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Management And Outcomes Of Traumatic Aortic Injuries In Children
Priscilla Tanamal, MD, Sophia Trinh, MD, Claudie Sheahan, MD, Bruce Torrance, III, MD, Amanda Tullos, MD, Melissa Donovan, MD, Malachi Sheahan, III, MD.
Louisiana State University Health Sciences Center, New Orleans, LA, USA.

INTRODUCTION: Although trauma continues to be the primary cause of death in the pediatric population, aortic injuries are rare. Due to the paucity of data, there are no clear management guidelines for the treatment of traumatic aortic injuries in children. The objective of this study is to review the management and outcomes of pediatric aortic injuries at our institution.
METHODS: This was a retrospective review of a prospectively maintained level 1 trauma center registry. All patients ≤18 years of age with traumatic aortic injuries between 2010 and 2023 were included. Demographics, injury grade and location, management and outcome variables were gathered. Descriptive statistics were performed.
RESULTS: Sixteen patients were identified. Nine were male (56.3%). Mean age was 13.25 years (3-18). Mean vital signs at presentation were systolic blood pressure 103.6±19.0 mmHg, heartrate 119.2±25.9, Glasgow coma scale 9.9±5, and injury severity score 28.1±7.4. Mechanism was blunt in 10 cases (62.5%) and penetrating in six (37.5%) (Table 1). Nine of the blunt injuries were from car accidents and one was from a fall. All penetrating injuries were due to firearms. All mortality occurred within <24 hours of presentation (blunt 1/10, 10%; penetrating 4/6, 66.7%). Management of the blunt injuries consisted of endovascular repair (n=5), open repair (n=3), resuscitative thoracotomy (n=1), and anticoagulation alone (n=1). Three patients in the penetrating group were managed with exploratory laparotomy, two with endovascular repair, and one with resuscitative thoracotomy. There were no complications related to repair in either group identified throughout the follow-up. Average follow-up was 1344 days, with a median of 1606 days, (range 92 to 3119 days).
CONCLUSION: Aortic trauma is a rare, but serious entity in the pediatric population. Blunt mechanism is the most common etiology while penetrating is associated with high mortality. In both groups, operative or endovascular repair in those who survived past initial presentation were associated with excellent long-term outcome.

Table 1. Pediatric Aortic Injury Clinical Demographics Abbreviations: MVC, motor vehicle crash; TEVAR, thoracic endovascular aortic repair; EVAR, endovascular aortic repair; IMV, inferior mesenteric artery; SMV, superior mesenteric artery
Mechanism of Injury	Age	Specific MOI	Anatomical Site of Injury	Grade of Injury	Management of Aortic Injury	Outcome	Other Injuries	Follow-up (days)
Blunt	3	MVC	Descending Aorta	III	TEVAR with 10 x 22 mm stent		Cardiac contusion, tricuspid valve injury, sternal fracture	1977
	6	MVC	Infrarenal Aorta	IV	Open repair with 10 mm Dacron tube graft		Small bowel injury	1856
	6	MVC	Aortic bifurcation	III	Open repair with 10 mm aorto-iliac and 8 mm limb to contra iliac		None	3119
	8	MVC	Infrarenal aorta	III	Open repair with 10 mm Dacron tube graft		Renal laceration, spine fracture	1658
	11	MVC	Aortic isthmus	III	TEVAR with 21 x 100 mm stent		Splenic laceration, pneumothorax, femur fracture, rib fracture	123
	14	MVC	Infrarenal aorta	III	EVAR with 16 x 14.5 x 70 mm excluder iliac limb		Sternal fracture, thoracic spine fracture, pulmonary contusion	92
	15	MVC	Infrarenal aorta	II	Anticoagulation		Small bowel injury	471
	16	MVC	Aortic isthmus	III	TEVAR with 21 x 100 mm stent		Pneumothorax, rib fracture, splenic laceration, humerus fracture	843
	16	Fall	Descending aorta	IV	Resuscitative thoracotomy	Death
	17	MVC	Descending aorta	III	TEVAR with 21 x 100 mm stent		Pneumothorax, pelvic fractures, rib fractures, splenic hematoma, liver laceration	2589
Penetrating	15	GSW	Visceral aorta		Exploratory laparotomy	Death	IMV, SMV, colon
	16	GSW	Descending aorta		Resuscitative thoracotomy	Death	Lung laceration
	16	GSW	Descending aorta		TEVAR with 21 x 100 mm stent		Diaphragm, stomach, colon injury; liver laceration	448
	17	GSW	Visceral aorta		Exploratory laparotomy	Death	Stomach and renal injuries
	18	GSW	Visceral aorta		Exploratory laparotomy	Death	Liver laceration
	18	GSW	Descending aorta		TEVAR with 23 x 30 mm excluder cuff		Spine fracture, rib fractures	1606

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