Simultaneous traumatic brain injury (TBI) and aortic injury has been considered unsurvivable for many years because treatments such as sedation and blood pressure goals conflict for these 2 conditions. Additionally, surgical interventions for aortic injury often require full anticoagulation, which is contraindicated in patients with TBI. For these reasons, and due to the relative rarity of aortic injury/TBI, little data are available to guide treating physicians.
A retrospective review was performed on all simultaneous TBI and aortic injury cases from 2000 to 2012 at a university-affiliated, Level I trauma center. Patient demographics, imaging studies, interventions, and outcomes were analyzed. Traumatic brain injury/aortic injury cases treated with endovascular stenting were specifically studied to determine trends in procedure timing, use of anticoagulation, and neurological outcome.
Thirty-three patients with concurrent TBI and aortic injury were identified over a 12-year period. The median patient age was 44 years (range 16–86 years) and the overall mortality rate after imaging diagnosis was 46%. All surviving patients were awake and neurologically functional at discharge, and 83% were discharged home or to rehabilitation facilities. Patients who died had a higher Injury Severity Scale score (p = 0.006). Severe TBI (p = 0.045) or hemodynamic instability (p = 0.015) upon arrival to the hospital was also correlated with increased mortality rates. Thirty-three percent of aortic injury/TBI patients (n = 11) underwent endovascular stenting, and 7 of these patients received intravenous anticoagulation therapy at the time of surgery. Six of these 7 anticoagulation-treated patients experienced no significant progression on postoperative brain CT, whereas 1 patient died of hemodynamic instability prior to undergoing further imaging.
Simultaneous TBI and aortic injury is a rare condition with a historically poor prognosis. However, these results suggest that many patients can survive with a good quality of life. Technological advances such as endovascular aortic stenting may improve patient outcome, and anticoagulation is not absolutely contraindicated after TBI.
Abbreviations used in this paper:GCS = Glasgow Coma Scale; ISS = Injury Severity Scale; SAH = subarachnoid hemorrhage; SDH = subdural hematoma; TBI = traumatic brain injury.
Address correspondence to: M. Ross Bullock, M.D., Ph.D., Department of Neurosurgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, 1095 NW 14th Terrace, Miami, FL 33136. email: firstname.lastname@example.org.
Please include this information when citing this paper: published online June 14, 2013; DOI: 10.3171/2013.5.JNS1397.
AndrewsPJSleemanDHStathamPFMcQuattACorrubleVJonesPA: Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression. J Neurosurg97:326–3362002
DakeMDWhiteRADiethrichEBGreenbergRKCriadoFJBavariaJE: Report on endograft management of traumatic thoracic aortic transections at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg53:1091–10962011
DemetriadesDVelmahosGCScaleaTMJurkovichGJKarmy-JonesRTeixeiraPG: Blunt traumatic thoracic aortic injuries: early or delayed repair—results of an American Association for the Surgery of Trauma prospective study. J Trauma66:967–9732009
HongMSFeezorRJLeeWANelsonPR: The advent of thoracic endovascular aortic repair is associated with broadened treatment eligibility and decreased overall mortality in traumatic thoracic aortic injury. J Vasc Surg53:36–432011
MosqueraVXMariniMLopez-PerezJMMuñiz-GarciaJHerreraJMCaoI: Role of conservative management in traumatic aortic injury: comparison of long-term results of conservative, surgical, and endovascular treatment. J Thorac Cardiovasc Surg142:614–6212011
PhalenHAWolfSENorwoodSHAldyKBrakenridgeSCEastmanAL: A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk traumatic brain injury: The Delayed Versus Early Enoxaparin Prophylaxis I (DEEP I) study. J Trauma Acute Care Surg73:1434–14412012