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Grading system modification and management of blunt aortic injury

Chinese Medical Journal 2013年第3期126卷 442-445页

作者： Kaavya N Reddy Tim Matatov Linda D Doucet Maureen Heldmann Cynthia X Zhao Wayne W Zhang Division of Vascular and endovascular Surgery Louisiana State-University' Health Sciences Cemer Shreveport LA USA Department of Radiology Louisiana State University Health Sciences Center Shreveport LA USA Department of Pathology Louisiana State University Health Sciences Center Shreveport LA USA

Background The traditional approach to blunt aortic injury （BAI） has been emergent intervention. This study aimed to utilize a modified imaging grading system that may allow us to categorize these injuries as needing emergent, urgent, or non-operative management. Methods From January 2003 to December 2011, 28 patients with BAI were managed at our institution. Imaging and medical records were reviewed retrospectively. BAI was classified into 4 grades based on imaging studies. Grade la： intimal tear, Grade Ib： intramural hematoma; Grade Ⅱ： intimal injury with periaotic hematoma; Grade Ilia： aortic transection with pseudoaneurysm, Grade Illb： multiple aortic injuries; and Grade IV： free rupture. Progression and clinical outcomes of ABI were analyzed. Results Of the 28 patients, 22 were males and 6 were females with mean age of 38 （range, 7-69） years, Twenty-five （89.3%） had descending thoracic aortic injury, two （7.1%） had abdominal aortic injury and one （3.6%） presented with multiple aortic injuries. Three patients （10.7%） with Grade I, 1 （3.6%） Grade Ⅱ, 22 （78.6%） Grade Ⅲ, and 2 （7.1%） Grade IV injuries. Twenty-five patients underwent thoracic endovascular aortic repair and 3 were managed medically. Median time between injury and surgical intervention was （2±1） days. One （3.6%） patient developed paraplegia after thoracic endovascular aortic repair （TEVAR）. One Type 2 endoleak spontaneously sealed within 1 month, and another patient died from ruptured Type 1 endoleak 3 years later. Median follow-up time was 16 （range, 1-96） months. Perioperative 30-day mortality rate was 3.6%. Conclusions This study based on our modified BAI grading system indicated that Grade Ⅰ BAI can be managed conservatively. Grade Ⅱ injury requires close observation and repeated computerized tomography angiogram （CTA） within 48-72 hours. If injury appears worse on follow up imaging, surgery should be performed. Delayed repair of Grade Ⅲ BAI is acceptable if associated life threatenina traumatic i

关键词： blunt aortic injury imaging grading system endovascular management

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