Non-penetrating traumatic injuries of the aortic arch

Abstract

Background In severely injured trauma patients, non-penetrating aortic arch injuries (NAAI) have a remarkable incidence and mortality. Both diagnostics and therapy of NAAI recently underwent significant changes. Purpose To assess mortality, morbidity, and the risk factors associated with NAAI in severely injured patients (Injury Severity Score [ISS] ≥16) under the light of recent technical and procedural advances in trauma care. Material and Methods A total of 230 consecutive trauma patients with ISS ≥16 admitted to our level-I trauma center during a 24-month period, were prospectively included and underwent standardized whole-body computed tomography (CT) in a 2 × 128-detector-row scanner. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded for patients with NAAI. Localization of NAAI was described referring to Mitchell and Ishimaru; severity was graded according to the proposal of Heneghan et al. Results Thirteen of 230 patients had a NAAI, yielding an incidence of 5.6%. Mean age and ISS was not elevated in NAAI (44.4 ± 14.8 years, ISS = 38 ± 12.4). Mortality was 23.1%. One patient had severe neurologic sequelae from a stroke; all surviving patients had to undergo (transient) anticoagulant therapy. Trauma mechanism was of high kinetic energy in all cases. Concomitant injuries were predominantly thoracic (rib fractures = 76.9%, thoracic spine fracture = 38.5%). Conclusion Whenever an individual possibly encountered a deceleration–acceleration trauma mechanism, a high level of suspicion for NAAI should be maintained. It remains to be determined whether recent advances in mortality are due to changes in trauma care or due to improved vehicle and road safety.