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OBJECTIVES: Aortic transection (AT) is rare; information on elderly patients with AT has not been published. This study describes the clinical spectrum and evaluates the treatment outcomes of AT in a cohort of elderly patients.
METHODS: All patients > 80 years with AT treated in a Level 1 trauma center over a 19-year period were included. Outcomes of interest were length of intensive care unit (ICU) and hospital stay (LOS), and
early morbidity and mortality.
RESULTS: There were 5 (50%) males and 5 (50%) female patients with AT and mean age of 86 years (range from 80 to 95). All ATs were secondary to blunt trauma. All but one patient who fell were involved in motor vehicle accidents. The mean ISS was 29±12. The most significant component of the ISS was thorax followed by head trauma. Two (20%)patients (ISS=36 and 33) succumbed in the emergency department during initial evaluation and 6 (60%) patients were treated nonoperatively. The remaining 2 (20%) patients (88 and 84 years) underwent open aortic repair with patch angioplasty and Dacron interposition graft. No postoperative paraplegia and stroke related to surgery occurred. All but two admitted patients died in the ICU with a median stay of 12 days (range, 1 to 65). An 87-year-old male treated nonoperatively (ISS=50) and an 88-year-old (ISS=21) male treated with aortic interposition graft survived, and were discharge to a rehabilitation facility. The length of LOS and ICU stay for those two survivors were 23 and 75, and 21 and 62 days.
CONCLUSIONS: AT in elderly patients carries high mortality rates regardless of head injury or overall ISS. A prolonged LOS and ICU stay can be anticipated. It remains to be investigated whether or not endovascular therapy can decrease mortality, expedite discharge, and ultimately reduce the burden on healthcare costs in this
subset of patients.