Abdominal aortic injury

Abdominal aortic injuries are a very rare form of traumatic aortic injury and are much less common than thoracic aortic injury. 

Epidemiology

Aortic injury occurs in <1% of blunt trauma patients, with abdominal aortic injury representing only ~5% of all aortic injuries ¹. Males are more frequently injured, with the median age ~30 years ⁵. 

Pathology

Abdominal aortic injuries are most commonly from a deceleration in motor vehicle accidents and range from intimal tears/flaps (minimal aortic injury), pseudoaneurysm to aortic transection ³. Aortic wall rupture can be due to branch avulsion ⁵.

Location

• level of the inferior mesenteric artery (~33%)
• level of renal arteries (~25%)
• inferior to the inferior mesenteric artery (~20%) ³

Aetiology

• blunt trauma
  • motor vehicle collisions (~70%) ^2,3
  • crush injuries (~20%) ³
• penetrating trauma
  • gunshot injuries more than stabbing ⁵
• iatrogenic trauma

Associations

Associated traumatic injuries in blunt abdominal aortic injury include ^2,5:

• retroperitoneal haematoma (50%)
• bowel and mesenteric injury, especially small bowel (up to 40%)
• lumbar spine fracture (~25%)
• pelvic fracture (~20%)
• splenic injury (~20%)
• thoracic aortic injury (<10%)
• inferior vena caval injury (<10%)
• renal and iliac artery injury
• hepatic, renal and pancreatic injury

Radiographic features

The radiographic features are not dissimilar to thoracic aortic injuries ⁴. The seatbelt sign is positive in ~35% of cases ⁵.

Treatment and prognosis

Most (~90%) abdominal aortic injuries are managed non-operatively. Those who require operative management, endovascular repair is more common ². Mortality is reported at 30% ^2,3.