In Reply to: Case 0298_09 --Non-operative Management of Traumatic Aortic Injury posted by Editor on February 03, 1998 at 11:52:55:
I have several cases of aortic injury first identified by abdominal CT: manifesting as multiple renal infarcts, an sma infarct and emboli to the spleen.
My point is that while intimal injuries heal, we should protect the intima from platelet adherence and clumping and subsequent emboli.Antiplatelet therapy seems like a reasonable approach. I wouldn't want to anticoagulate any of these patients.
Ironically, Nonoperative therapy is best considered in the sickest patients: those with concomitant abdominal, head and pelvic injuries. They develop hypothermia coagulopathy and do not tolerate hypotension or hypertension in the heads.
I have done followup on three patients with aortic injury, one abdominal aortic injury was written up by my colleague mike herskowitz in cvir a few years ago. None of my patients had a worse looking angiogram but only one went on to heal and look normal, the patient with abdominal aortic injury.