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Outcome after Thoracic Aortic Injury: Experience in A Level-1 Trauma Center

Munier Nazzal, MD, Yazan Duwayri, MD, Edwin Chan, MD, Jihad Abbas and Gregory Cerilli, MD
Surgery, Medical College of Ohio, Toledo, OH

Objectives: : 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 paper we present our experience with traumatic thoracic aortic injury and compare the outocme in patients with delayed repair to those who underwent urgent repair.
Methods: We performed a retrospective data analysis of the medical records of 30 patients who have sustained a traumatic rupture of the thoracic aorta during the years 2000-2005. The mechanism of injury, diagnostic modalities used, location of aortic injury, associated body injuries, timing of aortic repair, as well as the resultant morbidities and mortalities were reviewed.
Results:
From 1/1/2000 to 10/30/2005, traumatic rupture of the thoracic aorta was diagnosed in 30 patients. Associated imjuries included: Head injury (50%), C-spine (23.3%), lung injury (80%), Visceral (63%) and extremity injury (60%). Nine patients(30%) expired shortly after arrival due to hemodynamic instability. Twleve patients (40%) were hemodynamically unstable, while 9 patients (30%) were stable. 11 of the hemodynamically unstable patients (92 %)underwent urgent repair of the thoracic aorta resulting in 5 deaths(45.5%), while one patient (8 %) underwent delayed repair after initial stabilization with splenectomy. The overall early mortality was 46.7% ( 14/30). Ten (33.3%) patients were hemodynamically stable. Three patients (30%) from the stable group underwent early (within 24 hours) aortic surgery while repair was delayed in 7 (70%). There was no mortality in both groups. Mortality in patients who underwent urgent repair (35.7%) was higher than those who underwent delayed repair (0%) (NS). None of the patients who underwent delayed repair developed aortic rupture before surgery.
Conclusions:
Acute traumatic thoracic aortic rupture remains to be a highly fatal condition. Hemodynamic instability remains the main mortality risk factor. Delayed repair is safe and is not assciated with increased risk of aortic rupture.