Injury to the thoracic aortaVerletzungen der thorakalen Aorta

BACKGROUND: This article reviews the mechanisms of thoracic aortic injury and therapeutic options for its repair. METHODS: We retrospectively analyze our data on surgery of the thoracic aorta for blunt trauma in 25 patients during the last two decades. RESULTS: Blunt aortic trauma is a rare but life-threatening incident, mainly resulting from deceleration forces in vehicle accidents and falls from a height. Dissection and rupture of the descending aorta distal to the left subclavian artery is the most frequently seen pathological correlate. Iatrogenic injuries resulting from cardiovascular surgery and endovascular interventions may also cause aortic trauma. Results of surgery in acute cases are less good than in a stable subacute or chronic phase (mortality, 20% vs. 0%). CONCLUSIONS: Traumatic injury to the thoracic aorta is a potentially lethal problem. When acute traumatic dissection or rupture of the thoracic aorta is diagnosed, surgical aortic repair must be performed immediately. In an unstable patient or if a contraindication for surgery exists, an endovascular stent graft prosthesis is a rational alternative. For acute aortic replacement, use of extracorporeal circulation is essential for organ protection and for a satisfactory surgical outcome.