Predictors of Blunt Abdominal Aortic Injury in Trauma Patients and Analysis for Mortality

Female sex is independently associated with reduced inpatient mortality after endovascular repair of blunt thoracic aortic injury

BACKGROUND

Female sex has been associated with decreased mortality after blunt trauma, but whether sex influences the outcomes of thoracic endovascular aortic repair (TEVAR) for traumatic blunt thoracic aortic injury (BTAI) is unknown.

METHODS

In this retrospective study of a prospectively maintained database, the Vascular Quality Initiative registry was queried from 2013 to 2020 for patients undergoing TEVAR for BTAI. Univariate Student's t-tests and χ² tests were performed, followed by multivariate logistic regression for variables associated with inpatient mortality.

RESULTS

Of 806 eligible patients, 211 (26.2%) were female. Female patients were older (47.9 vs 41.8 years, P < .0001) and less likely to smoke (38.3% vs 48.2%, P = .044). Most patients presented with grade III BTAI (54.5% female, 53.6% male), followed by grade IV (19.0% female, 19.5% male). Mean Injury Severity Scores (30.9 + 20.3 female, 30.5 + 18.8 male) and regional Abbreviated Injury Score did not vary by sex. Postoperatively, female patients were less likely to die as inpatients (3.8% vs 7.9%, P = .042) and to be discharged home (41.4% vs 52.2%, P = .008). On multivariate logistic regression, female sex (odds ratio [OR]: 0.05, P = .002) was associated with reduced inpatient mortality. Advanced age (OR: 1.06, P < .001), postoperative transfusion (OR: 1.05, P = .043), increased Injury Severity Score (OR: 1.03, P = .039), postoperative stroke (OR: 9.09, P = .016), postoperative myocardial infarction (OR: 9.9, P = .017), and left subclavian coverage (OR: 2.7, P = .029) were associated with inpatient death.

CONCLUSIONS

Female sex is associated with lower odds of inpatient mortality after TEVAR for BTAI, independent of age, injury severity, BTAI grade, and postoperative complications. Further study of the influence of sex on postdischarge outcomes is needed.

Exposure of the abdominal aorta and visceral branches for hemorrhage control: A 2020 EAST Master Class Video Presentation

BACKGROUND

Rapid control of abdominal hemorrhage is a potentially life-saving surgical skill. Although open exposure and control of the abdominal aorta and its visceral branches is a fundamental part of surgical training, familiarity with the anatomy and spacial relationships of the surrounding structures can be challenging for even the experienced surgeon.

CONTENT (DESCRIPTION OF VIDEO)

Using a fresh perfused cadaver, this video provides a step by step visual guide for aortic exposure from the diaphragmatic hiatus to the iliac bifurcation. Key maneuvers including control of the supraceliac aorta, left medial visceral rotation with identification of superior mesenteric and celiac arteries, and exposure of the perirenal aorta and proximal renal vessels are outlined. Damage control and definitive management strategies are discussed and potential tips and pitfalls in addressing intraabdominal hemorrhage are highlighted.

CONCLUSION

The critical application of aortic exposure for hemorrhage control is a life-saving intervention if done rapidly and effectively. This requires a sound understanding of aortic anatomy and necessary steps for adequate exposure and subsequent repair. This video outlines the necessary steps to perform these interventions.