Abstract

PurposeTo assess biomechanical factors in aortic arch geometry contributing to the development of non-penetrating aortic arch injury (NAAI) in multiply injured patients with an Injury Severity Score (ISS) ≥ 16.Material and methods230 consecutive multiply injured trauma patients with an ISS ≥ 16 admitted to our Level-I trauma center during a consecutive 24-month period were prospectively included of whom 13 presented with NAAI (5.7%). Standardized whole-body CT in a 2x128-detector-row scanner included a head-and-neck CTA. Aortic arch diameters, width, height, angles and thoracic width and height were measured in individuals with NAAI and ISS-, sex-, age-, and trauma mechanism-matched controls.ResultsThere was no difference between groups regarding sex, age, ISS, and aortic diameters. The aortic arch angle in individuals with NAAI (71.3° ± 14.9°) was larger than in healthy control (60.7° ± 8.6°; p*<0.05). In patients with NAAI, the distance between ascendent and descendent aorta was larger (5.2 cm ± 1.9 cm) than in control (2.8 ± 0.5 cm; ***p<0.001). The aortic arch is higher above tracheal bifurcation in NAAI (3.6 cm ± 0.6 cm) than in matched control (2.4 cm ± 0.3 cm; ***p<0.001). Accordingly, the area under the aortic arch, calculated as half of an eliptic shape, is significantly larger in patients with NAAI (15.0 cm2 ± 6.5 cm2) when compared to age- and sex-matched controls without NAAI (5.5 cm2 ± 1.3 cm2; ***p<0.001).ConclusionBesides the magnitude of deceleration and direction of impact, width and height of the aortic arch are the 3rd and 4th factor directly contributing to the risk of developing traumatic NAAI in severely injured patients.

Highlights

  • Traumatic, non-penetrating aortic arch injuries (NAAI) are frequently fatal; despite advances in prehospital emergency services, up to 80% of patients with NAAI do not reach the hospital [1,2]

  • Besides the magnitude of deceleration and direction of impact, width and height of the aortic arch are the 3rd and 4th factor directly contributing to the risk of developing traumatic NAAI in severely injured patients

  • With respect to basic principles of physics, such as Newton’s 2nd law of motion, moment of inertia, and law of Laplace, further factors should contribute to the risk of development of NAAI; aortic arch geometry, blood pressure, and direction of force can add up and cause a tear in the aortic wall

Read more

Summary

Material and methods

230 consecutive multiply injured trauma patients with an ISS ! 16 admitted to our Level-I trauma center during a consecutive 24-month period were prospectively included of whom 13 presented with NAAI (5.7%). 230 consecutive multiply injured trauma patients with an ISS ! 16 admitted to our Level-I trauma center during a consecutive 24-month period were prospectively included of whom 13 presented with NAAI (5.7%). Standardized whole-body CT in a 2x128-detector-row scanner included a head-and-neck CTA. Width, height, angles and thoracic width and height were measured in individuals with NAAI and ISS-, sex-, age-, and trauma mechanism-matched controls

Results
Conclusion
Introduction
Discussion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call