What is the management approach for an aortic aneurysm resulting from a motor vehicle accident and trauma?

From the Guidelines

Management of a traumatic aortic aneurysm from a motor vehicle accident requires immediate stabilization and specialized care, with a preference for endovascular repair (TEVAR) over open surgical repair in stable patients due to lower morbidity and mortality, as recommended by the 2024 ESC guidelines 1. The initial management focuses on hemodynamic stabilization with blood pressure control using beta-blockers (such as labetalol 10-20 mg IV or esmolol 50-200 μg/kg/min) to maintain systolic blood pressure between 100-120 mmHg, reducing shear forces on the damaged aorta. Some key points to consider in the management of traumatic aortic aneurysms include:

• Concurrent pain management with opioids and fluid resuscitation are essential
• Immediate imaging with CT angiography is crucial for diagnosis and surgical planning
• For contained aneurysms in stable patients, TEVAR is preferred over open surgical repair due to lower morbidity and mortality
• In unstable patients with active bleeding, emergency surgery is necessary
• Post-procedure, patients require ICU monitoring, continued blood pressure control, serial imaging to assess repair integrity, and long-term follow-up The use of CT angiography for diagnosis and surgical planning is supported by studies such as the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines 1, which highlight the importance of prompt and accurate diagnosis in traumatic aortic injuries. The 2024 ESC guidelines 1 provide recommendations for the management of traumatic aortic injury, including the use of TEVAR in suitable cases, and emphasize the importance of medical therapy, including pain relief, blood pressure control, and heart rate control, in all patients with traumatic aortic injury. Overall, the management of traumatic aortic aneurysms requires a multidisciplinary approach, with a focus on prompt diagnosis, hemodynamic stabilization, and surgical intervention to prevent rupture and improve outcomes.

From the Research

Management Approach for Aortic Aneurysm Resulting from Motor Vehicle Accident and Trauma

The management approach for an aortic aneurysm resulting from a motor vehicle accident and trauma involves several key considerations, including:

• Early diagnosis and immediate surgery for acute aortic lesions 2
• Use of extracorporeal circulatory assistance (CA) or aortic cross clamping alone for surgical repair 2
• Prosthetic graft interposition or direct suture for repair of the aortic lesion 2
• Consideration of exploratory laparotomy after every acute aortic repair to rule out associated abdominal injuries 2

Diagnostic Considerations

• Computed tomography (CT) findings are crucial in diagnosing traumatic aortic injuries, with typical injury patterns including intimal flaps, false aneurysms, and ruptures 3
• Diagnostic pitfalls and injury mimics must be considered to avoid misdiagnosis 3

Treatment Options

• Open or endovascular repair are viable options for traumatic aortic injuries, with endovascular repair offering a less invasive alternative to conventional surgery 3, 4
• Delayed repair of traumatic aortic injuries has significant survival benefits and a lower mortality rate compared to early open repair 4
• Endovascular stent grafts for the thoracic aorta represent a valid and efficacious alternative to surgery, but long-term complications must be considered 4

Chronic Traumatic Aortic Aneurysm

• Surgical intervention for chronic traumatic aortic aneurysm is considered on a case-by-case basis, with guidelines including operation for new symptoms or asymptomatic densely calcified aneurysms detected more than 2 years after the accident 5
• Operative treatment is required in the presence of an intimal flap or an aneurysm, with resection and replacement by a graft being a common approach 6