Natural history of grade I-II blunt traumatic aortic injury

Michael J. Osgood, Josh M. Heck, Eric J. Rellinger, Stacey L. Doran, C. Louis Garrard, Raul J. Guzman, Thomas C. Naslund, Jeffery Dattilo

    Research output: Contribution to journalArticle

    34 Citations (Scopus)

    Abstract

    Background Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients. Methods We retrospectively reviewed all BAI presenting to an academic level I trauma center over a 10-year period (2000-2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery guidelines (grade I-IV). Demographics, injury severity, and outcomes were recorded. Results We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries or aortic dissection, and were excluded from this analysis. The remaining 49 patients had 50 grade I-II injuries. We managed 46 grade I injuries (intimal tear or flap, 95%), and four grade II injuries (intramural hematoma, 5%) nonoperatively. Of these, 41 patients had follow-up imaging at a mean of 86 days postinjury and constitute our study cohort. Mean age was 41 years, and mean length of stay was 14 days. The majority (48 of 50, 96%) were thoracic aortic injuries and the remaining two (4%) were abdominal. On follow-up imaging, 23 of 43 (55%) had complete resolution of injury, 17 (40%) had no change in aortic injury, and two (5%) had progression of injury. Of the two patients with progression, one progressed from grade I to grade II and the other progressed from grade I to grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention or died during follow-up. Conclusions Injury progression in grade I-II BAI is rare (∼5%) and did not cause death in our study cohort. Given that progression to grade III injury is possible, follow-up with repeat aortic imaging is reasonable.

    Original languageEnglish (US)
    Pages (from-to)334-342
    Number of pages9
    JournalJournal of Vascular Surgery
    Volume59
    Issue number2
    DOIs
    StatePublished - Feb 1 2014

    Fingerprint

    Natural History
    Wounds and Injuries
    Nonpenetrating Wounds
    Cohort Studies
    Tunica Intima
    Thoracic Injuries
    Trauma Centers
    False Aneurysm
    Abdominal Aorta
    Thoracic Aorta
    Hematoma
    Dissection
    Cause of Death
    Length of Stay
    Demography
    Guidelines

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Osgood, M. J., Heck, J. M., Rellinger, E. J., Doran, S. L., Garrard, C. L., Guzman, R. J., ... Dattilo, J. (2014). Natural history of grade I-II blunt traumatic aortic injury. Journal of Vascular Surgery, 59(2), 334-342. https://doi.org/10.1016/j.jvs.2013.09.007

    Natural history of grade I-II blunt traumatic aortic injury. / Osgood, Michael J.; Heck, Josh M.; Rellinger, Eric J.; Doran, Stacey L.; Garrard, C. Louis; Guzman, Raul J.; Naslund, Thomas C.; Dattilo, Jeffery.

    In: Journal of Vascular Surgery, Vol. 59, No. 2, 01.02.2014, p. 334-342.

    Research output: Contribution to journalArticle

    Osgood, MJ, Heck, JM, Rellinger, EJ, Doran, SL, Garrard, CL, Guzman, RJ, Naslund, TC & Dattilo, J 2014, 'Natural history of grade I-II blunt traumatic aortic injury', Journal of Vascular Surgery, vol. 59, no. 2, pp. 334-342. https://doi.org/10.1016/j.jvs.2013.09.007
    Osgood MJ, Heck JM, Rellinger EJ, Doran SL, Garrard CL, Guzman RJ et al. Natural history of grade I-II blunt traumatic aortic injury. Journal of Vascular Surgery. 2014 Feb 1;59(2):334-342. https://doi.org/10.1016/j.jvs.2013.09.007
    Osgood, Michael J. ; Heck, Josh M. ; Rellinger, Eric J. ; Doran, Stacey L. ; Garrard, C. Louis ; Guzman, Raul J. ; Naslund, Thomas C. ; Dattilo, Jeffery. / Natural history of grade I-II blunt traumatic aortic injury. In: Journal of Vascular Surgery. 2014 ; Vol. 59, No. 2. pp. 334-342.
    @article{c64e8e498d4a43eda6a1ff9d64098837,
    title = "Natural history of grade I-II blunt traumatic aortic injury",
    abstract = "Background Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients. Methods We retrospectively reviewed all BAI presenting to an academic level I trauma center over a 10-year period (2000-2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery guidelines (grade I-IV). Demographics, injury severity, and outcomes were recorded. Results We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries or aortic dissection, and were excluded from this analysis. The remaining 49 patients had 50 grade I-II injuries. We managed 46 grade I injuries (intimal tear or flap, 95{\%}), and four grade II injuries (intramural hematoma, 5{\%}) nonoperatively. Of these, 41 patients had follow-up imaging at a mean of 86 days postinjury and constitute our study cohort. Mean age was 41 years, and mean length of stay was 14 days. The majority (48 of 50, 96{\%}) were thoracic aortic injuries and the remaining two (4{\%}) were abdominal. On follow-up imaging, 23 of 43 (55{\%}) had complete resolution of injury, 17 (40{\%}) had no change in aortic injury, and two (5{\%}) had progression of injury. Of the two patients with progression, one progressed from grade I to grade II and the other progressed from grade I to grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention or died during follow-up. Conclusions Injury progression in grade I-II BAI is rare (∼5{\%}) and did not cause death in our study cohort. Given that progression to grade III injury is possible, follow-up with repeat aortic imaging is reasonable.",
    author = "Osgood, {Michael J.} and Heck, {Josh M.} and Rellinger, {Eric J.} and Doran, {Stacey L.} and Garrard, {C. Louis} and Guzman, {Raul J.} and Naslund, {Thomas C.} and Jeffery Dattilo",
    year = "2014",
    month = "2",
    day = "1",
    doi = "10.1016/j.jvs.2013.09.007",
    language = "English (US)",
    volume = "59",
    pages = "334--342",
    journal = "Journal of Vascular Surgery",
    issn = "0741-5214",
    publisher = "Mosby Inc.",
    number = "2",

    }

    TY - JOUR

    T1 - Natural history of grade I-II blunt traumatic aortic injury

    AU - Osgood, Michael J.

    AU - Heck, Josh M.

    AU - Rellinger, Eric J.

    AU - Doran, Stacey L.

    AU - Garrard, C. Louis

    AU - Guzman, Raul J.

    AU - Naslund, Thomas C.

    AU - Dattilo, Jeffery

    PY - 2014/2/1

    Y1 - 2014/2/1

    N2 - Background Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients. Methods We retrospectively reviewed all BAI presenting to an academic level I trauma center over a 10-year period (2000-2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery guidelines (grade I-IV). Demographics, injury severity, and outcomes were recorded. Results We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries or aortic dissection, and were excluded from this analysis. The remaining 49 patients had 50 grade I-II injuries. We managed 46 grade I injuries (intimal tear or flap, 95%), and four grade II injuries (intramural hematoma, 5%) nonoperatively. Of these, 41 patients had follow-up imaging at a mean of 86 days postinjury and constitute our study cohort. Mean age was 41 years, and mean length of stay was 14 days. The majority (48 of 50, 96%) were thoracic aortic injuries and the remaining two (4%) were abdominal. On follow-up imaging, 23 of 43 (55%) had complete resolution of injury, 17 (40%) had no change in aortic injury, and two (5%) had progression of injury. Of the two patients with progression, one progressed from grade I to grade II and the other progressed from grade I to grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention or died during follow-up. Conclusions Injury progression in grade I-II BAI is rare (∼5%) and did not cause death in our study cohort. Given that progression to grade III injury is possible, follow-up with repeat aortic imaging is reasonable.

    AB - Background Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients. Methods We retrospectively reviewed all BAI presenting to an academic level I trauma center over a 10-year period (2000-2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery guidelines (grade I-IV). Demographics, injury severity, and outcomes were recorded. Results We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries or aortic dissection, and were excluded from this analysis. The remaining 49 patients had 50 grade I-II injuries. We managed 46 grade I injuries (intimal tear or flap, 95%), and four grade II injuries (intramural hematoma, 5%) nonoperatively. Of these, 41 patients had follow-up imaging at a mean of 86 days postinjury and constitute our study cohort. Mean age was 41 years, and mean length of stay was 14 days. The majority (48 of 50, 96%) were thoracic aortic injuries and the remaining two (4%) were abdominal. On follow-up imaging, 23 of 43 (55%) had complete resolution of injury, 17 (40%) had no change in aortic injury, and two (5%) had progression of injury. Of the two patients with progression, one progressed from grade I to grade II and the other progressed from grade I to grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention or died during follow-up. Conclusions Injury progression in grade I-II BAI is rare (∼5%) and did not cause death in our study cohort. Given that progression to grade III injury is possible, follow-up with repeat aortic imaging is reasonable.

    UR - http://www.scopus.com/inward/record.url?scp=84892936313&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84892936313&partnerID=8YFLogxK

    U2 - 10.1016/j.jvs.2013.09.007

    DO - 10.1016/j.jvs.2013.09.007

    M3 - Article

    VL - 59

    SP - 334

    EP - 342

    JO - Journal of Vascular Surgery

    JF - Journal of Vascular Surgery

    SN - 0741-5214

    IS - 2

    ER -