Overview of traumatic injury of the thoracic aorta. Traumatic aortic rupture traumatic rupture of aorta. In very serious cases, stabilisation with drugs that decrease the stress on the aortic wall is preferred, followed by early surgery. Management of traumatic aortic rupture request pdf. Traumatic aortic rupture after blunt trauma diseases of the. Thoracic aortic injury is the most common type of traumatic aortic injury and is a critical lifethreatening, and often life ending event. Table 1 presents some of the pertinent data regarding the cases of aortic rupture in autoaccident victims. Irc16106 ircobi conference 2016 investigations and injury.
It is estimated that aortic injuries are lethal in 8090% of cases. Current diagnosis and management of blunt traumatic rupture of the. Evaluation and management of blunt traumatic aortic injury. With the improved infield emergency care available today more patients survive to obtain diagnostic imaging and treatment. Cases of an endovascular treatment for traumatic aortic injury are extremely rare. Aortic disruption traumatic msd manual professional edition. Traumatic aortic rupture is a relatively uncommon lesion that presents the cardiothoracic surgeon with unique challenges in diagnosis and management. Traumatic aortic transection, also known as aortic rupture, is the nearcomplete tear through all the layers of the aorta due to trauma such as that sustained in a motor vehicle collision or a fall. An endovascular treatment is a trend for traumatic aortic injury because of lower invasivity. Blunt aortic injury ubc critical care medicine, vancouver bc. Transthoracic echocardiography showed moderate aortic valve regurgitation ar.
Tar can be remarkably occult and the emergency physician is paramount in making the initial diagnosis. Thoracic aortic rupture tar is recognised as a cause of death in victims of blunt trauma. If suggestive, but often subtle features are not recognised in the. Our interest in the mechanism of injury to the thoracic aorta with blunt trauma was spurred by the opportunity of treating a 25yearold man with a traumatic aortic aneurysm detected six. Traumatic aortic injury tai is a life threatening condition that requires prompt diagnosis and management. Apr 01, 2019 depending on its cause, an aortic rupture is classified into 2 types. Acute rupture of the thoracic aorta following blunt trauma is a lifethreatening injury that often requires urgent operative intervention. Tar can be remarkably occult and the emergency physician is paramount in. A great deal of consensus exists describing the circumstances under which acute traumatic aortic dissection occurs as well as its investigation and management. An auto accident predisposes people to numerous traumatic injuries, including a possible aortic rupture. An aortic aneurysm occurs when a weak spot in the wall of your aorta begins to bulge left. Immediate repair of traumatic rupture of thoracic aorta. The condition is frequently fatal due to the profuse bleeding that results from the rupture. Although death follows immediately in about 80 per cent of all cases of traumatic rupture of the aorta, 20 per cent of the patients survive to undergo diagnosis and treatment.
Guidelines from the eastern association for the surgery of trauma east recommend delayed repair for such patients. In the case of multiple or complex lesions of the aortic valve, valve replacement is the safest technique. Acute traumatic aortic injuries rsna publications online. Traumatic aortic rupture tar is a highly fatal injury mechanism resulting from blunt deceleration forces against the descending aorta. A prompt diagnosis of traumatic thoracic aortic pseudoaneurysm through a 3dimensional computed tomographic angiography of aorta and emergency repair are mandatory to rescue the lifethreatening condition. Traumatic aortic rupture, where the aorta ruptures due to any trauma or injury to the chest wall or abdomen, such as could occur in motor vehicle accidents. Traumatic rupture of the thoracic aorta is a life threatening situation, and may be secondary to several mechanisms. Fortytwo patients with traumatic thoracic aortic ruptures were managed between. Aortic rupture occurring secondary to an aortic aneurysm, which is the commonest cause. Aortic aneurysm leak and rupture and traumatic aortic transection katarzyna j.
Diagnosing traumatic rupture of the thoracic aorta in the. Jan 23, 20 a traumatic thoracic aortic injury is a severe and lifethreatening clinical entity. Clinical practice guidelines of the society for vascular surgery. The lack of other chest injuries suggests rapid deceleration of the body without direct trauma to the chest itself. The appropriate management of traumatic aortic rupture is oftendifficult to determine, particularly if the rupture is associated withsevere additional lesions. The mechanism of injury in blunt traumatic rupture of the aorta. Traumatic aortic rupture tar is a serious sequela of blunt chest trauma, and its diagnosis and treatment have always challenged thoracic surgeons. Several mechanical factors may explain the typical locations of thoracic aortic rupture aortic isthmus, ascending aorta.
Incidence and crash mechanisms of aortic injury during the past decade. The recent development of endovascular stentgraft prostheses offers a potentially less invasive alternative to open chest surgery, especially in patients with associated injuries. Traumatic blunt aortic injury often involves rapid deceleration, likely from a fall from height or motor vehicle collision, and can be life threatening. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Their chest could strike the steering wheel, leading to. Endovascular treatment for traumatic thoracic aortic. In this type of injury, death can follow by immediate exsanguination from a tear that involves all layers of the aorta, by a delayed rupture of an hematoma related to a partially torn aorta, or by a late rupture of a traumatic aortic aneurysm.
Between 1986 and 1991, ten consecutive patientswith acute traumatic rupture of the thoracic aorta atrta and concomitantinjuries were initially treated medically and submitted to. Management and endovascular treatment of traumatic aortic. In a patient in a major trauma, a widened mediastinum is extremely concerning for aortic injury, especially in the setting of hypotension injury can progress to free rupture which is almost always fatal grading blunt aortic injury grade i. Fortytwo patients with traumatic thoracic aortic ruptures were managed between january 1988 and. Traumatic aortic transection aortic rupture cedarssinai. Management of traumatic aortic rupture springerlink. Primarily successful resuscitation of traumatic aortic rupture after highenergy car accident. The prognosis is favorable after treatment, but the diagnosis may be difficult. Understanding these factors and the patho physiology involved helps the radiologist to recognize aortic trauma. Traumatic injury of the thoracic aorta is a major clinical concern in patients who sustain deceleration or crush injuries. Surgical versus endovascular treatment of traumatic thoracic. Immediate mortality is 85% but in the group who survive to reach hospital there is a reasonable chance of successful surgical repair. According to data from two different studies in 1985, tar was responsible for 16% to 23% of all motor vehicle fatalities. A case report christian kleber and eric tille university center of orthopaedics and traumatology, ag polytrauma, university medicine carl gustav carus, technische universitat dresden, germany.
The mechanism of tar is directly attributed to the aorta suffering damage by indirect shearing forces. Unfortunately this patient died before a repair could be attempted. In those who make it to hospital, clinical diagnosis is difficult. Fifteen percent of the initial survivors live long enough to reach the hospital for diagnosis and treatment and 90% o f those who remain undiagnosed may not survive four months. This condition is most often lethal and requires immediate medical attention. Traumatic aortic rupture refers to a condition in which there is a tear or rupture of the aorta. Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. Traumatic aortic rupture the annals of thoracic surgery. Damage control resuscitation of a patient with traumatic.
It is always worth remembering however that a normal chest xray does not exclude an aortic injury. Management and endovascular treatment of traumatic aortic rupture. Presented at the 2010 vascular annual meeting of the society for vascular surgery, june 10, 2010, boston, mass. Rupture of the aorta accounts for a significant proportion of fatalities following blunt trauma. Traumatic aortic rupture definition of traumatic aortic. It is estimated that aortic injuries are lethal in 8090% of. If someone isnt wearing their seatbelt, they could be thrown forward when their car collides with another vehicle or object. A traumatic thoracic aortic injury is a severe and lifethreatening clinical entity.
Disruption of the thoracic aorta following blunt trauma is commonly a catastrophic injury. We sought to compare the results of conventional surgical repair and endovascular. Despite improvements in resuscitation, transport, and critical care, emergency repair of aortic disruption in a trauma patient with multiple injuries is still associated with a high mortality rate. Therefore, early triage of this condition is critically important.
Followup transesophageal echocardiography tee showed severe ar caused by rupture of the acoronary cusp, a rare entity after blunt chest trauma figures 1 and 2 and movies i. The descending aorta remains fixed to the posterior chest wall, while the heart and. Delayed repair is an option for hemodynamically stable patients provided there are no signs of impending thoracic aortic rupture, significant aortic thrombus, massive pneumothorax, or luminal encroachment. Endovascular repair of traumatic thoracic aortic injury. Our interest in the mechanism of injury to the thoracic aorta with blunt trauma was spurred by the opportunity of treating a 25yearold man with a traumatic aortic aneurysm detected six months after injury. She was treated for her closed head injury and made a remarkable recovery. It is the second most common cause of death associated with motor. Thoracic trauma, thoracic aorta, thoracic aortic rupture, endovascular repair, endoprosthesis, stent graft, paraplegia. Typical chest xray appearance of traumatic aortic rupture.
256 1252 1424 1009 713 1507 1516 812 44 1119 179 1213 437 63 1091 1359 241 1141 1240 1019 514 342 30 597 962 75 14 880 86 220 323 141 666 477 350 1022 1111