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Pseudoaneurysms after high-grade blunt solid organ injury and the utility of delayed computed tomography angiography

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Pseudoaneurysms (PSA) can occur following high-grade solid organ injury. PSA natural history is unclear but risk for spontaneous rupture and exsanguination exist. The yield of delayed CT Angiography (dCTA) for PSA diagnosis is not well delineated and optimal timing is undefined. The study objective was definition of dCTA utility in diagnosing and triggering intervention for PSA after high-grade blunt solid organ injury.

Methods

All blunt trauma patients arriving to our ACS-verified Level 1 trauma center with AAST grade ≥ III liver, spleen, and/or kidney injury were included in this retrospective observational study (01/2017–10/2021). Exclusions were age < 18 year, transfers in, death < 48 h, and immediate nephrectomy/splenectomy. dCTA performance was not protocolized and pursued at attending surgeon discretion. Demographics, clinical/injury data, and outcomes were collected. Primary outcome was dCTA-triggered intervention. Statistical testing with ANOVA/Chi squared compared outcomes by type of solid organ.

Results

349 blunt trauma patients with 395 high-grade solid organ injuries met study criteria. Median AAST grade of solid organ injury was 3 [3–4]. dCTA for PSA screening was pursued in 175 patients (44%), typically on hospital day 4 [3–7]. dCTA identified vascular lesions in 16 spleen, 10 liver, and 6 kidney injuries. dCTA triggered intervention in 24% of spleen, 13% of kidney, and 9% of liver injured patients who were screened, for an overall yield of 14%. Intervention was typically AE (n = 23, 92%), although two splenic PSA necessitated splenectomy.

Conclusion

Delayed CTA for PSA screening after high-grade blunt solid organ injury was performed in half of eligible patients. dCTA identified numerous vascular lesions requiring endovascular or surgical intervention, with highest yield for splenic injuries. We recommend consideration of universal screening of high-grade blunt solid organ injuries with delayed abdominal CTA to avoid missing PSA.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA

    Morgan Schellenberg, Natthida Owattanapanich, Brent Emigh, Chance Nichols, Joshua Dilday, Chaiss Ugarte, Atsushi Onogawa, Kazuhide Matsushima, Matthew J. Martin & Kenji Inaba

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  1. Morgan Schellenberg
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  2. Natthida Owattanapanich
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  3. Brent Emigh
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  4. Chance Nichols
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  5. Joshua Dilday
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  6. Chaiss Ugarte
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  7. Atsushi Onogawa
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  8. Kazuhide Matsushima
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  9. Matthew J. Martin
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  10. Kenji Inaba
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Corresponding author

Correspondence to Morgan Schellenberg.

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Conflict of interest

Authors Schellenberg, Owattanapanich, Emigh, Nichols, Dilday, Ugarte, Onogawa, Matsushima, Martin, and Inaba declare that they have no conflict of interest.

Ethical approval

All procedures performed in this retrospective observational study involving human participants were in accordance with the ethical standards of the Institutional Review Board of the University of California (HS-22- 00050) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study received a waiver for informed consent by the Institutional Review Board of the University of Southern California (HS-22-00050).

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Schellenberg, M., Owattanapanich, N., Emigh, B. et al. Pseudoaneurysms after high-grade blunt solid organ injury and the utility of delayed computed tomography angiography. Eur J Trauma Emerg Surg 49, 1315–1320 (2023). https://doi.org/10.1007/s00068-022-02197-2

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  • DOI: https://doi.org/10.1007/s00068-022-02197-2

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