G. Bergman1, J. Hassoun1, L. S. Burkhalter3, G. P. Wools3, J. Tweed4, L. S. Hynan2, F. G. Qureshi1,3 1University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 2University Of Texas Southwestern Medical Center,Department Of Clinical Sciences,Dallas, TX, USA 3Children’s Medical Center,Pediatric Surgery,Dallas, Tx, USA 4Children’s Medical Center,Trauma Services,Dallas, TX, USA
Introduction: Blunt traumatic aortic injuries are rare in children and management strategies are not well defined. These injuries can be managed expectantly, via open operation, or with endovascular techniques. We evaluated pediatric blunt aortic injuries at a level I pediatric trauma center over a ten-year period, focusing on management and outcomes between intervention and nonintervention groups.
Methods: After IRB approval, a retrospective chart review occurred. Demographics, injury mechanisms, associated injuries, injury severity score (ISS), management, and outcome data were collected and analyzed with SPSS. Data is presented as counts and percentage, or mean and standard deviation as appropriate. Fisher’s Exact Test was employed to test difference between groups.
Results: In a facility with an average of 1,200 trauma admission annually, 14 suffered blunt aortic injuries, 9 (65%) were males, average 9.6 (±3.2) years of age, there were 12 abdominal and two thoracic aortic injuries. Average ISS of 30 (±12.3), in which all patients survived to hospital discharge. All were passengers in a vehicle with restraint status including lap and shoulder belt (n=6, 43%), lap belt alone (n=5, 36%), or restrained but unspecified (n=3, 21%). Thirteen (93%) patients had documented seatbelt signs. Aortic injuries included three (21%) intimal tears, three (21%) pseudo aneurysms, three (21%) dissections, two (14%) transections, and three (21%) with a combination of injuries. All patients had at least one associated injuries including bowel (79%), chance fractures (50%), and solid organ (36%). Exploratory laparotomy was required in 12 (86%) patients with 10 being immediate operations. A total of five patients required open abdominal aortic repair, three performed immediately, one on second-look laparotomy, and one in conjunction with a delayed laparotomy. Open repair methods included thrombectomy with patch (3/5, 60%) and PTFE graft (2/5, 40%). Two patients underwent endovascular repair. The remaining seven were managed conservatively. Surgical intervention and non-surgical intervention patients were similar in demographics and ISS. As seen in table 1, the groups did not significantly differ terms of presentation or associated injuries.
Conclusions: Blunt aortic injuries are rare in the pediatric population, but have excellent survival outcomes. Vascular management is varied and determined by type of aortic injury and clinical findings. While sample size is small, there are no apparent differences apart from severity of aortic injury between those requiring intervention and those that do not.
