Traumatic aortic rupture overview

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Differentiating Traumatic Aortic Rupture from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Traumatic aortic rupture is a condition in which the aorta, the largest artery in the body, is torn or ruptured as the result of trauma.

Epidemiology and Demographics

Traumatic aortic rupture is a common killer of victims of automotive accidents and other traumas,[1] with up to 18% of deaths that occur in automobile collisions being related to the injury.[2]

Natural History, Complications and Prognosis

The condition is frequently fatal due to the massive bleeding that results from the rupture. Since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it is very great, and blood may be pumped out of a tear in the blood vessel very rapidly. This can quickly result in hemorrhagic shock and death. Death occurs immediately after traumatic rupture of the thoracic aorta 75% to 90% of the time since bleeding is so severe, and 80 to 85% of patients die before arriving at a hospital. Though there is a concern that a small, stable tear in the aorta could enlarge and cause complete rupture of the aorta and heavy bleeding, this may be less common than previously believed as long as the patient's blood pressure does not get too high. Patients who survive to hospital admission generally have a partial tear with pseudoaneurysm formation.

Diagnosis

Chest X Ray

Though not completely reliable, chest X-rays are sometime used to diagnose the condition.

Other Imaging Findings

The preferred method of diagnosis is aortography.

Other Diagnostic Studies

If a chest tube drains a large amount of bright red arterial blood, or if there is sustained drainage of over 200mls, then aortic rupture should be suspected and the patient should undergo thoracotomy.

Treatment

Medical Therapy

Since a high blood pressure could exacerbate the tear in the aorta or even separate it completely from the heart, which would almost inevitably kill the patient, hospital staff take measures to keep a patient's blood pressure low. Such measures include giving pain medication, administration of beta blockers, keeping the patient calm, and avoiding procedures that could cause gagging or vomiting.

Surgery

Traumatic aortic rupture is treated with surgery. However, morbidity and mortality rates for surgical repair of the aorta for this condition are among the highest of any cardiovascular surgery. For example, surgery is associated with a high rate of paraplegia,[3] because the spinal cord is very sensitive to ischemia (lack of blood supply), and the nerve tissue can be damaged or killed by the interruption of the blood supply during surgery.

References

  1. Schrader L, Carey MJ (2000). "Traumatic Aortic Rupture". The Doctor Will See You Now. interMDnet Corp. Retrieved 2007-07-21. 
  2. Rousseau H, Soula P, Perreault P; et al. (1999). "Delayed treatment of traumatic rupture of the thoracic aorta with endoluminal covered stent". Circulation. 99 (4): 498–504. PMID 9927395. 
  3. Attar S, Cardarelli MG, Downing SW; et al. (1999). "Traumatic aortic rupture: recent outcome with regard to neurologic deficit". Ann. Thorac. Surg. 67 (4): 959–64; discussion 964–5. PMID 10320235. 

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