Aortic Trauma: Diagnosis, Treatment, Follow-Up
Diagnosis: Blunt chest trauma or decelerating injury is an indication for CT scan of chest with contrast. Apart from identifying the bony or soft tissue injuries, it can clearly demonstrate vascular trauma including aortic tears.
Treatment: Once the CT scan is done the extent and severity of aortic injury becomes clear. Depending on the type of injury the treatment varies. A small hematoma on the aortic wall may be left alone.
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Even a small tear in the aortic intima (inner layer of the aorta) may be treated conservatively with caution and rigorous follow up. However, more serious injuries need definitive treatment.
A full thickness tear in the aortic wall is a potentially fatal injury. If the bleeding continues, the victim may develop hypovolemic (low blood volume in the circulation) shock. Large volume of blood can get collected in the thoracic cavity. Often after the initial bleed, the blood clot in the vicinity of injury prevents further bleeding. In these circumstances proper treatment can save the person.
There are two types of definitive treatment. Open Surgery and Endovascular Stenting. In open surgery, the injured part of aorta is replaced with artificial tubes or prosthetic grafts made of PTFE, Dacron or Polyester.
In Endovascular procedures, a folded tube with a self-expanding stent is inserted into the aorta from the femoral artery (Groin) and expanded inside the injured portion to seal the area and prevent bleeding.
Sometimes a HYBRID technique is employed. ie., a combination of surgery and Endovascular procedure.
Follow Up: It is important to keep a close watch on these patients and get a CT aortogram at 3 and 12 months.
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