Minimal Aortic Injury: Mechanisms, Imaging Manifestations, Natural                    History, and Management

Kapoor, Harit; Lee, James T.; Orr, Nathan; Nisiewicz, Michael J; Pawley, Barbara; Zagurovskaya, Marianna

doi:10.1148/rg.2020200066

Cited by 17 publications

(14 citation statements)

References 64 publications

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“…6). 22 Although often clinically occult, MAI is a distinct form of ATAI. As of this writing, limited case series have shown more favorable clinical outcomes for those patients with grade I MAIs compared with more classic grade II and III aortic injuries.…”

Section: Discussionmentioning

confidence: 99%

Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience

et al. 2022

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Background Minimal aortic injury (MAI), a subtype of acute traumatic aortic injury, is being increasingly recognized with better imaging techniques. Given conservative management, the role of follow-up imaging albeit important yet has to be defined. Methods All trauma chest computed tomography angiographies (CTAs) at our center between January 2012 and January 2019 were retrospectively reviewed for presence of MAI. MAIs were generally reimaged at 24 to 72 hours and then at a 7- and 30-day interval. Follow-up CTAs were reviewed for stability, progression, or resolution of MAI, along with assessment of injury severity scores (ISS) and concomitant injuries, respectively. Results A total of 17,569 chest CTAs were performed over this period. Incidence of MAI on the initial chest CTA was 113 (0.65%), with 105 patients receiving follow-up CTAs. The first, second, third, and fourth follow-up CTAs were performed at a median of 2, 10, 28, and 261 days, respectively. Forty five (42.9%), 22 (21%), 5 (4.8%), and 1 (1%) of the MAIs were resolved by first, second, third, and fourth follow-up CTAs. Altogether, 21 patients showed stability (mean ISS of 16.6), and 11 demonstrated improvement (mean ISS 25.8) of MAIs. Eight patients had no follow-up CTA (mean ISS 21). No progression to higher-grade injury was observed. Advancing age decreased the odds of MAI resolution on follow-up. A possible trend (p-value 0.22) between increasing ISS and time to resolution of MAIs was noted. Conclusion In our series of acute traumatic MAIs diagnosed on CTA imaging, there was no progression of injuries with conservative management, questioning the necessity of sequential follow-up imaging.

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Section: Discussionmentioning

confidence: 99%

Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience

et al. 2022

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“…[16][17][18] After initiation of intravenous anti-impulse therapy, patients should have a plan for repeat CTA 48 to 72 hours after admission to evaluate for injury progression, which may occur in up to 10% to 15% of cases. 19 If the injury remains stable on repeat imaging, patients should be transitioned to an oral antihypertensive medication regimen. In addition, patients should have interval outpatient imaging to confirm healing of the injury, which should occur in most cases within 8 weeks of injury.…”

Section: E Management Of Low-grade Injuriesmentioning

confidence: 99%

“…The majority of low-grade injuries (grades I and II) can be managed with anti-impulse therapy alone 16–18 . After initiation of intravenous anti-impulse therapy, patients should have a plan for repeat CTA 48 to 72 hours after admission to evaluate for injury progression, which may occur in up to 10% to 15% of cases 19 . If the injury remains stable on repeat imaging, patients should be transitioned to an oral antihypertensive medication regimen.…”

Section: Algorithmmentioning

confidence: 99%

Blunt thoracic aortic injury: A Western Trauma Association critical decisions algorithm

Brown

Moya

Brasel

et al. 2022

J Trauma Acute Care Surg

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“…Such LIT lesions are typically managed according to the Stanford classification of aortic dissections ( 5 ). Furthermore, in the setting of traumatic injury, small intimal flaps can be an indication of minimal aortic injury (MIA) ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Natural history and clinical significance of aortic focal intimal flaps

Maas

Bakel

Ahmed

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveFocal intimal flaps (FIF) are a variety of defects of the aorta that result in a short, flap-like projection into the lumen, and are often encountered in asymptomatic patients undergoing computed tomography angiography (CTA) surveillance for aortic aneurysm, but the natural history and clinical significance of such lesions has not yet been studied.MethodsWe retrospectively identified patients with an asymptomatic FIF and available imaging follow-up (>1 year). FIF was defined as flap-like intimal irregularity < 4 cm in length involving the thoracic aorta (TA), abdominal aorta (AA) or common iliac arteries (CIA). FIF characteristics included length and circumferential extent as well as the presence and size (width and depth) of associated penetrating aortic ulcers (PAUs). Patient characteristics, adverse events and history of surgical repair was determined by chart review. FIFs and associated PAUs were assessed for progression by comparing baseline and follow-up CTA studies.ResultsA total of 84 FIFs were identified in 77 patients. Average age was 69.2 ± 10.1 years, and 81% were male (81%). Common co-morbidities included: hypertension (78%), hyperlipidemia (68%), smoking (60%), coronary artery disease (41%), aortic aneurysm (34%), type II diabetes mellitus (27%) and prior cardiovascular surgery (25%). FIFs were most commonly located in the abdominal aorta (n = 50, 60%). Nearly all FIFs were associated with local atherosclerotic plaque (93%). Mean follow-up interval was 3.5 ± 2.6 years (259 cumulative follow-up years). Change in FIF length and local aortic diameter over follow-up were 0.7 ± 2.3 mm and 0.8 ± 1.1 mm, respectively. Nearly half (47%) of FIFs were associated with penetrating aortic ulcers (PAU) with baseline depth of 7.3 mm (IQR: 6.1–10.2) and change in depth of 0.5 ± 1.4 mm. Only 12% of FIFs and 0% of associated PAUs demonstrated growth (≥3 mm) at follow-up. No acute pathology developed in the location of FIFs and no aortic interventions were performed specifically to treat FIFs.ConclusionFocal intimal flaps identified in asymptomatic patients with aortic disease were co-localized with atherosclerotic plaque and PAUs, and demonstrated indolent behavior, not leading to significant growth or acute aortic events, supporting a conservative management approach.

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Minimal Aortic Injury: Mechanisms, Imaging Manifestations, Natural History, and Management

Cited by 17 publications

References 64 publications

Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience

Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience

Blunt thoracic aortic injury: A Western Trauma Association critical decisions algorithm

Natural history and clinical significance of aortic focal intimal flaps

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