Long-term Results of a Decade of Pediatric Aortic Trauma

Limited data are available reporting the long-term results of pediatric patients undergoing emergent aortic repair secondary to blunt or penetrating trauma. Therefore, this analysis was completed to abrogate this deficit. A retrospective review of a prospectively maintained level one pediatric trauma database at a high-volume urban children’s hospital between 2008 and 2018 was completed to capture all cases of traumatic aortic injury and associated demographics, mechanisms, injury severity, treatment, and clinical outcomes. During the time period queried, 2189 children (age <18 years) presented to our facility as a level one trauma activation. Of these cases, a total of 10 patients (0.4%) had a demonstrable thoracic or abdominal aortic injury. The mean age of patients was 10.5 ± 5.7 years old. The mechanism of injury consisted of eight motor vehicle accidents, one pedestrian struck by a vehicle, and one patient struck by a falling boulder. Injuries were identified through computed tomography angiography (n = 9) or autopsy (n = 1) and consisted of six thoracic aortic injuries and four abdominal aortic injuries. Of the study population, seven of the patients underwent open surgical intervention, one underwent endovascular intervention, one was treated with medical management, and one patient expired in the trauma bay before surgery could be performed. Aortic pathologies observed were six transections, two dissections, two occlusions, and one pseudoaneurysm. The mean Injury Severity Score was 37.6 ± 19.9. Four patients underwent nonaortic surgical procedures. Excluding the patient who died in the trauma bay, the mean hospital length of stay was 12.8 ± 4.8 days, with 6.8 ± 4.1 days in the intensive care unit. All nine patients who survived the initial trauma evaluation survived to discharge from the hospital. Mean follow-up was 38.3 ± 43.0 months, during which, we observed no additional mortality and no aortic reintervention. The only endovascular stent deployed remained in stable position without evidence of endoleak or migration. Traumatic aortic injury is exceedingly rare in children and is primarily of blunt etiology in our series. Of the patients who survive the scene, operative repair is associated with excellent perioperative and long-term survival.