Aortic Disease: 7 Things You Didn't Know About Traumatic Aortic Injury | Cardiovascular Disorders and Diseases articles | Body & Health Conditions center

The aorta can become injured over the course of physical trauma or accidents during medical procedures. Although rare, as less than one percent of patients affected by blunt trauma have aortic injuries, these situations quickly become lethal. Due to increasingly faster methods of transport, but also better diagnostics, aortic injuries are detected more often than before.

What do you need to know about aortic injuries?

1. Blunt trauma is the leading cause of aortic injury

Blunt trauma is most often sustained during motor vehicle accidents or falls from a great height. So-called “rapid deceleration”, a process in which a body in fast motion suddenly stops moving, is the most frequent mechanism causing these cases. During this process, mobile segments of internal organs rapidly stretch and move around, hitting nearby structures. The most frequently seen cause of imminent death is, in these scenarios, aortic rupture.

Blast injuries (caused by explosions), and crush injuries (where an external force squeezes your body) can also lead to similar damage, although this time the effects come from an outside source. The aorta is rarely the only structure affected by these kinds of injuries. Almost all victims have other traumatic injuries outside the chest.

The descendent part of the aorta, for example, is very susceptible to rupture because, unlike the ascending aorta and the aortic arch, it is relatively fixed only in two places – near the heart, and on the diaphragm.

Penetrating trauma, such as gunshot or stab wounds usually results in relatively simpler aortic lacerations, or tears.

It’s important to mention that different invasive medical procedures, such as catheter placing, can also cause aortic trauma.

2. Most patients die at the scene of the trauma

Instant death can be avoided if the external layer of the aortic wall happens to be intact. Also, the ascending aorta and the aortic arch, when injured, bleed into the pericardium (a sac containing the heart), which causes pericardial tamponade.

However, eight out of 10 people suffering severe trauma will die instantly, and almost half of those who don't will die in the next 24 hours unless surgery is performed.

3. Thoracic aortic injury is the most common type

The abdominal aorta is generally well protected, as it is surrounded by organs in your abdomen, so injuries of this part of the aorta are very rare. The aortic isthmus, a naturally constricted part of the descending aorta, is a frequent victim of blunt force trauma, and almost all of the injuries in the aorta take place right here.

4. It doesn’t show any specific signs or symptoms

There are no signs specific to aortic injuries. Keeping in mind that these patients have usually survived physical trauma, other injuries often distract doctors, potentially delaying diagnosis. It’s interesting to note that almost half of all patients have no outside signs of trauma.

Patients mostly feel exhausted, have trouble breathing, or show symptoms of shock, such as low blood pressure, nausea, chest and back pain, or loss of conscience.

Patients who survived traffic accidents usually have wounds on the skin, originating from the steering wheel or the seat belt. Fractured bones, mostly ribs, are also a common finding. It’s important to check the neurological condition of the patients too, because there is always a risk of lower extremity dysfunction if the spinal cord isn’t getting enough blood.

5. Imaging is the most reliable diagnostic method

A chest X-ray is usually the first imaging method, where doctors can quickly see if there are any signs that can point to aortic trauma, such as an inability to see the aorta. There are also some indirect signs of injury, like broken ribs or blood in the chest cavity.
A CT scan is used in definitive aortic injury diagnosis, and in operation planning as well.
Aortography is a method superior to CT in confirming the diagnosis, although it is not used very often, because in these kinds of injuries, time is of the essence.
MRI has virtually no practical value in diagnosing aortic injuries, predominantly because the procedure is very slow.

6. Initial treatment include specific protocols

The so-called “Advanced Trauma Life Support” protocol requires patients to receive 100 percent oxygen, along with intravenous catheters to replenish lost fluids. Thorax drainage is applied if there are air or fluids in the chest cavity. Blood transfusion is also indicated.

7. Immediate surgical treatment is almost always required

Aortic injury is a surgical emergency, so the first step is to open the thoracic cavity and stop the bleeding via a suture. This prevents the blood from draining, while simultaneously fixing circulation to the brain. Next, the problematic part of the aorta is replaced with a synthetic graft.

Nowadays, it is possible to treat most aortic injuries with a minimally invasive procedure called a thoracic endovascular aortic repair (TEVAR), where a synthetic stent-graft is placed in the damaged part of the aorta.

Small tears can be treated by lowering blood pressure with medications, and letting the natural coagulation process repair the leakage. This gives time for the patient to recover until the time for a more permanent solution comes.

Injuries of major blood vessels present one of the most urgent medical conditions. With many potential complications such as major blood loss, blood clot formation, the inability to supply blood to other tissues, or even death, these kinds of injuries require immediate treatment.