Blunt thoracic aortic injury with small pseudoaneurysm may be managed by nonoperative treatment.
OBJECTIVE
The efficacy of nonoperative management of blunt thoracic aortic injury (BTAI) was evaluated in patients with pseudoaneurysm.


METHODS
A retrospective review was done for patients with BTAI at Fukui Prefectural Hospital during a 9-year period. Charts were reviewed for age, gender, Injury Severity Score, Abbreviated Injury Scale for each body area, initial type of aortic injury, site of aortic injury, type of definitive management, complications, and outcomes.


RESULTS
Eighteen patients with BTAI were treated at Fukui Prefectural Hospital. Of 18 patients with pseudoaneurysm, seven patients were hemodynamically unstable and four patients died because of associated injuries; there were no aortic-related deaths. All 14 surviving patients were followed up for an average of 40.9 months. Only two patients with pseudoaneurysm required operative management because of the progression of the pseudoaneurysm. The pseudoaneurysm/normal aortic diameter ratio of those with any intervention was higher than that of those with nonoperative management.


CONCLUSIONS
BTAI with pseudoaneurysm can be managed nonoperatively, with about 10% risk of progression to require surgical repair.
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan. Electronic address: sytanizak@yahoo.co.jp.
Shinsuke
S
Tanizaki
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Shigenobu
S
Maeda
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Hideyuki
H
Matano
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Makoto
M
Sera
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Hideya
H
Nagai
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Taizo
T
Nakanishi
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Hiroshi
H
Ishida
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult