Surveillance of Posttraumatic Abdominal Pseudoaneurysms

Abstract

ObjectiveTraumatic pseudoaneurysms are a serious complication following blunt and penetrating trauma, carrying a significant risk of morbidity and mortality if ruptured. However, there is a lack of specific guidelines for their detection and surveillance. This study aimed to evaluate the detection and management of posttraumatic solid organ pseudoaneurysms.Materials and MethodsA prospectively maintained database was created at a Level 1 trauma center from January 2023 to June 2024. All patients aged 15 years and older who presented with a high-grade liver, kidney, or spleen injury were included in the study. Univariate data analyses was utilized with P < 0.05 considered statistically significant.ResultsTwo hundred and five patients were included in the study. Pseudoaneurysms were identified in 10.7% of patients (n = 22/205). Gunshot wounds (n = 8/22, 36.4%) and motor vehicle collisions (n = 7/22, 31.8%) were the most common mechanisms of injury. Pseudoaneurysms were identified in the liver (n = 10/22, 45.5%), spleen (n = 9/22, 40.9%), and kidney (n = 3/22, 13.6%). 90.9% (n = 20/22) of pseudoaneurysms were identified within 5 days of initial injury. Seventeen (n = 17/22, 77.3%) patients underwent endovascular embolization for pseudoaneurysm repair with an 88.2% success rate. Five (n = 5/22, 22.7%) patients with pseudoaneurysms were managed by observation alone with no intervention. Overall, 48.3% (n = 99/205) of patients had a follow-up abdominal CTA prior to discharge.ConclusionAbdominal CTAs provide adequate surveillance for post-traumatic abdominal pseudoaneurysms, allowing for timely repair to decrease the risk of mortality from pseudoaneurysm rupture. Future prospective multi-center studies are needed to establish evidence-based guidelines for pseudoaneurysm detection and management.

Keywords: Kidney; Liver; Pseudoaneurysm; Spleen; Trauma.