Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

Abstract

BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed.RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS:In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an eff ective therapeutic option for TAD.

Traumatic Aortic Dissection as a Unique Clinical Entity: A Single-Center Retrospective Study

“…Therefore, the PETs are ideally positioned in the aortic isthmus, particularly in the lesser curvature. This finding aligns with previous research [23]. The inherent vulnerability of the aorta to any injury in NTAD induces blood to strike the arterial wall, causing tears in the aortic isthmus between the aortic arch and the descending aorta.…”

Using machine learning to predict outcomes of patients with blunt traumatic aortic injuries

“…26 The significance of injury at the lesser or greater curvature has not been well-described in the literature. Injury pattern and dissection extent has been shown to be similar between lesser and greater curvature, 27 but the impact of injury location on mortality has been unclear. Lesser curvature injury significantly affects mortality prediction in the ML model.…”