Clinical Spectrum and Outcome Analysis of Blunt Thoracic Aortic Injuries: a 10-year Experience from a Level I Trauma Center

Blunt traumatic aortic injury is a rare life-threatening injury. Last few decades had witnessed a paradigm shift in the management of blunt traumatic aortic injury. This study was conducted to review the clinical spectrum of thoracic aortic injuries, the different management strategies and their associated outcomes at a level 1 trauma centre. Case series analysis of all the patients admitted with blunt thoracic aortic injuries between January 2010 and December 2020 was done. The primary endpoints were in-hospital mortality and early morbidity between the different grades of aortic injury. The overall incidence of blunt thoracic aortic injury was 0.9% (n = 55). The median age of the cohort was 30 years (IQR, 23–40 years). The predominant mode of injury was road traffic injury involving the vulnerable road users (42.3%). One-third of the patients were hemodynamically unstable on arrival with odds of mortality of 4.5 (Odds ratio 16, 95%CI 2.91–87.7). Grade III aortic injury was predominant (63.5%). Of all, 31 (59.6%) patients underwent endovascular stenting, 19 (36.5%) had NOM and 2 (3.9%) had surgical repair. In-hospital mortality was 21.1%; however, aortic injury–specific mortality was 1.92%. Mortality was highest in operative followed by NOM and endovascular stenting cohorts with 50%, 26.3% and 16.1% respectively. Endovascular stent repair is the preferred mode of treatment in hemodynamically stable patients with blunt thoracic aortic injuries with reduced risk of complications. The final outcome in patients with blunt thoracic aortic injury correlates with the hemodynamic status on arrival, severity of the concomitant injuries and the grade of the aortic injury.