Traumatic Rupture of the Aorta

Blunt Thoracic Aortic Injuries: An Autopsy Study

“…Feczko et al 8 found a 54% incidence of aortic injury at the isthmus, which was also lower than the classic clinical reports. 14,15 This is in agreement with the findings of this study, which identified that the site of aortic injury was at the isthmus/descending aorta in 66% of the cases. After reviewing 275 cases of nonpenetrating aortic injuries, Parmley et al 12 found that 38% of these patients had an associated cardiac injury.…”

Endovascular Repair of Acute Traumatic Thoracic Aortic Transection With Laser-Assisted In-Situ Fenestration of a Stent-Graft Covering the Left Subclavian Artery

“…In fact, 58% to 100% of thoracic aortic lacerations occur in close proximity to the LSA, 1,5 eliminating the 15-to 25-mm landing zone required by current endografts. [6][7][8] While pre-endografting LSA revascularization or, more recently, the use of fenestrated or branched endografts 14 have extended the proximal landing zone and preserved the LSA in elective cases with good initial and midterm results, these techniques are often not advisable or feasible in the emergent setting. Preoperative LSA revascularization may result in longer operative times or the need for multiple surgical interventions when staged with endografting, which may be deleterious in patients who often have substantial increased operative risk due to associated injuries.…”

“…Further, in light of the extensive risks associated with open surgery, most surgeons have relied on routine overstenting of the LSA to extend the applicability of TEVAR in these patients. [6][7][8] However, recent reports question the safety of this technique. 9,10 Experience with routine intentional LSA occlusion without revascularization has demonstrated substantially increased risk of subsequent subclavian steal syndrome, watershed posterior circulation strokes, and an increased incidence of spinal cord ischemia by eliminating collateral blood supply to the spinal cord from the vertebral artery.…”

Post Traumatic Occlusion of the Aortic Isthmus—Case Report

“…But in 10% to 15%, survival is temporarily possible because the aortic adventitia and the surrounding mediastinal tissues and structures contain the rupture and allow transfer of the victim to the hospitals. 4,5 In some cases the narrowing of the aortic lumen by the hematoma causes a pseudocoarctation syndrome2'4-6 but it rarely leads to complete aortic occlusion with subsequent disastrous distal ischemia.…”