[Traumatic rupture of the thoracic aorta in iceland 1980-1989.]

Since an article was published by Parmley in 1958 it has been generally known that patients with traumatic rupture of the thoracic aorta do not all die immediately. Parmley found that 20% of the victims who did not have an associated cardiac injury lived long enough to be brought to a hospital making a repair of the injury at least a possibility. During the seventies and eighties an increasing number of case reports was published where the aortic injury had been successfully repaired and in a few major institutions 30-40 such operations had been performed.

The purpose of the study was to disclose the incidence of traumatic rupture of the thoracic aorta in Iceland, the causes of the injury, the location of the rupture in the vessel and to discover how many reach to a hospital alive and are being treated.

The autopsy reports of the Section of Forensic Medicine in the Institute for Pathology at the University of Iceland from 1980 through 1989 were thoroughly studied. It is believed that autopsy was performed in practically all cases of accidental death in the study period. The injury severity score was calculated for each individual indicating the magnitude of the total injury and chances of survival. The hospital records of those admitted were studied in a similar manner. The time from the accident to admission was noted when on record.

The study revealed 57 cases of traumatic rupture of the thoracic aorta which gives an incidence of approximately 2.3 per 100,000 inhabitants per year. Traffic accidents were the most common cause (77%) and fall from height the second most common. Traffic accidents happened most frequently in the latter part of the week during summer and fall. The use of seatbelts is unknown. The victim was most commonly the driver or a passenger in the front seat. Twenty nine par cent of the drivers were drunk. Eighty four per cent of the victims were men, most of them young. The vessel ruptured most often at the isthmus (75%). Thirty nine of the victims (68.4%) died at the scene of the accident and fifteen (26.3%) were dead on arrival to the hospital in spite of apparantly speedy ambulance services. Only three patients reached the hospital alive (5.3%). In most instances the aortic rupture was only a part of a very serious multitrauma. One aortic rupture which presented as a continuous bleeding from the left chest was successfully repaired immediately after arrival using simple clamp and sew technic. The patient made a full recovery and is well 11 years after the accident.

The study shows that all but three (5.3%) of the cases with traumatic rupture of the thoracic aorta died at the scene of the accident or were dead upon arrival to the hospital. In most instances the aortic rupture is only a part of a most serious multitrauma. Patients with rupture of the descending aorta, without major associated injuries, who are brought quickly to the hospital can be saved by surgically repairing the artery.