Outcome after thoracic aortic injury: experience in a level-1 trauma center

Abstract

Traumatic rupture of the thoracic aorta is a potentially fatal injury that leads to death in 75-90% of cases at the time of injury. In this report, we present our experience with traumatic thoracic aortic injury and compare the outcome in patients with respect to their hemodynamic stability at presentation and the timing of surgical repair. We performed a retrospective data analysis of the medical records of 30 patients who had sustained a traumatic rupture of the thoracic aorta during the period from January 1, 2000 to October 30, 2005. The demographic data, mechanism of injury, modality of diagnosis, location of injury, other associated injuries, hemodynamic stability at presentation, response to resuscitation, timing of aortic repair, as well as the resultant morbidities and mortalities were reviewed. Traumatic rupture of the thoracic aorta was diagnosed in 30 patients. The injury was located in the ascending aorta in two patients, in the aortic isthmus in 25 patients, and in the descending aorta (distal to the isthmus) in three patients. Associated injuries included head injury (50%), C spine (23.3%), lung injury (80%), and visceral (63%) and extremity (60%) injury. Seven patients (23%) were pronounced dead on arrival to the emergency room, 14 patients (47%) were hemodynamically unstable upon arrival, and nine patients (30%) were hemodynamically stable. In the unstable group, two patients (14%) expired before operative repair, 11 patients (79%) underwent emergent repair of the thoracic aorta resulting in 46% mortality, and one patient (7%) underwent delayed repair after initial stabilization with a splenectomy for a splenic laceration. In the stable group, three patients (33%) underwent early (within 24 hr) aortic surgery, while repair was delayed in six (67%). The mean duration of time spent prior to delayed repair was 20.85 days (range 2-53, median = 25). There was no mortality in this group. Acute traumatic thoracic aortic rupture remains a highly fatal condition. Hemodynamic instability remains the main mortality risk factor. Delayed repair is safe and is not associated with increased risk of aortic rupture in hemodynamically stable patients.