Vascular injuries after blunt chest trauma: diagnosis and management

James V O'Connor,Bartley P Griffith,David G Neschis,Christopher Byrne,Thomas M Scalea

doi:10.1186/1757-7241-17-42

Abstract

BackgroundAlthough relatively rare, blunt injury to thoracic great vessels is the second most common cause of trauma related death after head injury. Over the last twenty years, the paradigm for management of these devastating injuries has changed drastically. The goal of this review is to update the reader on current concepts of diagnosis and management of blunt thoracic vascular trauma.MethodsA review of the medical literature was performed to obtain articles pertaining to both blunt injuries of the thoracic aorta and of the non-aortic great vessels in the chest. Articles were chosen based on authors' preference and clinical expertise.DiscussionBlunt thoracic vascular injury remains highly lethal, with most victims dying prior to reaching a hospital. Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries. More stable injuries can often be medically temporized in order to optimize definitive management. Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.

Highlights

Blunt thoracic great vessel trauma is relatively rare; representing less than 5% of traumatic vascular injuries, with penetrating mechanism predominating [1]
The true incidence is likely underestimated, as many victims die prior to arriving at the hospital for definitive treatment[2]. Of those alive on hospital admission, traumatic aortic rupture accounts for the vast majority of blunt thoracic vascular injuries [3]
Thoracic aortic rupture accounts for nearly 18% of all deaths in motor vehicle collisions[6]

Summary

Discussion

Blunt thoracic vascular injury remains highly lethal, with most victims dying prior to reaching a hospital. Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries. More stable injuries can often be medically temporized in order to optimize definitive management. Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios

Introduction

Mattox KL

Greendyke RM