The mechanism of injury in blunt traumatic rupture of the aorta

Richens, David; Field, Mark; Neale, Michael; Oakley, Charles

doi:10.1016/s1010-7940(01)01095-8

Cited by 197 publications

(133 citation statements)

References 26 publications

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“…Former studies showed that the aortic rupture was detected in 10-15% of vehicle mortalities and that it was the primary cause of death in a high percentage of cases [1,29,33,34]. Richens et al [2] mentioned an occurrence of blunt traumatic aortic ruptures in 20% of all automobile fatalities and a scene survival of the victim of 2-5%. Following Pongratz et al [3] a rupture of the descending thoracic aorta is the second most common cause of death after the most common cause, the traumatic brain injury.…”

Section: Introductionmentioning

confidence: 99%

“…In the previous studies, most of the casualties with aortic ruptures were found in not belted situations. The former studies [2,10] pointed out a rapid chest deceleration as an important factor for the occurrence of aortic ruptures whereas in newer studies [15,16,35] the chest deceleration is mostly mentioned as a side effect along with chest compression and should not be the main influencing factor for such kind of severe injury.…”

Section: Introductionmentioning

confidence: 99%

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Injury Mechanisms of Aortic Ruptures to Vehicle Occupants and Vulnerable Road Users – An In-Depth-Investigation over Time

Otte¹,

Facius²,

Br³

2017

Forensic Biomechanics

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A rupture of the aorta was a common injury observed in the 60ies and 70ies regarding unprotected car occupants, reported in 10% to 15% of vehicle mortalities in the past. With this study it is investigated how often the Aortic Rupture can be observed in today´s traffic accident scene and what changes happened in the course of time history regarding different kinds of traffic participation and different kinds of injury mechanisms. Based on very well documented in-depth-accident cases by GIDAS (German-In-Depth-Accident-Study) a representative sample of all traffic accidents during a 40 year period (years 1973 to 2014) is available (n>100.000 involved persons) and the cases with Aortic ruptures AR (n=142) are analyzed in detail.The Aortic rupture can be observed in high speed accidents with high body deceleration and direct load to the thorax. Nearly always a high compression of the thorax is responsible for the load direction to the heart vessel. The analysis found load in most cases from caudal-ventral in 26.1% and from ventral 21.1%. Another high percentage could be registered from the left and the right (19.7% each) and 7.5% in roll-over events by vehicles with high thorax compression. The rupture was found mostly classical on the area of the aortic arch into pars descendens caused by a kind of scoop-mechanism and in few cases a hyper flexion mechanism, but never with deceleration effect only. Today the AR is very seldom registered for car occupants (0.1%) and also for cyclists (0.05%), more frequent for pedestrians (0.22%) and motorcyclists (0.23%). Related in the course of time history the focus of AR has to change from car occupants to vulnerable road users. Always the characteristic is linked with high thorax deformation mainly in accident situations under high impact speed, no seatbelt and direct body impact.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Injury Mechanisms of Aortic Ruptures to Vehicle Occupants and Vulnerable Road Users – An In-Depth-Investigation over Time

Otte¹,

Facius²,

Br³

2017

Forensic Biomechanics

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“…Aortic rupture occurs at this site in 80% of pathological series and in 90% of the clinical series Thompson & Morgan., 2009). Despite advances in surgical techniques, in emergency settings, open surgical repair of aortic rupture is still associated with a mortality rate of 18%-67% (Steingruber et al, 2007, Karmy-Jones et al 2003Richens et al, 2002;Williams et al, 1994). Most series report the technical success of TEVAR to be 81.1-100%, with a paraplegia rate of 0%.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of Thoracic Aortic Emergencies

Ribé¹,

Portero²,

Solis³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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“…Thoracic aortic injuries are associated with high mortality and are the second most common cause of death in trauma patients after intracranial hemorrhage (1). Thoracic aortic dissection is usually a result of sudden deceleration caused by a traffic accident or fall.…”

Section: Introductionmentioning

confidence: 99%

“…Thoracic aortic dissection is usually a result of sudden deceleration caused by a traffic accident or fall. The most common rupture location is the aortic isthmus (i.e., the region between the fixed aortic arch and mobile thoracic aorta) (1,2).…”

Section: Introductionmentioning

confidence: 99%

Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital

2016

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Background: Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition.This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. Methods:In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan.Results: The median age of the patients was 49±22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights.The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively.Conclusions: Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.

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The mechanism of injury in blunt traumatic rupture of the aorta

Cited by 197 publications

References 26 publications

Injury Mechanisms of Aortic Ruptures to Vehicle Occupants and Vulnerable Road Users – An In-Depth-Investigation over Time

Injury Mechanisms of Aortic Ruptures to Vehicle Occupants and Vulnerable Road Users – An In-Depth-Investigation over Time

Endovascular Repair of Thoracic Aortic Emergencies

Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital

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