Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

doi:10.5847/wjem.j.1920-8642.2022.091

Abstract

Abstract:

BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients.

METHODS: A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed.

RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period.

CONCLUSIONS: In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an effective therapeutic option for TAD.

Key words: Blunt trauma, Traumatic aortic dissection, Imaging characteristic, Diagnosis, Delayed thoracic endovascular aortic repair

Li Li, Li-ying Lin, Yuan-qiang Lu. Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience[J]. World Journal of Emergency Medicine, 2022, 13(5): 361-366.

Figures/Tables 3

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Characteristics	Value
Age, years	56.04±16.07
Gender
Male	20 (74.07)
Female	7 (25.93)
Smoking	11 (40.74)
Drinking	8 (29.63)
Hypertension	8 (29.63)
Atherosclerosis	9 (33.33)
Diabetes	1 (3.70)
Initial symptoms
Chest pain	24 (88.89)
Coma	2 (7.41)
Others	1 (3.70)
Intubation status
Not intubation	25 (92.59)
Intubation	2 (7.41)
Injury Severity Score	24.63±6.65
Number of patients with AIS ≥3 by body region
Chest	26 (96.30)
Head, neck	10 (37.04)
Face	0
Abdomen	6 (22.22)
External	0
Extremity	3 (11.11)
Trauma types
Falling injury	8 (29.63)
Motor-vehicle accidents	15 (55.56)
Others	4 (14.81)
Associated injuries
Brain injury	6 (22.22)
Thoracic injury	20 (74.07)
Abdominal injury	5 (18.52)
Pelvic injury	2 (7.41)
Extremity fracture	5 (18.52)
Associated spine fractures
Cervical spine	4 (14.81)
Thoracic spine	8 (29.63)
Lumbar spine	6 (22.22)
Spinal cord injury	1 (3.70)
Treatments
TEVAR	26 (96.30)
Non-operative management	1 (3.70)
Additional treatments
Craniotomy	1 (3.70)
Rib or clavicle fracture surgery	5 (18.52)
Laparotomy	1 (3.70)
Pelvic fracture surgery	2 (7.41)
Spinal fracture surgery	3 (11.11)
Extremity fracture surgery	5 (18.52)
Hospital days	21.04±14.26
In-hospital mortality	0

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