imaging studies, interventions, and outcomes were analyzed. Traumatic brain injury/aortic injury cases treated with endovascular stenting were specifically studied to determine trends in procedure timing, use of anticoagulation, and neurological outcome.
  
  
  RESULTS
  Thirty-three patients with concurrent TBI and aortic injury were identified over a 12-year period. The median patient age was 44 years (range 16-86 years) and the overall mortality rate after imaging diagnosis was 46%. All surviving patients were awake and neurologically functional at discharge, and 83% were discharged home or to rehabilitation facilities. Patients who died had a higher Injury Severity Scale score (p = 0.006). Severe TBI (p = 0.045) or hemodynamic instability (p = 0.015) upon arrival to the hospital was also correlated with increased mortality rates. Thirty-three percent of aortic injury/TBI patients (n = 11) underwent endovascular stenting, and 7 of these patients received intravenous anticoagulation therapy at the time of surgery. Six of these 7 anticoagulation-treated patients experienced no significant progression on postoperative brain CT, whereas 1 patient died of hemodynamic instability prior to undergoing further imaging.
  
  
  CONCLUSIONS
  Simultaneous TBI and aortic injury is a rare condition with a historically poor prognosis. However, these results suggest that many patients can survive with a good quality of life. Technological advances such as endovascular aortic stenting may improve patient outcome, and anticoagulation is not absolutely contraindicated after TBI.
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Kitagawa
authors.forename: Robert M
authors.initials: RM
authors.lastname: Van Haren
authors.forename: Shoji
authors.initials: S
authors.lastname: Yokobori
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Beckerman
authors.forename: Faiz
authors.initials: F
authors.lastname: Ahmad
authors.forename: M Ross
authors.initials: MR
authors.lastname: Bullock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000293:injuries* / Q000601:surgery; D001930:Brain Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D015607:Stents; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*