Management and outcome of traumatic aortic injuries

Aortic injuries are rare and associated with high early mortality challenging the surgical services both from a technical as well as organisational point of view, especially in countries with low incidence of trauma. A Finnish experience in the management of aortic injuries is reported with special emphasis on outcome after early involvement of cardiothoracic surgeons.

Retrospective analysis of hospital records identified 36 consecutive patients with aortic injuries arriving alive to the hospital during a 32-year period of 1967-98.

Of the 19 thoracic aortic injuries, 17 (89%) were caused by blunt trauma, 8 (42%) of the patients arrived in shock, 7 (37%) died before repair could be attempted, 11 (58%) underwent repair with prosthesis and one (5%) with sutures, with an overall mortality rate of 9/19 (47%). Of the 17 patients with abdominal aortic injuries (15 penetrating), 13 (76%) arrived in shock, 3 (18%) died before repair, 13 (76%) were repaired with sutures and one (6%) with prosthesis, with an overall mortality rate of 8/17 (47%). Fourteen (82%) of the 17 non-survivors died within 24 hours from the injury, 13 from exsanguination and one from associated brain injury.

Abdominal aortic injuries are usually penetrating, diagnosed intraoperatively and amenable to suture repair with good results indicating that stable and unstable patients with potential aortic injuries after penetrating abdominal trauma can safely be managed in hospitals with experienced general surgeons on call. In contrast, stable patients with suspected thoracic aortic injuries could benefit from early transfer to a hospital with cardiothoracic surgical facilities and personnel.