Aortic Injuries Can Be Safely Treated Nonsurgically

Select patients with blunt aortic injury (BAI) can be safely managed nonoperatively with beta-blockers to lower the heart rate and blood pressure (BP), according to a new study.

Researchers at the University of Washington Medical Center (Seattle, WA, USA) conducted a study that involved a total of 141 patients with BAI during a ten year period between January 1, 1999 and December 31, 2008; of these, 55 patients underwent open repair of the injury, 50 had endovascular repair, and 36 patients were treated nonoperatively. The patients were analyzed based on type and location of aortic injury, method of repair, injury severity score, morbidity, and mortality.

The results showed that survival in those who received an open repair was 69% (31% mortality), compared to those who had an endovascular procedure, of which 84% survived. The remaining 36 patients were treated nonoperatively with a mortality rate of 28%; significantly, none of these patients died directly from their BAI. The patients who were treated nonoperatively, principally had intimal tears (56%) and pseudoaneurysms (39%) with a small proportion of patients having large intimal flaps (5%); 35% of the injuries remaining stable with a majority (65%) completely healing. The study results were presented at the 64th vascular annual meeting of the Society for Vascular Surgery (SVS); held during June 2010 in Boston (MA, USA).

"At this point in time, CT angiography (CTA) has become the new 'gold standard' for diagnosing BAI's and increased utilization of CTA in the work-up of trauma patients has led to increasing diagnosis of major aortic injury,” said lead author Rachel Lundgren, M.D., of the division of vascular surgery. "At our Center a CTA of the chest is obtained in most high-mechanism or unstable trauma patients and in those with a widened mediastinum on initial chest X-ray; however, some patients are transferred from other hospitals with the CT already done.”

Aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta is torn or ruptured as the result of trauma. The condition is frequently fatal since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it high, causing profuse blood to be pumped out of a tear in the blood vessel. Thus, BAI is a common killer of victims of automotive accidents and is in fact the second leading cause of injury death, after traumatic brain injury (TBI).

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University of Washington Medical Center