Medline ® Abstracts for References 1-3
of 'Surgical and endovascular repair of blunt thoracic aortic injury'
The mechanisms of traumatic rupture of the thoracic aorta.
Br J Surg. 1977;64(3):166.
This paper reviews evidence and ideas on closed accidental rupture of the aorta, and refers to an analysis of 37 subjects in whom traumatic aortic ruptures were found at necropsy. The mechanisms of rupture of the ascending aorta and the proximal and distal parts of the descending aorta are discussed. Aortic rupture is one of the major causes of rapid death after traffic accidents, especially in occupants of motor vehicles. However, about 20 per cent of subjects survive for hours, days or longer after the accident, allowing time for surgical repair in some cases.
Traumatic rupture of the aorta: still a lethal injury.
Smith RS, Chang FC
Am J Surg. 1986;152(6):660.
A 10 year retrospective review of a community experience with blunt trauma of the aorta has been presented. We found that an overall mortality of 84 percent was associated with this injury. Fourteen patients reached the emergency department with stable vital signs. Of these patients, 10 underwent successful treatment (71 percent). Despite advances in many areas of trauma care, blunt trauma of the aorta remains a highly lethal injury. However, this review has demonstrated that with prompt diagnosis and treatment, a significant number of these patients can be salvaged. It is for this reason that we have adopted an aggressive approach toward victims of blunt trauma. We now proceed with diagnostic aortography in any patient who has undergone a significant deceleration injury.
Incidence and crash mechanisms of aortic injury during the past decade.
Schulman CI, Carvajal D, Lopez PP, Soffer D, Habib F, Augenstein J
J Trauma. 2007;62(3):664.
BACKGROUND: Aortic injuries were traditionally thought to be the result of severe frontal crashes. Newer data has suggested other crash types such as nearside crashes may also be important in aortic injury. We hypothesized the implementation of recent safety measures would decrease the incidence of aortic injury associated with fatal motor vehicle crashes.
METHODS: The autopsy reports of all traffic fatalities for motor vehicle occupants in a large urban county for the years 1993 to 2004 were examined. The demographics, impact types, safety measures used, and the presence of any aortic injury were recorded. Trends were evaluated for significance by weighted linear regression.
RESULTS: The incidence of aortic injury associated with fatal motor vehicle crashes has remained unchanged during the past 12 years (r = 0.057, p = 0.45). There is a trend toward decreased aortic injuries associated with frontal crashes (r = 0.26, p = 0.089) but no change in aortic injuries associated with nearside or farside crashes (r = 0.053, p = 0.47), when the crash resulted in a fatality. This is despite an increase in seat belt use and increased presence of airbags during the same time period.
CONCLUSIONS: Despite improved safety measures designed to minimize the occurrence of aortic injuries, the incidence of blunt aortic injury in fatal motor vehicle crashes has not decreased during the past decade. Although not statistically significant, there is a trend toward decreased frontal impacts in fatal motor vehicle crashes associated with aortic injuries. The nearside crash mechanism continues to play a prominent role, and efforts at improving vehicle safety should be focused on crash mechanisms as they relate to aortic injury.
University of Miami-Miller School of Medicine, Miami, FL, USA. firstname.lastname@example.org