Combined blunt thoracic aortic and abdominal trauma: diagnostic and treatment priorities

Combined blunt trauma to the thoracic aorta and abdomen challenges the surgeon from a diagnostic and therapeutic standpoint. Appropriately prioritizing diagnostic workup and treatment is critical to assuring patient survival. A management approach that considers the patient's injuries and clinical condition as well as the availability of aortography and cardiac surgery are essential. Patients with blunt aortic injury who are hemodynamically unstable with signs of intra-abdominal injury should have immediate abdominal exploration. Further assessment of the aortic injury and surgical repair can be delayed until after the critical intra-abdominal bleeding has been addressed. The stable patient who has both blunt abdominal trauma and blunt thoracic aortic injury but has no signs of ongoing abdominal hemorrhage should initially have arch aortography. Additional abdominal diagnostic studies may be done but should not delay indicated surgical repair of the aortic injury.