Relief from operation for some Aortic injuries patients

Getting operated is a thing of the past for some patients of blunt aortic injury (BAI)—a new study shows that BIA can be safely managed non-operatively with beta-blockade to lower the heart rate and blood pressure.

According to the researchers from the 64th Vascular Annual Meeting, as many as 141 patients with BIA were treated at the University of Washington Medical Center for a ten years study period from Jan. 1, 1999 to Dec. 31, 2008.

Out of the 141 patients, 55 had open repair and 49 had endovascular repair. Survival in those who received an open repair was 69 percent (31 percent mortality) whereas in endovascular procedure was 84 percent (16 percent).

The remaining 36 patients were treated non-operatively with a mortality of 28 percent.

However, none died from their blunt aortic injury.

Rachel Lundgren, vascular fellow from the Center’s Division of Vascular Surgery said that the analysis of the patients was based on type and location of aortic injury (determined by imaging), method of repair, injury severity score, morbidity, and mortality.

Patients who were treated non-operatively showed after-affects like intimal tears (56 percent) and PSA (39 percent) with very few patients having large intimal flaps (5 percent).

Follow-up imaging was observed in 88 percent of survivors treated non-operatively with 35 percent of the injuries remaining stable and a majority (65 percent) completely healing. Most intimal tears healed (14 healed, 2 stable); whereas the LIF and PSA remained stable (LIF 2 stable; PSA 1 healed, 4 stable).

“At this point in time, CT angiography (CTA) has become the new ‘gold standard’ for diagnosing BAI’s and increased utilization of CTA in the work-up of trauma patients has led to increasing diagnosis of MAI,” said Lundgren.

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“At our Center a CTA of the chest is obtained in most high-mechanism or unstable trauma patients and in those with a widened mediastinum on initial chest x-ray, however some patients are transferred from other hospitals with the CT already done,” he said.

Lundgren described this study as a major breakthrough in the management of patients with BAI.

The study was presented by the Society for Vascular Surgery.

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