Aortic Injury: A Rare, Challenging Injury in Multiorgan Trauma Patients

Abstract

Introduction: Aortic rupture may follow penetrating or predominantly blunt injuries and results in a sudden hemorrhagic shock which commonly is lethal. AIs are classified in the organ injury scale proposed by American Association for the Surgery of Trauma (AAST-OIS), dividing aortic injuries into thoracic (grades IV-VI) and abdominal (grades IV-V) segments. Materials and results:The demographic data, concomitant injuries, and mortality rates were evaluated retrospectively. During 9 years 10191 patients have been hospitalized. The aortic injury was revealed in 4 of multiorgan trauma patients undergoing surgery. All patients were victims of blunt motor-vehicle accidents. The revealed injury was located in the thoracic or abdominal aorta. Laparotomy was the surgical approach for the management of abdominal aorta injury, while left thoracotomy or bilateral thoracotomy for thoracic aorta injuries.Discussion: Multiorgan trauma is a severe condition. When the aorta is involved the condition becomes exceptionally challenging. Aortic injuries are the second, after head injuries, most lethal conditions in blunt trauma patients. Both thoracic and abdominal aortic injuries among our patients were AAST-OIS grade IV. There are several repair modalities including open and endovascular technique. The hemodynamically unstable patients with multiple concomitant injuries should receive a damage control surgery allowing repair of life-threatening injuries and delayed definitive surgery. The surgery has to be done by highly experienced vascular and trauma surgeon. Conclusion:Traumatic rupture of the aorta is a rare, yet lifethreatening and commonly lethal condition. It usually follows blunt motor-vehicle trauma and predominantly concerns thoracic aorta. The optimal management of AIs requires a highly experienced trauma team and correct treatment protocols.