Traumatic aortic rupture

Traumatic Aortic Rupture

Diagram of the aorta and its branches

Traumatic aortic rupture is a critical and often fatal injury that occurs when the aorta, the largest artery in the body, is torn or ruptured due to trauma. This condition is most commonly associated with high-impact events such as motor vehicle accidents, falls from significant heights, or severe blunt chest trauma.

Anatomy and Pathophysiology

The aorta is a major blood vessel that originates from the left ventricle of the heart and extends down to the abdomen, where it branches into the iliac arteries. It is divided into the ascending aorta, aortic arch, and descending aorta. Traumatic aortic rupture typically occurs at the isthmus, which is the portion of the aorta just distal to the left subclavian artery, due to its relative immobility compared to the rest of the aorta.

The mechanism of injury often involves rapid deceleration, which causes the heart and aortic arch to move forward while the descending aorta remains fixed, leading to a tear. The rupture can result in massive internal bleeding and is often rapidly fatal if not promptly diagnosed and treated.

Clinical Presentation

Patients with traumatic aortic rupture may present with a variety of symptoms, depending on the extent of the injury and associated trauma. Common signs include:

• Severe chest or back pain
• Shortness of breath
• Hypotension or shock
• Loss of consciousness

Due to the high mortality rate associated with this condition, rapid assessment and intervention are critical.

Diagnosis

The diagnosis of traumatic aortic rupture is typically made using imaging studies. Computed tomography angiography (CTA) is the preferred method due to its high sensitivity and specificity. Other imaging modalities that may be used include:

• Chest X-ray: May show widening of the mediastinum or other indirect signs of aortic injury.
• Transesophageal echocardiography (TEE): Useful in unstable patients or when CTA is not available.

Treatment

The management of traumatic aortic rupture involves immediate stabilization of the patient followed by surgical intervention. Treatment options include:

• Endovascular repair: A minimally invasive procedure where a stent graft is placed in the aorta to seal the tear.
• Open surgical repair: Involves direct repair of the aorta through a thoracotomy. This approach is less common due to the higher risk of complications.

The choice of treatment depends on the patient's condition, the location and extent of the rupture, and available resources.

Related Pages

• Aorta
• Blunt trauma
• Endovascular surgery
• Cardiothoracic surgery