Management and outcome of traumatic aortic injuries

Background and Aims: Aortic injuries are rare and associated with high earl y mortality challenging the surgical services both from a technical as well as organisational point of view, especially in countries with low incidenc e of trauma. A Finnish experience in the management of aortic injuries is r eported with special emphasis on outcome after early involvement of cardiot horacic surgeons. Material and Methods: Retrospective analysis of hospital records identified 36 consecutive patients with aortic injuries arriving alive to the hospita l during a 32-year period of 1967-98. Results: Of the 19 thoracic aortic injuries, 17 (89 %) were caused by blunt trauma, 8 (42 %) of the patients arrived in shock, 7 (37 %) died before re pair could be attempted, 11 (58 %) underwent repair with prosthesis and one (5 %) with sutures, with an overall mortality rate of 9/19 (47 %). Of the 17 patients with abdominal aortic injuries (15 penetrating), 13 (76 %) arri ved in shock, 3 (18 %) died before repair, 13 (76 %) were repaired with sut ures and one (6 %) with prosthesis, with an overall mortality rate of 8/17 (47 %). Fourteen (82 %) of the 17 non-survivors died within 24 hours from t he injury, 13 from exsanguination and one from associated brain injury. Conclusions: Abdominal aortic injuries are usually penetrating, diagnosed i ntraoperatively and amenable to suture repair with good results indicating that stable and unstable patients with potential aortic injuries after pene trating abdominal trauma can safely be managed in hospitals with experience d general surgeons on call. In contrast, stable patients with suspected tho racic aortic injuries could benefit from early transfer to a hospital with cardiothoracic surgical facilities and personnel.