Document Detail


A new classification scheme for treating blunt aortic injury.
MedLine Citation:
PMID:  22130426     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There are numerous questions about the treatment of blunt aortic injury (BAI), including the management of small intimal tears, what injury characteristics are predictive of death from rupture, and which patients actually need intervention. We used our experience in treating BAI during the past decade to create a classification scheme based on radiographic and clinical data and to provide clear treatment guidelines.
METHODS: The records of patients admitted with BAI from 1999 to 2008 were retrospectively reviewed. Patients with a radiographically or operatively confirmed diagnosis (echocardiogram, computed tomography, or angiography) of BAI were included. We created a classification system based on the presence or absence of an aortic external contour abnormality, defined as an alteration in the symmetric, round shape of the aorta: (1) intimal tear (IT)-absence of aortic external contour abnormality and intimal defect and/or thrombus of <10 mm in length or width; (2) large intimal flap (LIF)-absence of aortic external contour abnormality and intimal defect and/or thrombus of ≥10 mm in length or width; (3) pseudoaneurysm-presence of aortic external contour abnormality and contained rupture; (4) rupture-presence of aortic external contour abnormality and free contrast extravasation or hemothorax at thoracotomy.
RESULTS: We identified 140 patients with BAI. Most injuries were pseudoaneurysm (71%) at the isthmus (70%), 16.4% had an IT, 5.7% had a LIF, and 6.4% had a rupture. Survival rates by classification were IT, 87%; LIF, 100%; pseudoaneurysm, 76%; and rupture, 11% (one patient). Of the ITs, LIFs, and pseudoaneurysms treated nonoperatively, none worsened, and 65% completely healed. No patient with an IT or LIF died. Most patients with ruptures lost vital signs before presentation or in the emergency department and did not survive. Hypotension before or at hospital presentation and size of the periaortic hematoma at the level of the aortic arch predicted likelihood of death from BAI.
CONCLUSIONS: As a result of this new classification scheme, no patient without an external aortic contour abnormality died of their BAI. ITs can be managed nonoperatively. BAI patients with rupture will die, and resources could be prioritized elsewhere. Those with LIFs do well, and currently, most at our institution are treated with a stent graft. If a pseudoaneurysm is going to rupture, it does so early. Hematoma at the arch on computed tomography scan and hypotension before or at arrival help to predict which pseudoaneurysms need urgent repair.
Authors:
Benjamin W Starnes; Rachel S Lundgren; Martin Gunn; Samantha Quade; Thomas S Hatsukami; Nam T Tran; Nahush Mokadam; Gabriel Aldea
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Publication Detail:
Type:  Journal Article     Date:  2011-11-29
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-20     Completed Date:  2012-02-02     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  47-54     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA. starnes@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting / classification,  radiography,  surgery
Aneurysm, False / classification,  radiography,  surgery
Aorta / injuries,  physiopathology,  surgery*
Aortic Aneurysm / classification,  radiography,  surgery
Aortic Rupture / classification,  radiography,  surgery
Aortography / methods
Blood Vessel Prosthesis Implantation* / adverse effects,  mortality
Chi-Square Distribution
Child
Decision Support Techniques*
Endovascular Procedures* / adverse effects,  mortality
Female
Hematoma / radiography
Hemodynamics
Hospital Mortality
Humans
Hypotension / physiopathology
Logistic Models
Male
Middle Aged
Patient Selection
Practice Guidelines as Topic
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular System Injuries / classification*,  mortality,  physiopathology,  radiography,  surgery*
Washington
Wounds, Nonpenetrating / classification*,  mortality,  physiopathology,  radiography,  surgery*
Young Adult

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