Infrequent Locations Of Traumatic Aortic Lesion

Laceration of the ascending aorta represents the 5% of aortic injuries in the clinical series, while at autopsy they are found in 20% of cases24. Death is usually secondary to severe associated cardiac injury, as aortic valve tears, myocardial contusion, and coronary artery damage occur in 80% of cases of traumatic lesion of the ascending aorta. The point of anatomic fixation in the ascending aorta is constituted by the pericardial attachment. Compression and displacement of the heart between the sternum and the spine places greatest stress on the supravalvular aorta and mobile ascending aortic portion. Torsion forces are involved in determining injuries of the proximal great vessels, the innominate artery being the most frequently injured. Because tensile strength in the ascending aorta is greater than in the isthmus, the forces that may determine a tear in the ascending aorta would be expected to be greater than usually encountered in car deceleration impact. This type of lesion is frequently found in pedestrians hit by motor vehicles, ejected passengers, and victims of severe falls.

Posttraumatic aortic valve regurgitation secondary to valve cusp damage has been reported25, often associated with sternal and rib fractures. It seems that there is a latent period during which regurgitation develops, which allows operation to be deferred until the patient's condition stabilizes. Because of the protection of its retroperitoneal location, abdominal aortic lesion is a relatively rare occurrence. A review of the English-language literature26 since 1950 reported 46 cases of abdominal aortic lesions, the incidence being one twentieth that of thoracic aortic rupture. The infrarenal portion is the most frequent location, while the suprarenal portion is very rare. Atherosclerotic disease has been implicated in this lesion, being present in 44% of cases. Neurological symptoms were seen in 70% of patients, due to ischemic peripheral neuropathy or to occlusion of the artery of Adamkievicz. A decreased peripheral pulse has been reported in 96% of cases. The lesion, an intimal/medial tear, may lead to either false aneurysm formation or to intraperitoneal rupture. In some cases, thrombosis occurs with acute arterial insufficiency. The overall mortality reported in literature for abdominal aortic trauma, due to aortic rupture or severe associated lesions, is 28%.

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