Blunt traumatic aortic injuries of the ascending aorta and aortic arch: a clinical multicentre study

Victor X Mosquera, Milagros Marini, Javier Muñiz, Daniel Gulias, Vanesa Asorey-Veiga, Belen Adrio-Nazar, José M Herrera, Gonzalo Pradas-Montilla, José J Cuenca
Injury 2013, 44 (9): 1191-7

OBJECTIVE: To report the clinical and radiological characteristics, management and outcomes of traumatic ascending aorta and aortic arch injuries.

METHODS: Historic cohort multicentre study including 17 major trauma patients with traumatic aortic injury from January 2000 to January 2011.

RESULTS: The most common mechanism of blunt trauma was motor-vehicle crash (47%) followed by motorcycle crash (41%). Patients sustaining traumatic ascending aorta or aortic arch injuries presented a high proportion of myocardial contusion (41%); moderate or greater aortic valve regurgitation (12%); haemopericardium (35%); severe head injuries (65%) and spinal cord injury (23%). The 58.8% of the patients presented a high degree aortic injury (types III and IV). Expected in-hospital mortality was over 50% as defined by mean TRISS 59.7 (SD 38.6) and mean ISS 48.2 (SD 21.6) on admission. Observed in-hospital mortality was 53%. The cause of death was directly related to the ATAI in 45% of cases, head and abdominal injuries being the cause of death in the remaining 55% cases. Long-term survival was 46% at 1 year, 39% at 5 years, and 19% at 10 years.

CONCLUSIONS: Traumatic aortic injuries of the ascending aorta/arch should be considered in any major thoracic trauma patient presenting cardiac tamponade, aortic valve regurgitation and/or myocardial contusion. These aortic injuries are also associated with a high incidence of neurological injuries, which can be just as lethal as the aortic injury, so treatment priorities should be modulated on an individual basis.

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