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Alzerwi NAN. Effect of the Profit and Teaching Status of Hospitals on the Patterns and Outcomes of Abdominal Aorta and Inferior Vena Cava Injuries after Severe Abdominal Trauma. Emerg Med Int 2023; 2023:5616007. [PMID: 37599812 PMCID: PMC10438973 DOI: 10.1155/2023/5616007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Background The inferior vena cava (IVC) and the abdominal aorta (AA) are two important blood vessels located in the abdomen. The outcomes of such injuries rely heavily on the experience, expertise, and resources available at the hospital where the patient is treated. However, our current understanding of the potential impact of the hospital profit and teaching status on surgical outcomes in the context of traumatic injuries to the IVC and AA remains limited, making it important to investigate the potential association between these hospital characteristics and patient outcomes to enhance the quality of care and optimize treatment strategies. Objective This study aimed to compare demographics, trauma characteristics, and outcomes between nonprofit status (NPSH) and for-profit hospital status (FPSH), as well as among community hospitals (CHs), nonteaching hospitals (NTHs), and university hospitals (UHs), in patients with severe abdominal trauma and abdominal aorta injury (AAI), inferior vena cava injury (IVCI), and both (AAI + IVCI). Methods Demographics, trauma, and outcome measures associated with AAI, IVCI, and AAI + IVCI were compared between the different profit and teaching status groups using NTDB. Multivariate regression was used to identify independent factors associated with death under care (DUC). Results In the 2017 NTDB-RDS, 1,479 patients met the inclusion criteria, resulting in an overall incidence of 0.17% for AAI, IVCI, and AAI + IVCI after severe abdominal trauma. More patients died under care in the FPSH group than in the NPSH group (nonprofit vs. for-profit: 60.3% vs. 47.2%; P < 0.001). The results indicated that FPSH independently affected DUC. NTH had no significant effect on DUC; although the in-hospital complication rate varied with NTH, no independent association was observed. Conclusions The study findings demonstrated that in patients with severe abdominal trauma, including injuries to AAI, IVCI, or both (AAI + IVCI), the profit status of hospitals, rather than the teaching status, had a substantial influence on DUC. Future studies should examine differences in the volume of cases and levels of trauma centers to better understand how to improve patient outcomes in FPSH.
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Affiliation(s)
- Nasser A. N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, P. O. Box 66, Al-Majmaah 11952, Riyadh, Saudi Arabia
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Böckler D, Hatzl J, Bischoff MS, Chang DH, Meisenbacher K, Peters A. [Intra-abdominal vascular injuries after blunt abdominal trauma]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01931-9. [PMID: 37470862 PMCID: PMC10374704 DOI: 10.1007/s00104-023-01931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
Vascular injuries and hemorrhaging are serious potential complications in the management of patients with blunt abdominal trauma. The treatment depends on the extent and localization and can range from surveillance to endovascular treatment up to open surgery. The keys to success include the focused assessment with sonography for trauma (FAST) management and timely decision making. Abdominal vascular trauma continues to be a difficult problem and open and endovascular techniques continue to evolve in order to address this complex disease process.
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Affiliation(s)
- D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - J Hatzl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - M S Bischoff
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - De Hua Chang
- Klinik für Radiodiagnostik und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - K Meisenbacher
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - A Peters
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
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Li M, Yan Y, Wang C, Tu H. Hospital mortality of blunt abdominal aortic injury (BAAI): a systematic review and meta-analysis. World J Emerg Surg 2023; 18:26. [PMID: 36991444 DOI: 10.1186/s13017-023-00492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Studies on the mortality of blunt abdominal aortic injury (BAAI) are rare and have yielded inconsistent results. In the present study, we aimed to quantitatively analyse the retrieved data to more accurately determine the hospital mortality of BAAI. METHODS The Excerpta Medica Database, PubMed, Web of Science and Cochrane Library databases were searched to identify relevant publications without date restrictions. The overall hospital mortality (OHM) of BAAI patients was set as the primary outcome measure. English publications with data that met the selection criteria were included. The quality of all included studies was assessed by the Joanna Briggs Institute checklist and the American Agency for Health Care Quality and Research's cross-sectional study quality evaluation items. After data extraction, a meta-analysis of the Freeman-Tukey double arcsine transformation of data was performed using the Metaprop command in Stata 16 software. Heterogeneity was assessed and reported as a percentage using the I2 index value and as a P value using the Cochrane Q test. Various methods were used to determine the sources of heterogeneity and to analyse the sensitivity of the computation model. RESULTS Of the 2147 references screened, 5 studies that involved 1593 patients met the selection criteria and were included. There were no low-quality references after assessment. One study that only included 16 juvenile BAAI patients was excluded from the meta-analysis of the primary outcome measure due to high heterogeneity. Due to the low heterogeneity (I2 = 47.6%, P = 0.126 for Q test) that was observed after using the random effects model, the fixed model was subsequently used to pool the effect sizes of the remaining four studies, thus yielding an OHM of 28.8% [95% confidence interval (CI) 26.5-31.1%]. The stability of the model was verified by sensitivity analysis, and Egger's test (P = 0.339) indicated a low level of publication bias. In addition, we also performed meta-analyses and obtained a pooled hospital mortality of operation (13.5%, 95% CI 8.0-20.0%), a pooled hospital mortality of non-operation (28.4%, 95% CI 25.9-31.0%), and a pooled rate of aortic rupture (12.2%, 95% CI 7.0-18.5%) of BAAI. CONCLUSIONS The present study indicated that BAAI has an OHM of 28.8%, indicating that this disease deserves more attention and research.
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Affiliation(s)
- Mingxuan Li
- Department of Vascular Surgery, Beijing Fengtai You'anmen Hospital, 199 Youanmenwai St, Fengtai District, Beijing, China
| | - Yu Yan
- Department of Vascular Surgery, Beijing Fengtai You'anmen Hospital, 199 Youanmenwai St, Fengtai District, Beijing, China
| | - Chaonan Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haixia Tu
- Department of Vascular Surgery, Beijing Fengtai You'anmen Hospital, 199 Youanmenwai St, Fengtai District, Beijing, China.
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Lučev J, Breznik S, Lamanovska B, Šumer P, Slanič A. Endovascular Aortic Repair After Abdominal Aortic Injury in a Patient With an Aberrant Renal Artery. Cureus 2022; 14:e31450. [DOI: 10.7759/cureus.31450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
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Characteristics, treatments, and outcomes among patients with abdominal aortic injury in Japan: a nationwide cohort study. World J Emerg Surg 2019; 14:43. [PMID: 31467588 PMCID: PMC6712638 DOI: 10.1186/s13017-019-0262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/16/2019] [Indexed: 11/14/2022] Open
Abstract
Background Abdominal aortic injury (AAI) is a life-threatening condition that occurs in only 0.1% of all trauma admissions. Because of its rarity, the clinical features of AAI remain unclear. We investigated the characteristics, treatments, and clinical outcomes among patients with AAI. Methods This retrospective cohort study was performed using the Japanese Diagnosis Procedure Combination database. We identified patients with a confirmed diagnosis of AAI with emergency admission from 1 July 2010 to 31 March 2017. Eligible patients were divided into three groups: those who were treated with no surgery or endovascular treatment (non-repair group), those who underwent surgery without endovascular treatment (open repair group), and those who received endovascular treatment without surgery (endovascular repair group). Results A total of 238 patients met the inclusion criteria during the study period. Of these, 191 (80.3%) were allocated to the non-repair group, 20 (8.4%) were allocated to the open repair group, and 27 (11.3%) were allocated to the endovascular repair group. The proportions of patients in the non-repair group from July 2010 to March 2012, April 2012 to March 2014, April 2014 to March 2016, and April 2016 to March 2017 were 93.5%, 75.9%, 80.6%, and 73.2%, respectively. The crude in-hospital mortality rate was 26.2%, 35.0%, and 18.5% in the non-repair, open repair, and endovascular repair group, respectively. Conclusions In this cohort, the proportion of non-repair for AAI decreased from 2010 to 2017, whereas the proportion of endovascular repair increased. Younger patients were more likely to undergo open repair, whereas older patients were more likely to undergo endovascular repair.
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Tsai R, Raptis D, Raptis C, Mellnick VM. Traumatic abdominal aortic injury: clinical considerations for the diagnostic radiologist. Abdom Radiol (NY) 2018; 43:1084-1093. [PMID: 29492608 DOI: 10.1007/s00261-018-1523-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Traumatic abdominal aortic injury (TAAI) is a severe complication of penetrating and blunt trauma with significant morbidity and mortality, particularly if diagnosis is delayed. In patients with life-threatening injuries, accurate and prompt diagnosis of TAAI can be made with computed tomography (CT). Once the diagnosis of TAAI is made, the radiologist should provide an accurate description of the aortic lesion and the extent of injury in order to guide management whether it be non-operative, open aortic repair, or endoluminal stent repair. The purpose of this article is to review the key imaging aspects of TAAI and to discuss how the key CT imaging findings affect clinical management.
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Affiliation(s)
- Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA.
| | - Demetrios Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| | - Constantine Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
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Kalsi R, Drucker CB, Salazar JH, Luther LI, Diaz JJ, Kundi R. Blunt multifocal aortic injury with abdominal aortic intimointimal intussusception. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:37-40. [PMID: 29556589 PMCID: PMC5856673 DOI: 10.1016/j.jvscit.2017.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 11/26/2017] [Indexed: 11/28/2022]
Abstract
Blunt abdominal aortic injury is an infrequent occurrence after blunt trauma. The majority of these injuries result from deceleration forces sustained in motor vehicle collisions. Effects of these forces on the thoracic aorta are well described, but associated spinal compression or distraction can also lead to injury of the affixed abdominal aorta. We present a case of multifocal blunt thoracic and abdominal aortic injury with circumferential abdominal aortic dissection, resulting in aortoaortic intussusception associated with a thoracolumbar spinal injury. The unique diagnostic challenge and subsequent successful endovascular management of a rare nonocclusive abdominal aortic intussusception are herein discussed.
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Affiliation(s)
- Richa Kalsi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Charles B Drucker
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jose H Salazar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Lauren I Luther
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jose J Diaz
- R. Adams Cowley Shock Trauma Center, Baltimore, Md.,Division of Acute Care Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Rishi Kundi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
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Chandhok P, Civil ID. Intraabdominal Vascular Injuries in Blunt Trauma: Spectrum of Presentation, Severity and Management Options. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khattak MN, Olivero EV, Curi MA, Dhadwal AK, Padberg FT, Huang JT. Isolated blunt abdominal aortic injury without concomitant abdominal injuries treated with endovascular stent grafting. J Vasc Surg Cases 2015; 1:258-260. [PMID: 31724636 PMCID: PMC6849973 DOI: 10.1016/j.jvsc.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022] Open
Abstract
Blunt injury of the abdominal aorta is a rare event, seen in only 0.07% to 0.17% of all blunt traumas. These injuries are frequently associated with other intra-abdominal injuries, with high rates of morbidity and mortality. We present a case of isolated blunt abdominal aortic trauma to the infrarenal aorta without concomitant abdominal or spinal injuries. The patient was treated with endovascular aortic stent grafting and is without complications 12 months after the procedure.
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Affiliation(s)
- Monica N Khattak
- Division of Vascular Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Eric V Olivero
- Division of Vascular Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael A Curi
- Division of Vascular Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Ajay K Dhadwal
- Division of Vascular Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Frank T Padberg
- Division of Vascular Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Joe T Huang
- Division of Vascular Surgery, Rutgers New Jersey Medical School, Newark, NJ
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Lin CC, Liu KS, Chen HW, Huang YK, Chu JJ, Tsai FC, Lin PJ. Blunt aortic injury: risk factors and impact of surgical approaches. Surg Today 2015; 46:188-96. [PMID: 25843942 DOI: 10.1007/s00595-015-1152-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study reviews our 17-year experience of managing blunt traumatic aortic injury (BTAI). METHODS We analyzed information collected retrospectively from a tertiary trauma center. RESULTS Between October 1995 and June 2012, 88 patients (74 male and 14 female) with a mean age of 39.9 ± 17.9 years (range 15-79 years) with proven BTAI were enrolled in this study. Their GCS, ISS, and RTS scores were 12.9 ± 3.7, 29.2 ± 9.8, and 6.9 ± 1.4, respectively. Twenty-one (23.8 %) patients were managed non-operatively, 49 (55.7 %) with open surgical repair, and 18 (20.5 %) with endovascular repair. The in-hospital mortality rate was 17.1 % (15/81) and there were no deaths in the endovascular repair group. The mean follow-up period was 39.9 ± 44.2 months. The survivors of blunt aortic injury had lower ISS, RTS, TRISS, and serum creatinine level and lower rate of massive blood transfusion, shock, and intubation than the patients who died, despite higher rates of endovascular repair, hemoglobin, and GCS on presentation. The degree of aortic injury, different therapeutic options, GCS, shock presentation, and intubation on arrival all had significant impacts on outcome. CONCLUSIONS Shock, aortic injury severity, coexisting trauma severity, and different surgical approaches impact survival. Endovascular repair achieves a superior mid-term result and is a reasonable option for treating BTAI.
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Affiliation(s)
- Chien-Chao Lin
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc
| | - Kuo-Sheng Liu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc
| | - Huan-Wu Chen
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc.
| | - Jaw-Ji Chu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc
| | - Pyng Jing Lin
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi and Linkou Center, College of Medicine, Chang Gung University, 6.West Sec. Chiapu Road, Putzu City, Chiayi Hsien, 61636, Taiwan, Roc
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Blunt abdominal aortic injury: a Western Trauma Association multicenter study. J Trauma Acute Care Surg 2015; 77:879-85; discussion 885. [PMID: 25248064 DOI: 10.1097/ta.0000000000000353] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blunt abdominal aortic injury (BAAI) is a rare injury. The objective of the current study was to examine the presentation and management of BAAI at a multi-institutional level. METHODS The Western Trauma Association Multi-Center Trials conducted a study of BAAI from 1996 to 2011. Data collected included demographics, injury mechanism, associated injuries, interventions, and complications. RESULTS Of 392,315 blunt trauma patients, 113 (0.03%) presented with BAAI at 12 major trauma centers (67% male; median age, 38 years; range, 6-88; median Injury Severity Score [ISS], 34; range, 16-75). The leading cause of injury was motor vehicle collisions (60%). Hypotension was documented in 47% of the cases. The most commonly associated injuries were spine fractures (44%) and pneumothorax/hemothorax (42%). Solid organ, small bowel, and large bowel injuries occurred in 38%, 35%, and 28% respectively. BAAI presented as free aortic rupture (32%), pseudoaneurysm (16%), and injuries without aortic external contour abnormality on computed tomography such as large intimal flaps (34%) or intimal tears (18%). Open and endovascular repairs were undertaken as first-choice therapy in 43% and 15% of cases, respectively. Choice of management varied by type of BAAI: 89% of intimal tears were managed nonoperatively, and 96% of aortic ruptures were treated with open repair. Overall mortality was 39%, the majority (68%) occurring in the first 24 hours because of hemorrhage or cardiac arrest. The highest mortality was associated with Zone II aortic ruptures (92%). Follow-up was documented in 38% of live discharges. CONCLUSION This is the largest BAAI series reported to date. BAAI presents as a spectrum of injury ranging from minimal aortic injury to aortic rupture. Nonoperative management is successful in uncomplicated cases without external aortic contour abnormality on computed tomography. Highest mortality occurred in free aortic ruptures, suggesting that alternative measures of early noncompressible torso hemorrhage control are warranted. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV.
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Endovascular Repair of an Asymptomatic Aortic Pseudoaneurysm after Penetrating Injury. Ann Vasc Surg 2014; 28:1933.e15-8. [DOI: 10.1016/j.avsg.2014.06.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/30/2014] [Accepted: 06/19/2014] [Indexed: 11/21/2022]
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