EVOLUTION OF POSTTRAUMATIC AORTIC-ANEURYSM IN THE SUBACUTE PHASE - MAGNETIC-RESONANCE-IMAGING FOLLOW-UP AS A SUPPORT OF THE SURGICAL TIMING

Objectives: A recent surgical series documented that in traumatic aort ic rupture (TAR) a surgical repair postponed to the treatment of assoc iated lesions reduced operative and overall mortality. Nevertheless so me isolated cases may develop to free rupture. Until now, no imaging f ollow-up studies of post-traumatic aortic lesions have been reported i n the early stage. The aim of this study is to analyze the behaviour o f traumatic aortic ruptures in the subacute phase, in order to detect the morphological characteristics of unstable post-traumatic aneurysms . Methods: Twenty-five consecutive patients affected by traumatic aort ic rupture (one intimal hemorrhage, 19 partial lesions and five circum ferential lesions) were admitted to the department of cardiac surgery. Magnetic resonance imaging (MRI) was the imaging method used to confi rm the diagnosis. No one was operated on during the acute phase. All p atients were treated with beta-blockers and vasodilators as well as li mited fluid administration. Delayed surgery was carried out in 18 pati ents at 243 days (+/-127), after the resolution of associated lesions. A scheduled MRI follow-up was performed at 7, 15 and 30 days and imme diately before the operation. The parameters examined were increase of post-traumatic aneurysm, increase of periaortic hematoma and modifica tion of the thoracic associated lesions. Results: At 30 days a 3.0 +/- 3.7 mm median increase of the aneurysm was observed, while in the sub sequent period the lesions became substantially stable, resulting in a 4.4 +/- 3.6 mm increment at the end of the follow-up. The circumferen tial lesions presented a higher increment with respect to the partial lesions. In three cases an augmentation of 6, 7 and 12 mm was detected and surgical repair was anticipated. In 13 cases a periadventitial he matoma surrounding the aortic aneurysm decreased through the time. One case of intimal hemorrhage healed spontaneously, with no aneurysm for mation. Thoracic associated lesions (pleural and pericardial effusions , rib fractures, lung focal contusions and two cases of ARDS) resolved at 30-60 days. Conclusions: Despite common knowledge, considering TAR highly evolutive in the acute and subacute phase, this study demonstr ated that this pathological entity is relatively stable if a proper ph armacological treatment is administrated. MRI follow-up is recommended in order to detect isolated cases of unstable aneurysm. (C) 1998 Else vier Science B.V. All rights reserved.