Post-Traumatic Resuscitation Affects Stent Graft Sizing in Patients with Blunt Aortic Injury
Jordan Hoffman, Laura S Johnson, Luke P Brewster, Yazan Duwayri, James G Reeves, Ravi K Veeraswamy, Tom F Dodson, Ravi R Rajani
Emory University, Atlanta, GA
INTRODUCTION: Patients with blunt aortic injury have also often suffered extra-thoracic trauma that results in a hypovolemic state. The effect of post-traumatic resuscitation on aortic diameter has implications for stent graft sizing. Furthermore, the potential utility of repeat aortic imaging following resuscitation remains unclear.
METHODS: A retrospective chart review of all patients presenting to a level I trauma center between the years 2007 and 2011 was performed. All patients with two preoperative computed tomography (CT) scans of the chest were selected. Exclusion criteria were resuscitation at an outside hospital or fewer than two CT exams of the chest. Aortic centerline of flow reconstruction of available scans was performed. Patient demographics including pre- and post- resuscitation aortic diameter were collected. A one-sample t-test was used to compare aortic size changes before and after resuscitation.
RESULTS: Fifty-two total patients with blunt aortic injury were identified. Nine patients had undergone two pre-repair CT scans and were candidates for analysis. The mean pre-resuscitation proximal aortic diameter was 23.1 mm (21 - 25 mm). The mean post-resuscitation proximal aortic diameter was 24.9 mm (21 - 29 mm). The mean pre-resuscitation distal aortic diameter was 23.6 mm (20 - 28 mm). The mean post-resuscitation distal aortic diameter was 24.6 mm (21-28 mm). After resuscitation, there was an average increase of 1.8 mm (-2 - 5 mm; p = 0.03) in the proximal aortic diameter and an average increase of 0.9 mm (-2 - 3 mm; p = 0.069) in the distal aortic diameter.
CONCLUSIONS: Following post-traumatic resuscitation, there is a statistically significant increase in proximal aortic diameter and a trend towards increases in distal aortic diameter. While the difference in size remains small, it may be beneficial in severely hypovolemic patients to reimage the aorta after resuscitation purely for stent graft sizing purposes.
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