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Minimal aortic injury: a lesion associated with advancing diagnostic techniques
A K Malhotra1, T C Fabian, M A Croce
1Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA. akmalhot@hsc.vcu.edu
The Journal of Trauma
|December 12, 2001
Summary
Minimal aortic injuries (MAI) are increasingly detected with advanced imaging. Nonoperative management may be suitable for MAI, but long-term outcomes require further study.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Trauma Care
Background:
- Minimal aortic injuries (MAI) are increasingly identified due to advances in high-resolution imaging.
- Nonoperative therapy is emerging as a definitive treatment for MAI.
- This study reviews institutional experience with MAI patients treated nonoperatively.
Purpose of the Study:
- To examine the institutional experience with nonoperative management of minimal aortic injuries.
- To evaluate the outcomes of patients with MAI treated nonoperatively.
Main Methods:
- Patients with suspected blunt aortic injury (BAI) underwent screening helical CT (HCT).
- Confirmatory diagnosis involved aortography with or without intravascular ultrasound (IVUS).
- MAI was defined as a small intimal flap (<1 cm) with minimal periaortic hematoma.
Main Results:
- Of 15,000 patients, 198 (1.3%) had suspected BAI, with 87 confirmed (44%).
- Nine patients (10% of confirmed BAI) had MAI; IVUS or video angiography confirmed diagnosis in five initially missed cases.
- Of six discharged MAI patients, two showed flap resolution, one remained stable, and three developed pseudoaneurysms.
Conclusions:
- Minimal aortic injuries constitute 10% of BAI diagnosed via high-resolution imaging.
- Spontaneous healing suggests nonoperative management is a viable option for MAI.
- Long-term natural history of MAI remains unknown, necessitating cautious application of nonoperative treatment.
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