Acute traumatic injury of the aorta: presentation, diagnosis, and treatment

Abstract

Despite advances in detection and treatment, acute traumatic aortic injury (ATAI) is associated with high rates of morbidity and mortality. Both physical and hemodynamic forces have been postulated as mechanisms of aortic injury during a traumatic event. For patients who survive the initial injury, rapid detection is critical for diagnosis and procedural planning, which requires a thorough knowledge of both its clinical presentation and the available diagnostic imaging modalities. Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can each have a role in the diagnosis of ATAI.After stabilization of the patient, the management of ATAI is guided by the severity of injury. Appropriately selected patients with low grade injuries may be managed non-operatively. When treatment is required, there are both open surgical and endovascular options. In current practice, endovascular approaches with stentgraft placement are preferred due to their high clinical success and low rates of complications. Complications from endograft placement can include: endoleak, endograft collapse, infection, endograft failure, and endograft migration. Open surgical repair is now reserved for patients with unfavorable anatomy for endovascular therapies. This review provides a comprehensive overview of ATAI including its epidemiology and demographics, mechanisms of injury, clinical and radiographic diagnosis, treatment options, and posttherapeutic follow-up.

Traumatic aortic injury from pellet gun: A case report

“…Although the majority of ATAI in the thoracic aorta are caused by motor vehicle collisions, 5% are caused by penetrating gunshot wounds. An associated hemothorax and/or pneumothorax are present in 53.5% of cases involving the thoracic aorta [4] . ATAI are highly lethal, and most cases result in death prior to reaching the hospital.…”

“…Chest radiographs are often the first opportunity to detect significant mediastinal structure abnormalities and evaluate for any retained penetrating foreign body. The American College of Radiology currently recommends the use of noncontrast computed tomography followed by CTA as the first-line imaging modality when traumatic aortic injury is suspected [6] , and recent studies have shown CTA to have excellent sensitivity (96.0%-100%) and specificity (95.0%-99.8%) [4] . Direct signs of ATAI on CTA include pseudoaneurysm, focal contour abnormality, intimal flap, intramural hematoma, an abrupt change in aortic caliber, and contrast extravasation.…”

Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

“… 17 However, few mechanisms of injury compare in lethality to acute aortic trauma, which translates to elevated mortality of up to 90% of patients, the great majority of whom do not even survive long enough to receive care in a hospital setting. 3 , 18 , 19 …”

Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital

“…Therefore, computed tomographic angiography (CTA) is the diagnostic modality of choice for hemodynamically stable BTAI [ 1 ]. Transesophageal echocardiography (TEE) is frequently used to guide surgical decisions in unstable polytrauma patients because it may be conducted at the bedside or intraoperatively [ 10 ].…”