Blunt Traumatic Ruptures of the Aortic Isthmus: Favor Associated Lesions Rather than Rupture in Hemodynamically...

The optimal timing of management for grade II and III blunt thoracic aortic injuries (BTAIs) in polytrauma patients remains debated, with high mortality largely related to the severity of associated nonaortic injuries. This study aimed to evaluate the impact of early surgical management on perioperative mortality following polytrauma.

This was a retrospective study analyzing BTAI cases managed between January 2016 and March 2024. The primary objective was to assess the association between the timing of management of grade II/III BTAI and early mortality. The secondary objective was to identify the risk factors for early aortic-related mortality and to determine the total length of hospital stay, duration of intensive care unit stay, as well as vascular and nonvascular complications.

Forty patients with BTAI were included: 18 (45%) were grade III, 11 (27.5%) were grade II, 8 (20%) grade I, and 3 (7.5%) were grade IV. Mean age was 48.5 ± 19 years, and 33 patients (82.5%) were male. Mean Injury Severity Score was 28.2 ± 7.8. No deaths were observed among grade I injuries, with spontaneous healing occurring in 50% of cases. Mortality was high in grade IV injuries (66.7%, P = 0.05). No significant difference in morbidity or mortality was observed between grade II and III injuries. Hemodynamic shock at admission was a significant risk factor for mortality, particularly in grade III injuries (P = 0.04). Shock was more frequent in the presence of severe associated traumatic injury, including nonaortic arterial injuries (P = 0.03), traumatic brain injuries (P = 0.04), spinal injuries (P = 0.003), and thoracic injuries (P = 0.02). Among the 12 patients presenting with shock and grade II/III BTAI treated with endovascular repair, 7 stabilized while 5 remained in shock (P = 0.77). No significant impact of thoracic endovascular aortic repair timing (<24 hrs vs. > 24 hrs) on mortality was demonstrated (P = 0.37).

For grade II and III BTAI, a conservative approach prioritizing hemodynamic stabilization and management of severe associated nonaortic injuries should be favored. In patients presenting with shock, delayed treatment of BTAI may allow for hemodynamic stabilization or management of life-threatening associated injuries.