Acute Traumatic Aortic Injury: Imaging Evaluation and Management

Abstract

Despite recent advances in prehospital care, multidetector computed tomographic (CT) technology, and rapid definitive therapy, trauma to the aorta continues to be a substantial source of morbidity and mortality in patients with blunt trauma. The imaging evaluation of acute aortic injuries has undergone radical change over the past decade, mostly due to the advent of multidetector CT. Regardless of recent technologic advances, imaging of the aorta in the trauma setting remains a multimodality imaging practice, and thus broad knowledge by the radiologist is essential. Likewise, the therapy for acute aortic injuries has changed substantially. Though open surgical repair continues to be the mainstay of therapy, percutaneous endovascular repair is becoming commonplace in many trauma centers. Here, the historical and current status of imaging and therapy of acute traumatic aortic injuries will be reviewed.

Evaluation of patients diagnosed with acute blunt aortic injury and their bedside plain chest radiography in the emergency department: A retrospective study

“…There are studies in the literature stating that 60% to 80% of cases that reach the hospital and receiving definitive therapy survive. [1,6,24] In the present study, 5 patients (16.6%) who received surgical repair (TEVAR, EVAR) died. None of our cases were open surgical repair.…”

“…[5,12] Generally, these patients do not possess significant physical examination findings; however, they are hemodynamically unstable, and in case of high suspicion, CXR provides clues for diagnosis. [5,6] Blackmore et al described 7 risk factors related to aortic injury including age >50 years, BP <90 mmHg and thoracic trauma. [13] In a multicenter study, Mosquera et al (82 aortic injuries from years 1980-2010) defined a traumatic aortic injury score (TRAINS) that included these criteria: widened mediastinum, hypotension, hemothorax, contusion, left scapular fracture.…”

“…However, one-third of patients with aortic injury due to blunt trauma do not show any external signs at physical examination. [6] It is also mentioned in the literature that even though bedside CXR may reveal many signs pointing to major vessel injury, most of these findings lack sensitivity and specificity. [5,7] Chest computerized tomography (CCT) is a frequently used imaging modality for trauma patients in the ED, with sensitivity and specificity rates nearing 100%.…”

Endovascular treatment for acute traumatic thoracic aortic transection

“…[3,4] Most patients with acute traumatic aortic transection show no evidence of aortic injury until hemodynamic instability occurs. [2] In high impact motor vehicle accidents, rapid deceleration causes aortic arch injury mostly at the level of the isthmus. [5] Patients with aortic injury also have concomitant traumas.…”

“…Depending on all these factors, transverse tears occur mostly at the level of the aortic isthmus and also at the aortic root and diaphragm. [2] Current diagnosis of traumatic aortic transection is mainly made by contrast-enhanced computed tomography (CT). [2] Treatment options include open thoracic surgery and endovascular repair.…”