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The Annals of Thoracic Surgery, Vol 57, 726-730, Copyright © 1994 by The Society of Thoracic Surgeons
JS Williams, JA Graff, JM Uku and JP Steinig
A 5-year retrospective study of 530 motor vehicle fatalities revealed 105
aortic injuries occurring in 90 victims. These were reviewed to determine
the injury patterns, circumstances, and mechanisms involved. In addition,
the survival time, the driver's age and sex, the time of day of the
accident, and the blood alcohol level were considered. The aortic injuries
consisted of 61 transections and 44 tears (13% were multiple). Sixty-five
percent of the injuries were located in the proximal descending aorta (66%
of these were transections), 14% were in the ascending aorta and arch (33%
of these were transections), 12% were in the distal descending aorta (more
than 1 cm distal to the subclavian artery) (46% of these were
transections), and 9% were in the abdominal aorta (56% of these were
transections). Associated injuries consisted of multiple rib fractures
(78%), liver lacerations (61%), head injuries (42%), first rib fractures
(42%), splenic lacerations (36%), heart lacerations (34%), sternal
fractures (28%), cervical spine fractures (26%), and thoracic spine
fractures (20%). Death occurred within 1 hour in 94% and within 24 hours in
99%. The impact was head-on in 62% of the accidents. The victim was the
driver 74% of the time and male in 77% of the cases, and the blood alcohol
level exceeded 0.1 mg/dL in 43%. Most aortic disruptions were complete
transections of the proximal descending aorta, associated with serious
injury to the thorax, and occurred in head-on collisions. Findings support
a compression and upward thrust of the heart as a mechanism responsible for
the aortic disruption.
ARTICLES
Aortic injury in vehicular trauma
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia 31403-3089.
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