Thoracic aortic rupture in patients with multisystem injuries

Area of Science:

• Trauma Surgery
• Cardiovascular Surgery
• Emergency Medicine

Background:

• Thoracic aortic tears often occur with severe multisystem trauma, frequently from motor vehicle accidents.
• Patients typically present with multiple system injuries, including head trauma, intra-abdominal injuries, and fractures, alongside aortic tears.
• Hypotension is a common finding in these critically injured patients.

Purpose of the Study:

• To delineate management priorities for patients with thoracic aortic tears and severe multisystem trauma.
• To review outcomes and identify factors influencing survival in this complex patient population.
• To emphasize the importance of timely diagnosis and intervention for thoracic aortic injuries in trauma patients.

Main Methods:

• Retrospective review of 19 patients with thoracic aortic tears and severe multisystem trauma.
• Analysis of injury patterns, diagnostic workup (chest roentgenograms, angiography), and interventions (exploratory laparotomy, thoracotomy).
• Evaluation of causes of mortality and survival rates based on injury severity and treatment approach.

Main Results:

• The majority of patients sustained injuries to an average of five major systems, with head and intra-abdominal injuries being common.
• Widened mediastinum on chest roentgenograms prompted angiography in 18 of 19 patients.
• Survival was low (4/11) for patients requiring both laparotomy and thoracotomy; overall mortality was 10/19, often due to exsanguination or combined injuries.

Conclusions:

• Aggressive aortography is essential for diagnosing suspected thoracic aortic injuries in trauma patients.
• Clear procedural priorities are needed for managing patients with combined abdominal and thoracic injuries.
• Improved management strategies are required to enhance survival rates in severe multisystem trauma involving aortic tears.