Multidisciplinary management of thoracic aortic injury with hemodynamically unstable pelvic fracture in the elderly

Blunt thoracic aortic injury (BTAI) is a critical clinical emergency often presenting as severe trauma. The early diagnosis and treatment of BTAI pose significant challenges in its management, especially when patients experience early-stage hemodynamic instability. Presently, in the context of multiple traumas, there is an absence of clearly-defined and comprehensive guidelines capable of accurately determining the optimal timing and sequence of interventions for aortic injuries. This issue is particularly prominent when aortic injuries are complicated by abdominal vascular injuries, which exacerbate hemodynamic instability. This study aims to present two distinct cases of patients with BTAI complicated by pelvic vascular injuries, resulting in hemodynamic instability. These cases were treated at different trauma centers. The successful treatment strategies included the implantation of covered stents for aortic repair and arterial embolization for pelvic vascular injuries. By sharing these cases, we intend to enhance the understanding of the complex management of such combined - injury situations. We underscore that comprehensive aortic computed tomography angiography (CTA) is of crucial importance in the early detection of aortic injuries and other major vascular injuries in high-energy trauma scenarios. Although regional trauma centers have demonstrated positive impacts on patient outcomes, the retrospective nature of this study and its limited sample size necessitate further large-scale research to validate our findings and proposed management strategies.