Traumatic Aortic Injury

What are traumatic aortic injuries?

Traumatic aortic injuries are serious conditions caused by blunt or penetrating trauma to the aorta, the body’s main blood vessel. Although they are relatively uncommon, they are among the leading causes of death in trauma patients, second only to traumatic brain injury. These injuries require rapid diagnosis and treatment because they can lead to severe complications such as massive bleeding, rupture of the aorta, reduced blood supply to vital organs, or death. Thoracic aortic injuries are particularly severe and are responsible for about one-third of deaths related to motor vehicle accidents.

Different types of aortic injuries:

The aorta can be injured in two main ways:

  • Penetrating trauma: this includes injuries caused by gunshot wounds or stabbings. Penetrating trauma more commonly affects the abdominal aorta because the abdominal wall provides less protection than the chest. In contrast, the thoracic aorta is located deep inside the chest and is protected by the ribs, sternum, spine, lungs, and heart.

  • Blunt trauma: this is the most common type of traumatic aortic injury and mainly affects the thoracic aorta. It usually occurs during sudden deceleration injuries, such as high-speed car crashes. The heart and the large blood vessels in the chest can move freely inside the thoracic cavity, while the descending aorta is more fixed in position. During a violent impact, this difference in movement creates strong mechanical stress on the aortic wall, which can cause partial or complete rupture of the vessel.

Symptoms and presentation:

 

Diagnosing aortic traumatic injuries can be difficult, since there are no specific symptoms to an aortic injury, and patients can be completely asymptomatic. This condition should be suspected in patients that were involved in vehicle accidents or high-impact events, and with disease that may predispose to aortic disease, such as high blood pressure, connective tissue disorder or previous aortic disease. Anyway, the most frequent warning signs are:

-          Chest, abdominal or back pain

-          Difficult in breathing

-          Weakness, numbness or unequal pulses in arm or legs

After an accident or traumatic injury, even one that may initially seem minor, the appearance of these symptoms, as well as any other unusual symptoms, should not be ignored. If the patient has not already gone to the emergency department, they should seek medical attention promptly so that a physical examination can be performed.

When the doctors suspect any aortic injuries, the diagnosis can be confirmed trough a Computed Tomography Angiography (CTA) scan, that can show the damage, its localization and its degree.

How are they treated?

Treatment depends on the location of the aortic injury and on how severely the wall of the aorta has been damaged.

  • Medication and close monitoring: when the injury to the aortic wall is small or limited, treatment may consist of medications to lower blood pressure and reduce stress on the aorta. The patient is then carefully monitored with repeated imaging tests to make sure the injury does not worsen.

  • Open surgery or endovascular stent grafting: when the damage to the aortic wall is more severe, a procedure is usually necessary. Treatment may involve open surgical repair of the injured part of the aorta or the placement of an endovascular stent graft through a minimally invasive procedure. A stent graft is a metal tube covered with fabric that is inserted inside the aorta to strengthen the damaged area and restore normal blood flow.

The choice of treatment and the timing of the intervention depend on the patient’s overall condition, the part of the aorta involved, and the severity of the injury.