Outcomes of Traumatic Aortic Injury in a Primary Open Surgical Approach Paradigm.
BACKGROUND
Multiple classifications can be used to define the magnitude of aortic injury. The Vancouver Classification (VC) is a new and simplified computed tomography-based Blunt Aortic Injury (BAI) grading system correlating with clinical outcomes.


OBJECTIVE
The objectives of this study are: 1) to describe the severity of aortic injury in a center with a predominantly surgical approach to BAI; 2) to correlate the severity of aortic trauma to hospital survival rate and rate of adverse events according to the type of interventions performed during the hospital stay; and 3) to evaluate VC.


METHODS
All patients referring to the Sacre-Coeur Hospital of Montreal between August 1998 and April 2011 for management of BAI were studied. Two radiologists reviewed all CT scan images individually and classified the aortic injuries using VC.


RESULTS
Among the 112 patients presenting with BAI, 39 cases had local CT scans available for reconstruction. Seven patients were identified as suffering from grade I injuries (flap or thrombus of less than 1 cm), 6 from grade II injuries (flap or thrombus of more than 1 cm), and 26 from grade III injuries (pseudoaneurysm). Among the patients with grade I injuries, 57% were treated surgically and 43% medically with a survival rate of 100%. Among the patients with grade II injuries (67% treated surgically and 33% treated medically) survival was also 100%. Among patients with grade III injuries (85% treated surgically, 7% had Thoracic Endovascular Aortic Repair (TEVAR) and 8% treated medically) survival was 95%, 95% and 50%, respectively. There were no significant differences between groups as to clinical outcome. Inter-rater reliability was 0.81.


CONCLUSIONS
VC is easy to use and has low inter-observer variability. Low grades of injury were associated with low mortality related to medical treatment.
Division of Cardiovascular Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada.
Jessica
J
Forcillo
Division of Radiology, Sacre-Coeur Hospital of Montreal, Montreal, Canada.
Michel
M
Philie
Division of Radiology, Sacre-Coeur Hospital of Montreal, Montreal, Canada.
Andrea
A
Ojanguren
Division of Traumatology/General Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada.
Soazig
S
Le Guillan
Division of Cardiovascular Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada ; Division of Traumatology/General Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada.
Alain
A
Verdant
Division of Cardiovascular Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada ; Division of Traumatology/General Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada ; Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montreal, Canada.
Philippe
P
Demers
Division of Cardiovascular Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada ; Division of Traumatology/General Surgery, Sacre-Coeur Hospital of Montreal, Montreal, Canada ; Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montreal, Canada ; Critical Care Medicine, Sacre-Coeur Hospital of Montreal, Montreal, Canada.
Yoan
Y
Lamarche
Assessment Patient Outcomes; Thoracic Aorta; Trauma