Aortic Rupture, Traumatic (Tai)

Aortic Rupture, Traumatic (Tai) is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Traumatic aortic rupture (also referred to as traumatic aortic injury or TAI) is the cause of death in an estimated 20% of lethal motor vehicle collisions
  • An estimated 85% of patients with TAI die before reaching the hospital
  • Patients surviving to the ED usually have a contained rupture as aortic blood is tamponaded by the adventitia
  • Without proper treatment, of the 15% that survive the initial event, 49% will die within the first 24 hr, and 90% within 4 mo
  • Mean age of patients sustaining aortic rupture is 33 yr, and 70% are male
  • Most tears are transverse, not longitudinal
  • Tears may be partially or completely circumferential

Etiology

  • Most commonly results from motor vehicle collisions >30 mph
  • Unrestrained passengers, driver seat occupants (injuries from steering column and instruments), and ejected occupants
  • Other mechanisms: Auto vs. pedestrian, airplane crashes, falls from height >10 ft, crush and blast injuries, direct blow to chest
  • Proposed mechanisms of aortic injury:
    • Shear forces arising from unequal rates of deceleration of the relatively fixed descending aorta and the more mobile arch
    • “Bending” stress at the aortic isthmus may cause flexion of the aortic arch on the left mainstem bronchus and pulmonary artery
    • Twisting of the arch forces it superiorly and causes it to stretch
    • Osseous structures (e.g., medial clavicles, manubrium, first rib) cause pinching of the trapped aorta as they strike the vertebral column
    • “Water hammer” fluid wave causes explosive rupture of aorta just distal to the aortic valve

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Basics

Description

  • Traumatic aortic rupture (also referred to as traumatic aortic injury or TAI) is the cause of death in an estimated 20% of lethal motor vehicle collisions
  • An estimated 85% of patients with TAI die before reaching the hospital
  • Patients surviving to the ED usually have a contained rupture as aortic blood is tamponaded by the adventitia
  • Without proper treatment, of the 15% that survive the initial event, 49% will die within the first 24 hr, and 90% within 4 mo
  • Mean age of patients sustaining aortic rupture is 33 yr, and 70% are male
  • Most tears are transverse, not longitudinal
  • Tears may be partially or completely circumferential

Etiology

  • Most commonly results from motor vehicle collisions >30 mph
  • Unrestrained passengers, driver seat occupants (injuries from steering column and instruments), and ejected occupants
  • Other mechanisms: Auto vs. pedestrian, airplane crashes, falls from height >10 ft, crush and blast injuries, direct blow to chest
  • Proposed mechanisms of aortic injury:
    • Shear forces arising from unequal rates of deceleration of the relatively fixed descending aorta and the more mobile arch
    • “Bending” stress at the aortic isthmus may cause flexion of the aortic arch on the left mainstem bronchus and pulmonary artery
    • Twisting of the arch forces it superiorly and causes it to stretch
    • Osseous structures (e.g., medial clavicles, manubrium, first rib) cause pinching of the trapped aorta as they strike the vertebral column
    • “Water hammer” fluid wave causes explosive rupture of aorta just distal to the aortic valve

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