Abstract
Road traffic accidents are the main cause of traumatic aortic ruptures, mostly in combination with other severe injuries. The pre-hospital mortality rate is high. Suspected aortic trauma, following ahigh traumatic aortic injury score, is an indication for computer tomography. Injuries are triaged and the treatment priority of the aortic trauma is ascertained based on the severity of the aortic and concomitant injuries and the condition of the patient. Until definitive treatment of the aortic lesion is completed, the blood pressure of the patient must be kept low. GradeI andII lesions can be managed under strict monitoring with initial conservative treatment in individual cases. GradeIII (contained perforation) and gradeIV (open rupture) lesions need surgical or interventional treatment as swiftly as possible. In selected cases, adelayed treatment can also be advantageous.The endovascular stent graft therapy has established itself as the preferred form of treatment.
Highlights
Summary Road traffic accidents are the main cause of traumatic aortic ruptures, mostly in combination with other severe injuries
Injuries are triaged and the treatment priority of the aortic trauma is ascertained based on the severity of the aortic and concomitant injuries and
Grade I and II lesions can be managed under strict monitoring with initial conservative treatment in individual cases
Summary
Thomas Schachner · Julia Oji-Zurmeyer · Bartosz Rylski · Stephan Kapral · Olaf Stanger · Gerlig Widmann · Florian Schönhoff · Martin Czerny · Stefan Jochberger. Auch bei einem schweren Zugunglück fanden sich unter den Unfallopfern viele mit Thoraxtrauma und einer Aortenverletzung [3]. Die dabei an der Aorta auftretenden Dreh- und Scherkräfte können zu einer transversen Lazeration mit Ruptur führen [5]. 1. Die Deformation der Aorta (Scherkräfte, Zug, Spannung, Verdrehung, Verwindung, Biegung) kann dadurch verursacht werden, dass bei der plötzlichen Dezeleration die mehr flexiblen Anteile der proximalen Aorta und des Aortenbogens nach kranial ausweichen können, während die proximale Aorta descendens aber mit dem Isthmus an der Wirbelsäule fixiert ist und belastet wird [19]. Nach einer anderen Hypothese verhält sich die proximale Aorta unter lateraler Krafteinwirkung wie der lange Arm eines steifen Hebels mit der A. subclavia als Drehpunkt [20]. Außerdem besitzen Media und Adventitia eine größere Elastizität als die endothelseitigen Wandanteile, weshalb diese steifere Struktur bei Druckspitzen von größerem Stress betroffen ist [19, 26]
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