Outcomes of Traumatic Aortic Injury in a Primary Open Surgical Approach Paradigm

Background: Multiple classifications can be used to define the magnitude of aortic injury. The Vancouver Classification (VC) is a new and simplified computed tomography-based Blunt Aortic Injury (BAI) grading system correlating with clinical outcomes. Objectives: The objectives of this study are: ۱) to describe the severity of aortic injury in a center with a predominantly surgical approach to BAI; ۲) to correlate the severity of aortic trauma to hospital survival rate and rate of adverse events according to the type of interventions performed during the hospital stay; and ۳) to evaluate VC. Patients and Methods: All patients referring to the Sacre-Coeur Hospital of Montreal between August ۱۹۹۸ and April ۲۰۱۱ for management of BAI were studied. Two radiologists reviewed all CT scan images individually and classified the aortic injuries using VC. Results: Among the ۱۱۲ patients presenting with BAI, ۳۹ cases had local CT scans available for reconstruction. Seven patients were identified as suffering from grade I injuries (flap or thrombus of less than ۱ cm), ۶ from grade II injuries (flap or thrombus of more than ۱ cm), and ۲۶ from grade III injuries (pseudoaneurysm). Among the patients with grade I injuries, ۵۷% were treated surgically and ۴۳% medically with a survival rate of ۱۰۰%. Among the patients with grade II injuries (۶۷% treated surgically and ۳۳% treated medically) survival was also ۱۰۰%. Among patients with grade III injuries (۸۵% treated surgically, ۷% had Thoracic Endovascular Aortic Repair (TEVAR) and ۸% treated medically) survival was ۹۵%, ۹۵% and ۵۰%, respectively. There were no significant differences between groups as to clinical outcome. Interrater reliability was ۰.۸۱. Conclusions: VC is easy to use and has low inter-observer variability. Low grades of injury were associated with low mortality related to medical treatment.

Keywords:

Thoracic Aorta , Trauma , Assessment Patient Outcomes