Blunt Thoracic Aortic Injury

Most patients with blunt thoracic aortic injuries (BTAI) die at the scene and never receive medical care. For those cases reaching hospital care, early diagnosis and appropriate intervention remain the main tenets for survival and good functional results. Plain chest radiography is an unreliable screening method for BTAI, and contrast-enhanced CT scans should be considered for evaluation of all patients with high-speed deceleration injuries. Multislice CT scan technology provides a reliable and precise diagnosis, and traditional contrast arteriography is rarely needed. Early and intensive blood pressure control with restricted fluid resuscitation and administration of beta-blocker therapy are critical to reduce the risk of free rupture of contained aortic injuries. Delayed semi-elective repair of aortic injury is preferable in instances of contained rupture and is associated with better results than early emergent repair. Endovascular stent-graft repair has now become the most commonly used method of management in patients with BTAI. Endovascular repair is associated with improved survival and reduced incidence of paraplegia compared to open operative repair. However, the endovascular technique is associated with a risk of device-related complications, and there are no long-term results with this method. Conservative management with blood pressure control and monitoring may have a role in selected patients with minor BTAI. Overall, management of BTAI by multidisciplinary teams and in centers of excellence has resulted in major improvement in outcomes.