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Incidence and Outcomes of Vascular Pathology Unrelated to Trauma Found on Computed Tomography Scans for Trauma
Lidie Lajoie, MD, Johan Escribano, MD, Christopher Sangiovanni, BA, Frank Padberg, MD, Ajay Dhadwal, MD, Michael Curi, MD, Timothy Wu, MD, Anastasia Kunac, MD, Joe Huang, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
OBJECTIVES:
The purpose of this study is to characterize the incidence and outcomes of clinically significant vascular pathology unrelated to trauma (VPUT) found by Computed Tomography (CT) scans for trauma.
METHODS:
A retrospective review was conducted at an urban Level 1 trauma center of all patients who underwent CT scans for trauma over 5 years (2009-2014). All patients over 17 years old who had a CT of the neck or torso were reviewed for VPUT. These vascular findings were categorized, along with demographic information, management, and outcomes data for each patient.
RESULTS:
Of the 2866 patients with CT scans performed for trauma during the study period, 415 patients (14%) were found to have VPUT. Compared to patients without VPUT, patients with VPUT were significantly older (mean 68 +/- 16yrs vs 40 +/- 17yrs, p<0.001), more likely to be female (34% vs 25%, p<0.001), and had greater median length of stay (6 days vs 5 days, p<0.001). There were 99 patients (3.5%) with 115 clinically significant VPUT (findings for which intervention or close surveillance is recommended) including: carotid stenosis (36), abdominal aortic aneurysm (25), thoracic aneurysm (24), iliac aneurysm (10), DVT (8), renal artery stenosis in hypertensive patients (5) major arterial occlusion (3), PE (3), splenic aneurysm (1) and aortitis (1). Vascular consultation was obtained in only 19 of these patients (19%). Two patients underwent EVAR for >5cm iliac artery aneurysms during the initial trauma admission. While 64 patients with clinically significant VPUT (65%) have been seen at our institution since trauma admission (median follow up 20 days), only four had vascular-specific follow up. Three vascular-related morbidities occurred in patients with VPUT who did not have vascular consultation or follow up arranged during trauma admission including two cerebrovascular accidents in patients with carotid stenosis and gangrene requiring above knee amputation in a patient with an aortoiliac occlusion.
CONCLUSIONS:
Trauma CT scans frequently demonstrate vascular pathology unrelated to trauma. A collaborative approach with trauma providers to ensure careful review of findings, appropriate referral, and follow up is important to minimize morbidity from incidentally noted vascular pathology. If clinically indicated, operative or endovascular management of vascular pathology should be considered during the trauma admission.
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