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Editorial comment

Management of traumatic aortic rupture: endovascular is the winner

Department of Cardiovascular Surgery, University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland

^_* Corresponding author. Tel.: +41 26 426 7185; fax: +41 26 426 7314. (Email: martyb@h-fr.ch).

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Massive deceleration either horizontal or vertical can cause rupture of the aorta typically at the level of the ligamentum arteriosum (the aortic isthmus) distal to the origin of the left subclavian artery. The moment of inertia displaces the relatively mobile heart together with the aortic arch, while the descending aorta tethered to the spine via the intercostals pedicles remains fixed. With the vast majority of these injuries incurred through car crashes, nearly 80% of the victims die at scene of the accident as a result of complete aortic transection including the adventitia and attached connective tissue [1]. Approximately 20% reach the hospital alive due to an incomplete disruption of the tunica intima and media. Tensile strength is provided by the intact adventitia, and the parietal pleura contain the hematoma. However, if left untreated, 5–20 % of these patients are at risk of secondary rupture and intrapleural exsanguination within the first week [2]. In surgically untreated survivors, the natural course of aortic rupture is false aneurysm formation with secondary rupture after months or years.

For decades . . . [Full Text of this Article]