Aortic Rupture, Traumatic (Tai)
- 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
- 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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Schaider, Jeffrey J., et al., editors. "Aortic Rupture, Traumatic (Tai)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_.
Aortic Rupture, Traumatic (Tai). In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_. Accessed May 28, 2023.
Aortic Rupture, Traumatic (Tai). (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_
Aortic Rupture, Traumatic (Tai) [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 May 28]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Aortic Rupture, Traumatic (Tai) ID - 307282 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -