World Journal of Surgery. 2012; 36:1571-1580 Traumatic aortic injuries associated with major visceral vascular injuries in major blunt trauma patients Victor X. Mosquera, Milagros Marini, Ignacio Cao, Daniel Gulías, Javier Muñiz, José M. Herrera-Noreña and José J. Cuenca Abstract Background. The objectives of this study were to report the clinical and radiological characteristics and outcomes of a series of acute traumatic aortic injuries (ATAIs) with associated injury to major aortic abdominal visceral branches (MAAVBs). Methods. From January 2000 to August 2011, 10 consecutive major blunt trauma patients with associated ATAI and injury to MAAVBs (group A) and 42 major blunt trauma patients presenting only an ATAI without MAAVB injuries (group B) were admitted to our institution. Results. Overall in-hospital mortality was 32.7%. In-hospital mortality in group A was 40% and in group B it was 31% (p = 0.86). Observed in-hospital mortality was slightly lower than the expected in-hospital mortality in both groups. Mean peak creatine phosphokinase was significantly higher in group A than in group B patients (23,008 ± 33,400 vs. 3,970 ± 3,495 IU/L; p < 0.001). Acute renal injury occurred in 50% of group A and in 26.2% of group B patients. Hemodiafiltration was required in 30% of group A and in 9.5% of group B patients. Median follow- up time was 64 months (range = 1–130 months). Group A survival was 60% at 1, 5 and 10 years. Group B survival was 69% at 1 year and 63.3% at 5 and 10 years (p = 0.15). Conclusions. Aortic injuries associated with MAAVB injuries in major trauma patients seem to present in a different clinical scenario. These patients present increased risk of rhabdomyolysis, visceral ischemia, and acute renal failure, as well as higher in-hospital mortality. A multidisciplinary approach combining endovascular and open surgical techniques for a staged treatment of these life-threatening aortic and MAAVB injuries is mandatory in this critical subset of trauma patients. Introduction Acute traumatic aortic injuries (ATAIs) associated with injuries to major aortic abdominal visceral branches (MAAVBs) are uncommon but highly lethal situations among major blunt trauma patients. In- hospital mortality in this critical subset of major trauma patients may vary between 50 and 100% [1, 2], with exsanguinating hemorrhage being the most important cause of early death [3, 4]. The vast majority of this subset of major trauma patients present in shock, severely physiologically compromised; sustain multiple injuries; and develop acute renal failure, an abdominal malperfusion syndrome, and/or coagulopathy [4, 5]. Intra-abdominal vascular injuries are associated with extremely rapid rates of blood loss and pose a surgical challenge for exposure during celiotomy [5, 6], given the posterior position of the MAAVBs. The advent of different endovascular therapies for treating both ATAI [7, 8] and injuries to visceral arteries [9–11] has enabled a revolution in the management of these catastrophic injuries among major trauma patients leading to a decrease in in-hospital mortality in most current series. Clinical, anatomical, and radiological characteristics and both in-hospital and long-term survival from ATAI with associated injury to MAAVBs are poorly documented. All the studies published to date are separately focused on either visceral arterial injuries or ATAI management, with a lack of information about the management and outcomes of this critical subset of patients. The objectives of this study were to describe the clinical profile and outcomes of a series of 10 consecutive patients with ATAI and associated injury to MAAVBs, and to compare such data with our last 10 years’ experience managing ATAI in trauma patients.