Traumatic aortic injury (TAI) is an uncommon condition that can result from penetrating or more often blunt trauma. Blunt traumatic aortic injury (BTAI) occurs in 0.3% of polytrauma victims transported to hospital and, despite its relative rarity, is a life-threatening event representing the second leading cause of death, after head injury, in polytrauma patients.
The most common mechanism involved in TAI is sudden deceleration that occurs mainly in motor vehicle accidents, and the majority of lesions (approximately 90% of all cases) is localized at the level of the aortic isthmus.
Over the years, the mortality among the patients with TAI has decreased, being currently close to 5% in patients with TAI that reaches the hospital, mainly due to significant advancements that over the past two decades have been made in the diagnosis and treatment of aortic injuries.
Computer tomography angiography (CTA), with a sensitivity and specificity to as high as 98–100% and a 100% negative predictive value, is currently the modality of choice for the acute diagnosis of BTAI, being able to exclude aortic injuries without doing any other diagnostic test. It has replaced conventional angiography, actually most commonly used in a preoperative phase.
Several different classification systems have been proposed to determinate grade of severity of BTAI. The classification scheme based on the CTA images is able to discriminate patients with varying severity of aortic injury, providing more perspective on the outcomes with different treatment approaches in patients with traumatic aortic injury.
As regards the treatment for BTAI patients, there is an ongoing debate among the best management options. It can be used a conservative (medical) approach or an interventional (surgical or thoracic endovascular repair—TEVAR) management, depending on an individual basis related to the severity of aortic injuries, the clinical assessment, and the presence or absence of other associated lesions.
Today, in several institutions, TEVAR has supplanted open surgery as the primary treatment of blunt aortic injury.
During the last years, many studies have shown that not all traumatic injuries of the thoracic aorta require emergency treatment and suggested delayed repair in patients diagnosed with BTAI. Regarding the best time of intervention (immediate or delayed), several studies have demonstrated the safety and reduction in mortality and morbility in delayed traumatic aortic repair (>24 h).
KeywordsTrauma Trauma imaging Thoracic trauma Aortic injury Computed tomography angiography (CTA) Angiography Minimal aortic injury (MAI) Medical management Operative repair Thoracic endovascular repair (TEVAR)
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