Trauma

Traumatic aortic transection occurs as a result of an acceleration-deceleration injury such as a high velocity motor vehicle accident or fall.  The aorta tears at the proximal descending thoracic aorta (isthmus) where the aorta is anchored to the thorax.  Traditionally, this is treated with emergency surgery to replace this portion of the aorta.  This surgery was considered risky because the patients usually had associated injuries such as abdominal organ lacerations or contusions (spleen or liver), lung or brain injury.  The contempory approach to these particular injuries is thoracic endovascular aortic repairs (stents).  Occasionally patients are too ill to undergo any intervention and are treated conservatively with Beta-blockade and other blood pressure medications to lower the shear stress on the aortic wall.  These patients are followed careful with serial imaging  to determine the timing of aortic repair. These patients need to be followed after this type of repair especially when long-term durability is unknown with thoracic aortic stents.  These patients are usually young so they need to be followed with serial imaging studies annually.