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A new classification scheme for treating blunt aortic injury.

Benjamin W Starnes1, Rachel S Lundgren, Martin Gunn

  • 1Division of Vascular Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA. starnes@u.washington.edu

Journal of Vascular Surgery
|December 2, 2011
PubMed
Summary

A new classification system for blunt aortic injury (BAI) aids in treatment decisions. This system helps identify patients who need intervention, improving outcomes for blunt aortic injury.

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Area of Science:

  • Cardiovascular Surgery
  • Trauma Surgery
  • Diagnostic Imaging

Background:

  • Blunt aortic injury (BAI) management remains challenging, with questions regarding small intimal tears and predictive factors for rupture.
  • Existing treatment guidelines for BAI lack clarity, necessitating a refined classification system.

Purpose of the Study:

  • To develop a classification scheme for blunt aortic injury based on radiographic and clinical data.
  • To establish clear treatment guidelines for blunt aortic injury.

Main Methods:

  • Retrospective review of 140 patients with BAI from 1999-2008.
  • Development of a classification system based on aortic external contour abnormality: intimal tear (IT), large intimal flap (LIF), pseudoaneurysm, and rupture.
  • Inclusion criteria: radiographically or operatively confirmed BAI via echocardiogram, CT, or angiography.

Main Results:

  • Survival rates varied by classification: IT (87%), LIF (100%), pseudoaneurysm (76%), and rupture (11%).
  • Nonoperative management of ITs, LIFs, and pseudoaneurysms resulted in no worsening and 65% complete healing.
  • Hypotension and periaortic hematoma size predicted mortality in BAI patients.

Conclusions:

  • The new classification system demonstrated that patients without external aortic contour abnormalities did not die from BAI.
  • Intimal tears (ITs) can be managed nonoperatively; patients with rupture have poor survival.
  • Urgent repair of pseudoaneurysms is indicated by computed tomography findings and pre-hospital hypotension.