Diameter Changes in Traumatic Aortic Injury: Implications for Stent-Graft Sizing

Area of Science:

• Cardiovascular Surgery
• Trauma Surgery
• Diagnostic Imaging

Background:

• Traumatic aortic injury (TAI) is a severe condition requiring prompt management.
• Accurate assessment of aortic dimensions is critical for successful endovascular repair.
• The impact of significant blood loss on aortic diameter in TAI patients is not fully understood.

Purpose of the Study:

• To compare aortic diameters from admission computed tomography angiography (CTA) scans to postoperative aortic diameters in patients with TAI.
• To evaluate the influence of substantial blood loss on aortic diameter in TAI patients.

Main Methods:

• Retrospective screening of aortic databases from two tertiary university centers (February 2002 - February 2019).
• Evaluation of concomitant organ injuries, bone fractures, blood loss, and clinical outcomes.
• Measurement of aortic diameters on admission CTA and pre-discharge CTA at three levels: mid-ascending aorta, 5 cm distal to stent graft, and celiac trunk level.

Main Results:

• 45 patients with TAI treated by thoracic endovascular aortic repair were identified.
• A significant reduction in aortic diameter was observed post-stabilization: +1.7 mm (mid-ascending), +2.1 mm (distal to stent graft), and +1.5 mm (celiac trunk).
• The most frequent cause of TAI was car accidents (n=24), with high rates of concomitant injuries (89% bone fractures, 33% pelvic fractures).

Conclusions:

• Aortic diameter is significantly reduced in TAI patients compared to their post-discharge measurements.
• Hemorrhagic shock is a potential cause for this aortic diameter reduction.
• This finding necessitates consideration for appropriate stent-graft sizing in TAI management.