Chronic Post-Traumatic Aortic Isthmus Pseudoaneurysm After Conservative Management of Grade II Injury: Why Is Continuous Follow-Up Mandatory?

TL;DR

This paper highlights the need for long-term monitoring of patients with conservatively treated aortic injuries, as pseudoaneurysms can develop years later.

Contribution

The study emphasizes the importance of continuous follow-up for chronic complications in conservatively managed blunt traumatic aortic injuries.

Findings

Chronic pseudoaneurysms can develop up to 50 years after conservatively managed aortic injuries.

32.4% of cases were asymptomatic or incidentally diagnosed through routine imaging.

Successful hybrid procedures were performed in the reported cases with no complications at follow-up.

Abstract

Background: Grade I-II blunt traumatic aortic injuries (BTAIs) are typically managed conservatively, but their long-term progression is poorly understood. Chronic pseudoaneurysms may develop years after the injury, often remaining asymptomatic and being incidentally diagnosed. Methods: Two cases of post-traumatic aortic pseudoaneurysms, detected 20 and 25 years following conservatively managed BTAIs, are reported. Additionally, a comprehensive review of all post-traumatic pseudoaneurysms reported in the MedLine (PubMed.gov, U.S. National Library of Medicine, National Institute of Health) database between January 1984 and December 2024 was performed. Results: Both our patients underwent successful hybrid procedures, with no complications at the 1- and 4-year follow-ups. Our literature review identified 37 patients across 22 studies, with 32.4% presenting asymptomatically or incidentally diagnosed through routine imaging, between 1 month and 50 years after the initial trauma. In 37.8% of cases, the patients underwent open or endovascular repair. Conclusions: This case series and literature review emphasize the importance of long-term follow-up for patients with conservatively managed BTAIs, as chronic complications such as aortic pseudoaneurysms can arise decades later. Continuous surveillance is critical to ensure early detection and management.

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