Blunt thoracic aortic injury
- David G Neschis, MD
David G Neschis, MD
- Clinical Associate Professor of Surgery
- University of Maryland School of Medicine
- Section Editors
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Eileen M Bulger, MD, FACS
Eileen M Bulger, MD, FACS
- Section Editor — Trauma Surgery
- Professor of Surgery
- University of Washington
Patients involved in high-energy blunt trauma involving rapid deceleration are at significant risk for blunt aortic injury. The majority of blunt aortic injuries are due to motor vehicle collision. In the United States, blunt aortic injury is the second leading cause of death behind head injury for individuals aged 4 to 34 [1,2]. Only approximately 20 percent of patients with blunt aortic injury survive long enough following the injury to be treated .
The presence of risk factors for blunt aortic injury should prompt a diagnostic evaluation, the nature of which depends upon the patient's clinical status. The grade of injury taken together with the patient's associated injuries and medical comorbidities determine the timing and type of thoracic aortic repair.
Blunt thoracic aortic injury will be reviewed here. The factors that determine whether an open surgical or endovascular approach should be taken to repair these injuries are discussed separately. (See "Surgical and endovascular repair of blunt thoracic aortic injury".)
MECHANISM OF INJURY
The incidence of blunt thoracic aortic injury is estimated between 1.5 and 2 percent of patients who sustain blunt thoracic trauma [4-7]. In a multicenter study involving 274 cases of blunt aortic injury, 81 percent were caused by automobile collisions . Other etiologies of blunt thoracic aortic injury include motorcycle and aircraft crashes, automobile versus pedestrian accidents, falls, and crush injury . Approximately 70 percent of victims are male , with approximately 67 percent of patients described as overweight or obese .
The main risk factor for blunt thoracic aortic injury is rapid deceleration, either from high-speed motor vehicle collision or falls from a significant height. Injury mechanism and other patient-related factors that increase the risk for blunt thoracic aortic injury are discussed elsewhere. (See "Initial evaluation and management of blunt thoracic trauma in adults", section on 'Epidemiology'.)
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- MECHANISM OF INJURY
- Associated injuries
- PATHOPHYSIOLOGY OF INJURY
- TRAUMA EVALUATION
- History and physical examination
- Plain chest film
- Laboratory studies
- DIFFERENTIAL DIAGNOSIS
- INITIAL MANAGEMENT
- Heart rate and blood pressure control
- Patient transfer
- AORTIC INJURY GRADING
- APPROACH TO MANAGEMENT
- Immediate versus delayed repair
- Thoracic aortic repair
- SUMMARY AND RECOMMENDATIONS