Posttraumatic Thoracic Aortic Aneurysm: Recognition and Treatment

The clinical findings suggesting traumatic aortic laceration and false aneurysm formation in patients incurring severe decelerative trauma may be subtle or totally absent. Review of 12 patients with traumatic aortic aneurysm reveals that the only consistent findings were a history of decelerative injury and suggestive findings on x-ray films of the chest. All ruptures were at the level of the left subclavian artery. One patient died in the emergency room; in 11, operative repair was performed with the aid of left atriofemoral bypass, six hours to 13 years after injury. Grafts were used in nine cases, direct suture in two. Nine survived, one with paraplegia. The indications for urgent aortography in the severely traumatized patient should include the presence of fractured sternum, first rib fracture, and multiple fractures with crushed chest.