Abdominal Aorta Injuries

Abstract

Blunt abdominal aortic injury occurs in less than 1 % of all traumas and is associated with a high morbidity and mortality. A high index of suspicion is necessary to achieve prompt diagnosis and surgical management. The most common site of injury is to the infrarenal aorta, presenting with an intimal flap or tear and subsequent pseudoaneurysm formation in a subset of patients. Patients with blunt abdominal aortic injury typically present with hypotension; associated injuries include small bowel trauma and injury to the thoracolumbar spine. Patients with an uncomplicated intimal flap may be treated with anti-impulse and antiplatelet agents. Patients with a pseudoaneurysm benefit from endovascular or open repair to avoid a long-term risk of degeneration and rupture. Patients with free rupture or thrombosis of the aorta require immediate operative management. Overall outcomes depend on the site and extent of injury, along with the associated injuries a patient has developed. A multidisciplinary approach to the management of abdominal aortic trauma helps to coordinate and prioritize the activities of the various surgical teams involved in the care of these patients.