Introduction: Simultaneous traumatic brain injury (TBI) and aortic injury (AI) has been considered “unsurvivable” for many years because treatments such as sedation and blood pressure goals conflict for these two conditions. Additionally, surgical interventions for AI often require full anticoagulation, which is contra-indicated in TBI patients. For these reasons and due to the relative rarity of AI/TBI, little data are available to guide treating physicians.
Methods: A retrospective review was performed on all simultaneous TBI and AI cases from 2000 to 2012 at a university affiliated, level I trauma center. Patient demographics, imaging studies, interventions, and outcomes were analyzed. TBI/AI cases treated with endovascular stenting were specifically studied to determine trends in procedure timing, use of anticoagulation, and neurologic outcome.
Results: Thirty-three patients with concurrent TBI and AI were identified over a 12 year period. Median patient age was 44 years (range 16-83), and overall mortality after imaging diagnosis was 46%. All surviving patients were awake and neurologically functional at discharge, and 83% were sent home or to rehabilitation facilities. Patients who died had a higher injury severity scale (ISS) score (p=0.006). Severe TBI (p=0.045) or hemodynamic instability (p=0.015) upon arrival to the hospital were also correlated with increased mortality. Thirty-three percent of AI/TBI patients underwent endovascular stenting (n=11), and seven of these patients received intravenous anticoagulation at the time of surgery. Six of these seven anticoagulation treated patients had no significant progression on postoperative brain computed tomography, and one patient died of hemodynamic instability prior to further imaging.
Conclusions: Simultaneous TBI and AI is a rare condition with a historically poor prognosis. However, our results suggest that many patients can survive with good quality of life. Technological advances such as endovascular aortic stenting may improve patient outcome, and anticoagulation is not absolutely contraindicated after TBI.
Patient Care: These data will assist neurosurgeons and trauma surgeons in the management of the rare and difficult condition of simultaneous traumatic brain and aortic injury.
Learning Objectives: By the conclusion of this session, participants should be able to 1) understand the prognosis of simulatenous traumatic brain and aortic injury and 2) be aware of treatment strategies for these conditions.