Air Medical Journal
Volume 27, Issue 3 , Pages 139-143 , May 2008

Clinical Decision Making and Management of Blunt Traumatic Thoracic Aortic Injuries

  • Leanne R. Pérez, RN, MS, ACNP

      Affiliations

    • Stanford Life Flight, Stanford, CA
    • Corresponding Author InformationLeanne Pérez, Stanford Hospital and Clinics, Stanford Life Flight, 300 Pasteur Dr, Mail Code 5246, Room HG011, Stanford, CA 94305-5246
  • ,
  • Garrett K. Chan, RN, PhD, CNS, NP

      Affiliations

    • Stanford Hospital and Clinics, Stanford, CA

References 

  1. Jackson DH . Of TRAs and ROCs . Chest . 1984;85:585–587
  2. Mattox KL . Fact and fiction about management of aortic transection . Ann Thorac Surg . 1989;48:1–2
  3. Parmley L , Mattingly T , Manion W . Nonpenetrating traumatic injury of the aorta . Circulation . 1958;17:1086–1101
  4. Greendyke RM . Traumatic rupture of aorta; special reference to automobile accidents . JAMA . 1966;195:527–530
  5. Feczko JD , Lynch L , Pless JE , Clark MA , McClain J , Hawley DA . An autopsy case review of 142 nonpenetrating (blunt) injuries of the aorta . J Trauma . 1992;33:846–849
  6. Dischinger P , Cowley R , Shankar B . The incidence of ruptured aorta among vehicular fatalities . Proc Assoc Adv Automot Med Conf . 1988;32:15
  7. Smith RS , Chan FC . Traumatic rupture of the aorta: still a lethal injury . Am J Surg . 1986;152:660–663
  8. Fabian TC , Richardson JD , Croce MA , Smith JS , Rodman G , Kearney PA , et al.   Prospective study of blunt aortic injury: Multicenter Trial of the American association for the surgery of Trauma . J Trauma . 1997;42:374–380
  9. Groskin SA . Selected topics in chest trauma . Radiology . 1992;183:605–617
  10. Attar S , Cardarelli MG , Downing SW , Rodriguez A , Wallace DC , West RS , et al.   Traumatic aortic rupture: recent outcome with regard to neurologic deficit . Ann Thorac Surg . 1996;7:959–964
  11. Kim FJ , Moore EE , Moore FA , Read RA , Burch JM . Trauma surgeons can render definitive surgical care for major thoracic injuries . J Trauma . 1994;36:871–875
  12. Von Oppell UO , Dunne TT , DeGroot MK , Zilla P . Traumatic aortic rupture: twenty-year meta-analysis of mortality and risk of paraplegia . Ann Thorac Surg . 1994;58:585–593
  13. Warren RL , Akins CW , Conn AKT , et al.   Acute traumatic disruption of the thoracic aorta: emergency department management . Ann Emerg Med . 1992;21:391–396
  14. Mirvis SE , Shanmuganathan K , Buell J , Rodriguez A . Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury . J Trauma . 1998;45:922–930
  15. Kish MM , Behrendt DM , Orringer MB , Gago O , Gray LA , Mills LJ , et al.   The treatment of acute traumatic rupture of the aorta: A 10-year experience . Ann Surg . 1976;184:308–316
  16. Akins CW , Buckley MJ , Daggett W , McIlduff JB , Austen WG . Acute traumatic disruption of the thoracic aorta: A ten-year experience . Ann Thorac Surg . 1981;31:305–309
  17. Fisher RG , Oria RA , Mattox KL , Whigham CJ , Pickard LR . Conservative management of aortic lacerations due to blunt trauma . J Trauma . 1990;30:1562–1566
  18. Pezzella AT , Todd EP , Dillon ML , et al.   Early diagnosis and individualized treatment of blunt thoracic aortic injury . Am Surg . 1978;44:699–703
  19. Fabian TC , Davis KA , Gavant ML , Croce MA , Melton SM , Patton JH , et al.   Prospective study of blunt aortic injury: Helical CT is diagnostic and antihypertensive therapy reduces rupture . Ann Surg . 1998;227:666–677
  20. Banasik J . Cardiac function and alterations in cardiac function . In: Copstead L , Banasik J editor. Pathophysiology . St. Louis: Elsevier Saunders; 2003;p. 386; 437
  21. Blood vessels Available at: http://greenfield.fortunecity.com/rattler/46/comparison_of_types_of_vessels.htm. Accessed January 7, 2006.
  22. Creasy JD , Chiles C , Routh WD , Dyer RB . Overview of traumatic injury of the thoracic aorta . Radiographics . 1997;17:27–45
  23. Jenson BT . Fourteen years survival with an untreated traumatic rupture of the thoracic aorta . Am J Forensic Med Pathol . 1988;9:58–59
  24. Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal blunt aortic injuries: A review of 242 autopsy cases.
  25. Katyal D , McLellan BA , Brenneman FD , Boulanger BR , Sharkey PW , Waddell JP . Lateral impact motor vehicle collisions: Significant cause of blunt traumatic rupture of the thoracic aorta . J Trauma . 1997;42:769–772
  26. Ben-Menachem Y . Rupture of the thoracic aorta by broadside impacts in road traffic and other collisions: Further angiographic observations and preliminary autopsy findings . J Trauma . 1993;35:363–367
  27. Brundage SI , Harrugg R , Jurkovich GJ , Maier RV . The epidemiology of thoracic aortic injuries in pedestrians . J Trauma . 1998;45:1010–1014
  28. Gleason TG , Bavaria JE . Trauma to great vessels . In: Cohn LH , Edmunds LH editor. Cardiac surgery in the adult . New York: McGraw-Hill; 2003;p. 1229–1250
  29. Driscoll PA , Hyde JA , Curzon I , Derbyshire S , Graham TR , Nicolson DA . Traumatic disruption of the thoracic aorta: A rational approach to imaging . Injury . 1996;27:670–685
  30. Beel T , Harwood AL . Traumatic rupture of the thoracic aorta . Ann Emerg Med . 1980;9:483–486
  31. Lundevall J . The mechanism of traumatic rupture of the aorta . Acta Pathol Microbiol Scand . 1964;62:34–46
  32. Sevitt S . The mechanism of traumatic rupture of the thoracic aorta . Br J Surg . 1977;64:166–173
  33. Smith MD , Cassidy JM , Southers S , Morris EJ , Sapin PM , Johnson SB , et al.   Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta . N Engl J Med . 1999;332:356–362
  34. Esterra A , Mattox KL , Wall MJ . Thoracic aortic injury . Semin Vasc Surg . 2000;13:345–352
  35. Crass JR , Cohen AM , Motta AO , Tomashefski JF , Wiesen EJ . A proposed new mechanism of traumatic aortic rupture: The osseous pinch . Radiology . 1990;176:645–649
  36. Chest trauma: Traumatic aortic injury. Available at: http://www.trauma.org/thoracic/CHESTaorta.html. Accessed December 6, 2005.
  37. Lee J , Harris JH , Duke SH , Williams JS . Noncorrelation between thoracic skeletal injuries and acute traumatic aortic tear . J Trauma . 1997;43:400–404
  38. Kram HB , Appel PL , Wohlmuth DA , Shoemaker WC . Diagnosis of traumatic thoracic aortic rupture: A 10-year retrospective analysis . Ann Thorac Surg . 1989;47:282–286
  39. Ting JYS . Blunt traumatic aortic injury: A review of initial diagnostic modalities and a proposed diagnostic algorithm . Eur J Trauma . 2003;3:1–11
  40. Gavant ML . Helical CT grading of traumatic aortic injuries: Impact on clinical guidelines for medical and surgical management . Radiol Clin North Am . 1999;37:553–574
  41. Demetriades D , Gomez H , Velmahos GC , Asensio JA , Murray J , Cornwell EE , et al.   Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients . Arch Surg . 1998;133:1084–1088
  42. Cook Ad , Klein JS , Rogers FB , Osler TM , Shackford SR . Chest radiographs of limited utility in the diagnosis of blunt traumatic aortic laceration . J Trauma . 2001;50:843–847
  43. Burney RE , Gundry SR , MacKenzie JR , Whitehouse WM , Wu SC . Chest roentgenograms in diagnosis of traumatic rupture of the aorta; Observer variation in interpretation . Chest . 1984;85:605–609
  44. Cigarroa JE , Isselbacher EM , DeSanctis RW , Eagle KA . Diagnostic imaging in the evaluation of suspected Aortic dissection: Old standards and new directions . N Engl J Med . 1993;328:35–43
  45. Gundry SR , Burney RE , MacKenzie JR , Wilton GP , Whitehouse WM , Wu SC , et al.   Assessment of mediastinal widening associated with traumatic rupture of the aorta . J Trauma . 1983;23:293–299
  46. Heystraten FM , Rosenbusch G , Kingman LM , Lacquet LK , de Boo T , Lemmens WA . Chest radiography in acute traumatic rupture of the thoracic aorta . Acta Radiol . 1988;29:411–417
  47. Parker MS , Matheson TL , Rao AV , Sherbourne CD , Jordan KG , Landay MJ , et al.   Making the transition: The role of helical CT in the evaluation of potentially acute thoracic aortic injuries . Am J Roentgenol . 2001;176:1267–1272
  48. Raptopoulos V , Sheiman RG , Phillips DA , Davidoff A , Silva WE . Traumatic aortic tear: Screening with chest CT . Radiology . 1992;182:667–673
  49. Woodring JH . The normal mediastinum in blunt traumatic rupture of the thoracic aorta and brachiocephalic arteries . J Emerg Med . 1990;8:467–476
  50. Marsh DG , Sturm JT . Traumatic aortic rupture: Roentgenographic indications for angiography . Ann Thorac Surg . 1976;21:337–340
  51. Vignon P , Lagrange P , Boncoeur MP , Francois B , Gastinne H , Lang RM . Rountine transesophageal echocardiography for the diagnosis of aortic disruption in trauma patients without enlarged mediastinum . J Trauma . 1996;40:422–427
  52. Nagy K , Fabian T , Rodman G , Fulda G , Rodriguez A , Mirvis S . Guidelines for the diagnosis and management of blunt aortic injury: An EAST practice management guidelines workshop . J Trauma . 2000;48:1128–1143
  53. Papadakos PJ . Hypertensive and hypotensive crisis. Lecture notes from course syllabus of 45th Annual symposium on critical care, trauma and emergency medicine . 2007;699
  54. Opie LH . In: Drugs for the heart . 4th. Philadelphia: W.B. Saunders; 1995;p. 17–21

PII: S1067-991X(08)00008-4

doi: 10.1016/j.amj.2008.01.005

Air Medical Journal
Volume 27, Issue 3 , Pages 139-143 , May 2008