PC170. Management Challenges in Patients With Blunt Abdominal Aortic Injuries

Abstract

Blunt abdominal aortic injuries (BAAI) are rare, accounting for only 5% of all blunt aortic traumas. We reviewed the incidence, management, and outcomes of patients with BAAI at a Level I urban trauma center over a 10-year period. Through our trauma registry, we retrospectively reviewed all patients who presented with BAAI to a Level I urban trauma center from 2004 to 2014. Medical records and autopsy data were used to analyze the severity and location of aortic trauma, associated injuries, treatment methods, and outcomes. We identified 38 total patients with blunt aortic injuries. Blunt thoracic aortic trauma accounted for 85% of the injuries. BAAI were identified in 6 patients (15%). The median age of BAAI patients was 41 years (range, 29-82 years). Motor vehicle collision was the etiology in 4 patients and pedestrian struck in 2 patients. Median injury severity score (ISS) was 66.5 (range, 34-75). There were 5 injuries of the infrarenal aorta (2 intimal tears, 1 dissection, 1 pseudoaneurysm, 1 free rupture) and 1 free rupture at the level of the left renal artery. All patients sustained additional spine or other bony fractures. There were 11 associated solid organ and bowel injuries in 4 patients. In-hospital mortality was 50%, which included both free ruptures and one case of infrarenal aortic dissection in the setting of brain death. Laparotomy and repair of an aortic tear at the level of the left renal artery was performed on one free aortic rupture, with a hospital course complicated by multiple organ resections, intra-abdominal sepsis, and death secondary to aortic rupture 8 days after initial repair. The patient with the infrarenal aortic pseudoaneurysm was treated with aortic stent graft cuffs, with survival to discharge after a course complicated by respiratory failure from lung injuries. Two patients with intimal tears were managed nonoperatively to discharge. Two of the survivors were found to be isolated blunt abdominal aortic traumas, without concomitant intra-abdominal injuries, while the third survivor sustained additional blunt gastric, small bowel, and colon injuries. In contrast, both free aortic ruptures were associated with multiple solid organ and bowel injuries. BAAIs are rare events with high mortality rates. Management decisions are challenging and must be made in the setting of complex injuries across multiple systems.