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Citation
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Jammeh ML, Ohman JW, Reed NR, English SJ, Jim J, Geraghty PJ. Ann. Vasc. Surg. 2020; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: "Seatbelt-type" pediatric abdominal aortic trauma is uncommon but potentially lethal. During high speed motor vehicle collisions (MVCs), seat or lap belt restraints may concentrate forces in a band-like pattern across the abdomen, resulting in the triad of hollow viscus perforation, spine fracture and aorto-iliac injury. We report four cases of pediatric seatbelt-type aortic trauma, and review management strategies for the aortic disruption and the associated constellation of injuries.
METHODS: IRB-approved, retrospective review of all pediatric patients requiring surgical intervention for seatbelt-type constellation of abdominal aortic/iliac and associated injuries over a 5-year period. Blunt thoracic aortic injuries were excluded.
RESULTS: We identified 4 patients, ranging from 2 to 17 years of age, who required surgical correction of seatbelt-type aorto-iliac trauma and associated injuries: 3 abdominal aorta (AA) and 1 left common iliac artery (LCIA). The majority (3/4 patients) were hemodynamically unstable at ER presentation, and all underwent CT angiography of chest/abdomen/pelvis during initial resuscitation. Injuries of the suprarenal and proximal infrarenal aorta were accompanied by unilateral renal artery avulsion requiring nephrectomy. Presumed or proven spinal instability mandated supine positioning and midline laparotomy, with medial visceral rotation utilized for proximal injuries. Aorto-iliac injuries requiring repair were accompanied by significant distal intraluminal prolapse of dissected intima, with varying degrees of obstruction. Conduit selection was dictated by the presence of enteric contamination and the rapid availability of autologous conduit. The sole neurologic deficit was irreparable at presentation.
CONCLUSION: Seatbelt aorto-iliac injuries in pediatric patients require prompt multidisciplinary evaluation. Evidence of contained aorto-iliac transection, major branch vessel avulsion, and bowel perforation mandates immediate exploration, which generally precedes spinal interventions. Lesser degrees of aorto-iliac injury have been managed with surveillance, but long-term follow up is needed to fully validate this approach.
Language: en |