# Seat Belt Aorta in a Paediatric Patient: Conservative Management with Eight Year Follow Up to Adulthood

## TL;DR

A 10-year-old girl with a seat belt-related aortic injury was successfully managed without surgery for eight years, showing stable healing and the need for pediatric-specific guidelines.

## Contribution

Long-term conservative management of pediatric blunt aortic injury with non-invasive surveillance is demonstrated as a viable approach.

## Key findings

- The ectatic aortic segment increased from 14 to 22 mm over eight years without requiring intervention.
- Serial ultrasound provided effective, radiation-free monitoring during the patient's growth.
- Stable growth ratio suggests healing rather than aneurysmal degeneration in the injured aortic segment.

## Abstract

Seat belt syndrome can cause blunt abdominal aortic injury (BAAI) in children. No specific guidelines exist for managing aortic injury in the paediatric population, presenting challenges due to ongoing somatic growth and vascular development.

A 10 year old girl sustained BAAI in a high kinetic motor vehicle collision (90 km/h). Initial computed tomography revealed a grade III infrarenal abdominal aortic injury (circumferential intimal dissection extended to the common iliac arteries). Focal dilatation measured 13mm at the aortic segment compared to 11mm proximally. Despite injury severity, the patient remained haemodynamically stable with adequate lower extremity perfusion. Conservative management with antihypertensive therapy and intensive duplex ultrasound surveillance was pursued. The eight year follow up showed an increase of the ectatic segment from 14 to 22 mm, stability of the left common iliac artery stenosis, and no target lesion intervention.

Conservative management may avoid intervention during somatic growth, circumventing complications of undersized devices, endoprosthesis migration, and peri-operative risks. Haemodynamically stable paediatric BAAI with contained injury may be managed conservatively with intensive surveillance. Multicentre case registries are needed to establish evidence based guidelines.

•Blunt aortic injury from seat belts affects paediatric patients.•Conservative management succeeded through eight years of growth.•Serial ultrasound provided radiation free surveillance to adulthood.•Stable growth ratio suggests healing not aneurysmal degeneration.•Paediatric specific treatment guidelines are needed.

Blunt aortic injury from seat belts affects paediatric patients.

Conservative management succeeded through eight years of growth.

Serial ultrasound provided radiation free surveillance to adulthood.

Stable growth ratio suggests healing not aneurysmal degeneration.

Paediatric specific treatment guidelines are needed.