Improved Treatment Options for Traumatic Aorta Injury

A new review evaluates various treatments for blunt traumatic injury (BTI) to the aorta, spotlighting the newer, minimally invasive endograft procedure that enables repair of the aorta without opening the chest cavity.

Researchers from the University of Maryland (UNM, USA) reported that BTI injury occurs in less than 1% of motor vehicle crashes, but is responsible for 16% of the deaths. Up to 80% of patients die before their arrival at a hospital, and of those who survive the initial injury, a majority will die without definitive treatment. Also, due to the trauma, there can also be brain swelling, broken bones, spinal cord damage, and lung injuries, which further complicate open surgery. While traditional surgery for BTI requires that surgeons open the chest cavity to insert an artificial graft needed to repair the rent aorta, the less invasive endograft procedure involves inserting a catheter into the femoral artery. Using X-ray guidance, the surgeons then steer the catheter through the blood vessels into the aorta. At the site of the injury, the self-expanding graft is released, creating a new lining at the site of the trauma to the vessel. The authors have so far performed 39 endograft aorta repairs in trauma patients admitted to UNM since 2005, and stated that endovascular repair has supplanted open surgery as the primary treatment option in BTI cases. The review was published in the October 16, 2008, edition of the New England Journal of Medicine (NEJM).

"This type of injury to the aorta primarily affects young, healthy people and it has a very high mortality rate. For those who get to medical care quickly, our review found that treatment for blunt aortic injury has evolved and improved considerably,” said lead author David Neschis, M.D., a vascular surgeon at UNM. "The next step in this evolution will be more widespread use of the minimally invasive treatment that allows us to place a small, tube-like device called an endograft inside of the aorta without making a large incision. It offers tremendous promise as a way to save lives, make recovery easier and limit complications.”

"The minimally invasive endograft technique provides a way to fix this devastating injury with less blood loss, less operating time, and faster recovery time, which can be very important for patients recovering from multiple traumatic injuries,” said coauthor William Flinn, M.D., head of vascular surgery at UNM and a professor of surgery at the University of Maryland School of Medicine.

The review also examined the mechanisms of action that cause BTI, which can occur with vehicle crashes, collisions, falls, and crush injuries. These aortic injuries most likely involve a combination of forces, such as stretching and shearing, causing damages to the vital artery. For example, in a car crash, a person traveling at a high rate of speed decelerates rapidly; while one section of the aorta remains stationary, another section continues the inertia. The stress causes tears in the artery; in many cases, the aorta ruptures, causing death.

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University of Maryland Medical Center