Classification of blunt aortic injuries a new systematic overview of aortic trauma

Abstract

Blunt (non-penetrating) aortic injuries, in which the arterial wall is damaged in the direction from the intima towards the adventitia, are most commonly the result of a traffic accident. The various forms of blunt aortic injuries, from limited laceration of the intima to complete transection of the aorta, depend on the morphological structure of the arterial wall and the strength of forces causing the trauma. An overview of the literature and medical documentation reveals that different terms, including tear, laceration, disruption, transection, rupture and pseudoaneurysm, are used to describe certain forms of traumatic aortic injuries, which can lead to misinterpretation of findings or diagnoses. We therefore, propose a classification that would enable uniform systematic screening of all forms of blunt aortic injuries. In a retrospective examination of autopsy reports from 1999 to 2006, all those who had died in traffic accidents and who had blunt aortic injuries were selected from the archive at the Institute of Forensic Medicine of the Medical Faculty of the Universtiy of Ljubljana, Slovenia. Blunt aortic injuries (ruptures) were classified into three basic types and corresponding subtypes: type I (intramural), type II (transmural) and type III (multiple) aortic ruptures. The study included 230 deceased persons with 355 aortic ruptures. According to our classification, type I ruptures were observed in 25 (11%), type II ruptures in 131 (57%) and type III ruptures in 74 (32%) cases. The new classification we propose allows simple and systematic screening of all types of blunt aortic injuries. It prevents misinterpretation of various types of aortic injury in medical practice.