Age affects vascular morphology and predictiveness of anatomical landmarks for aortic zones in trauma patients: implications for resuscitative endovascular balloon occlusion of the aorta

Rui-Fa Li; Xue-Fang Gong; Hong-Bo Xu; Jin-Tuan Lin; Hai-Gang Zhang; Zhi-Jun Suo; Jing-Lan Wu

doi:10.1007/s00068-024-02512-z

Age affects vascular morphology and predictiveness of anatomical landmarks for aortic zones in trauma patients: implications for resuscitative endovascular balloon occlusion of the aorta

Eur J Trauma Emerg Surg. 2024 Apr 24. doi: 10.1007/s00068-024-02512-z. Online ahead of print.

Authors

Rui-Fa Li¹, Xue-Fang Gong², Hong-Bo Xu¹, Jin-Tuan Lin¹, Hai-Gang Zhang¹, Zhi-Jun Suo¹, Jing-Lan Wu³

Affiliations

¹ Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China.
² Department of Pulmonary and Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China.
³ Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen, 510182, Guangdong, China. doctorwu99@126.com.

PMID: 38656432
DOI: 10.1007/s00068-024-02512-z

Abstract

Purpose: Understanding the vascular morphology is fundamental for resuscitative endovascular balloon occlusion of the aorta. This study aimed to evaluate the effect of aging on length and diameter of aorta and iliac arteries in trauma patients, and to investigate the predictiveness of anatomical landmarks for aortic zones.

Methods: A total of 235 patients in a regional trauma center registry from September 1, 2018, to January 3, 2024, participated in the study. Reconstruction of computed tomography was applied to the torso area. The marginal diameter and length of aorta and iliac arteries were measured. Anatomical landmark distances and aortic marginal lengths were compared.

Results: The length and diameter of aorta and iliac arteries increased with age, and a tortuous and enlarged morphology was observed in older patients. There was a good regression between age and diameter of the aorta. Neither the jugular notch, the xiphisternal joint, nor the umbilicus could reliably represent specific margins of aortic zones. The distance between the mid-sternum and femoral artery (427 ± 25 to 442 ± 25 mm for right, and 425 ± 28 to 440 ± 26 mm for left) was predictive for zone 1 in all groups. The distance between the lower one-third junction of the xiphisternum to the umbilicus and femoral artery (232 ± 19 to 240 ± 17 mm for right, and 229 ± 20 to 237 ± 19 mm for left) was predictive for zone 3 aorta.

Conclusion: Aging increases the length and diameter of aorta and iliac arteries, with a tortuous and enlarged morphology in geriatric populations. The mid-sternum and the lower one-third junction of the xiphisternum to the umbilicus were predictive landmarks for zone 1 and zone 3, respectively.

Keywords: Age; Anatomical landmark; Aortic zone; REBOA; Trauma.