Title

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Document Type

Presentation

Publication Date

1-29-2012

Abstract

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively.

Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort.

Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months.

Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients.

Comments

This poster was presented at the Society of Thoracic Surgeons 48th Annual Meeting, Fort Lauderdale, FL.