Traumatic rupture of the descending thoracic aorta

Traumatic rupture of the descending thoracic aorta is a highly lethal injury caused by sudden, rapid deceleration in high-speed motor vehicular collisions and falls from heights. Deceleration causes the mobile ascending aorta and aortic arch to move forward while the descending thoracic aorta remains fixed by the mediastinal pleura. This opposing movement creates a tear at the aortic isthmus just distal to the origin of the left subclavian artery. Patients with traumatic ruptured descending thoracic aortas often have serious multisystem injuries, and approximately 85% of these patients die at accident scenes or during emergency department resuscitation. The most frequent cause of death is free rupture of periaortic tissues that temporarily have provided tamponade to the sites of aortic ruptures. Surgical mortality rates for patients who survive initial resuscitation are between 10% and 25%. Advances in field triage and emergency medical transportation systems and new preoperative evaluation modalities have improved the survival of patients with traumatic descending thoracic aorta ruptures.