Surveillance of Posttraumatic Abdominal Pseudoaneurysms

Area of Science:

• Trauma surgery
• Vascular surgery
• Radiology

Background:

• Traumatic pseudoaneurysms are a severe complication of blunt and penetrating trauma.
• Ruptured pseudoaneurysms carry significant morbidity and mortality risks.
• Current guidelines for detection and surveillance are lacking.

Purpose of the Study:

• To evaluate the detection and management of posttraumatic solid organ pseudoaneurysms.
• To assess the utility of abdominal CT angiography (CTA) in surveillance.
• To inform the development of evidence-based guidelines.

Main Methods:

• Prospective database from a Level 1 trauma center (January 2023 - June 2024).
• Inclusion criteria: patients aged 15+ with high-grade liver, kidney, or spleen injury.
• Univariate analysis with statistical significance at P < 0.05.

Main Results:

• 205 patients included; 10.7% (n=22) developed pseudoaneurysms.
• Common mechanisms: gunshot wounds (36.4%) and motor vehicle collisions (31.8%).
• Pseudoaneurysms occurred in liver (45.5%), spleen (40.9%), and kidney (13.6%), mostly identified within 5 days.
• Endovascular embolization success rate: 88.2% (n=17/22); 22.7% (n=5/22) managed by observation.
• 48.3% (n=99/205) had follow-up abdominal CTA before discharge.

Conclusions:

• Abdominal CTAs are effective for surveillance of post-traumatic pseudoaneurysms.
• Timely repair via endovascular embolization reduces mortality risk.
• Further multi-center studies are needed to establish guidelines.