Traumatic Aortic Transection (Aortic Rupture)

The aorta is the largest artery in the body. It rises from the heart's left ventricle (the major chamber that pumps blood out of the heart) and is filled with oxygen-rich blood that travels throughout the body.

Traumatic aortic transection, also known as aortic rupture, is the near-complete tear through all the layers of the aorta due to trauma such as that sustained in a motor vehicle collision or a fall. This condition is most often lethal and requires immediate medical attention. It is the second most common cause of death associated with motor vehicle accidents. Patients who survive to the emergency department usually have partial-thickness tears of the aortic wall with pseudoaneurysm formation.

Symptoms

An aortic rupture occurs after there is trauma to the aorta such as that from a motor vehicle accident or a penetrating injury. This can make diagnosis difficult because the patient often has multiple traumatic injuries with symptoms that may mask the ruptured aorta. In most cases the condition is not discovered until CT scans or other imaging tests are performed.

When present, symptoms of an aortic rupture may include:

  • Severe chest pain
  • Severe back pain
  • Severe abdominal pain
  • Signs of external chest injury


Causes and Risk Factors

The condition is caused by trauma to the aorta. Participating in certain activities or lifestyle choices could increase the risk of experiencing traumatic aortic transection. In rare cases, aortic surgery may be associated with aortic rupture.

Diagnosis

Diagnosis of aortic rupture is almost always done at the emergency room after a traumatic event. Imaging tests such as a magnetic resonance angiogram (MRA), CT scan or aortic angiogram may be used to view the aorta and determine if a tear is present. Some of the diagnostic imaging tests require a special dye to be injected into the vein so that it shows up more clearly on the images.

Another imaging diagnostic test that may be used is a transesophageal echocardiography — a type of echocardiography that uses an ultrasound probe inserted through the esophagus to view the aorta.

Treatments

Because traumatic aortic transection is a life-threatening condition, treatment is needed immediately. The most common treatment is endovascular treatment to repair the damaged area.

On occasion, open replacement surgery will be offered, thereby removing the damaged portion of the aorta and placing a graft where the tissue was removed in order to prevent blood from leaking from the aorta. The graft is generally a tube made of synthetic material that helps restore function to the damaged area.

Surgery may be delayed if the patient has other injuries that may complicate the surgery or put them at unnecessary risk during surgery. The knowledgeable and highly trained staff at the Cedars-Sinai Heart Institute will work with each patient to determine the best treatment option.