Traumatic aortic rupture pathophysiology

Jump to: navigation, search

Traumatic aortic rupture Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Traumatic Aortic Rupture from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Traumatic aortic rupture pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Traumatic aortic rupture pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Traumatic aortic rupture pathophysiology

CDC on Traumatic aortic rupture pathophysiology

Traumatic aortic rupture pathophysiology in the news

Blogs on Traumatic aortic rupture pathophysiology

Directions to Hospitals Treating Traumatic aortic rupture

Risk calculators and risk factors for Traumatic aortic rupture pathophysiology

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

Pathophysiology

Sheer Mechanism

The injury is usually caused by high speed impacts such as those that occur in vehicle collisions and serious falls. The location of the initial aortic tear is usually at the point in the proximal descending aorta with the greatest sheer where the relatively free and mobile aortic arch joins to the fixed descending aorta (ligamentum arteriousm). By far the most common site for tearing in traumatic aortic rupture is the aortic isthmus, near where the left subclavian artery branches off from the aorta.[1][2] This junction of the free and fixed part of the aorta is at the greatest risk of transection as a result of the shearing forces due to sudden deceleration.[3] Frontal or side impacts in motor vehicle accidents and falls from substantial heights pose the greatest risk of sheer.

The aorta may also be torn at the point where it is connected to the heart. The aorta may be completely torn apart from the heart, but patients with such injuries very rarely survive for very long after the injury; thus it is much more common for hospital staff to treat patients with partially torn aortas. When the aorta is partially torn, it may form a "pseudoaneurysm". In patients who do live long enough to be seen in a hospital, a majority have only a partially torn blood vessel, with the layer called the adventitia still intact. In some of these patients, the adventitia and nearby structures within the chest may serve to prevent severe hemorrhage.

Compressive Mechanism

Extrinsic compression of the aorta between the sternum and the spine may contribute at least in part to aortic rupture.

Elevated Intra-aortic Pressure Mechanism

A sudden, dramatic rise in intra-luminal aortic pressure at the time of impact may contribute to aortic rupture.

References

  1. Phillips BJ (2001). "Traumatic Rupture Of The Thoracic Aorta: An Endoluminal Approach". The Internet Journal of Thoracic and Cardiovascular Surgery. 4 (1). ISSN 1524-0274. 
  2. McKnight JT, Meyer JA, Neville JF (1964). "Nonpenetrating Traumatic Rupture of the Thoracic Aorta". Ann. Surg. 160: 1069–72. PMID 14246145. 
  3. Rittenhouse EA, Dillard DH, Winterscheid LC, Merendino KA (1969). "Traumatic rupture of the thoracic aorta: a review of the literature and a report of five cases with attention to special problems in early surgical management". Ann. Surg. 170 (1): 87–100. PMID 5789533. 




Linked-in.jpg