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[Blunt aortic injury/choosing appropriate time for surgery]
P Kalmar1, C Otto, V Steinkraus
1Abt. für Thorax-, Herz- und Gefässchirurgie, Universitäts-Krankenhaus Eppendorf, Hamburg, Bundesrepublik Deutschland.
Insights
Emergency surgery for aortic aneurysms is recommended for diameters over 6 cm, hemorrhage, or coarctation syndrome. Delayed surgery (2-8 weeks) is preferred for radiologic aortic lesions due to multiorgan injuries, achieving a 15% mortality rate.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Forensic Medicine
Context:
- Aortic injuries present complex management challenges.
- Post-mortem findings inform surgical decision-making.
- Multiorgan injuries are common in aortic trauma.
Purpose:
- To define optimal surgical timing for aortic injuries.
- To reduce mortality associated with aortic trauma management.
- To establish criteria for emergency versus delayed surgical intervention.
Summary:
- Surgical intervention for aortic aneurysms is prioritized for diameters >6 cm, hemorrhage, or coarctation syndrome.
- Delayed surgery (2-8 weeks post-injury) is indicated for aortic lesions with radiologic findings but no immediate hemodynamic compromise.
- This strategy, based on a cohort of 39 patients and forensic data, aims to mitigate risks associated with concomitant multiorgan injuries.
- The described approach yields a 15% mortality rate in surgical management of aortic injuries.
Impact:
- Provides evidence-based guidelines for managing aortic injuries.
- Potentially improves patient outcomes by optimizing surgical timing.
- Contributes to the understanding of aortic trauma management strategies.
Abstract:
Based on our experience in a cohort of 39 patients and also on the results of post-mortem findings obtained from the department of forensic medicine in Hamburg, we prefer to perform emergency surgery only in cases of aortic aneurysms over 6 cm in diameter, in cases of hemorrhage, or in coarctation syndrome. Because of the high incidence of concomitant multiorgan injuries, surgery for aortic lesions with only radiologic symptoms is not performed until a period of 2-8 weeks has elapsed since the injury, according to the degree of stabilisation. With this strategy, the mortality in surgical management of aortic injuries in our department is about 15%.