Diagnostics and treatment of traumatic aortic injuries

• Published in: Der Unfallchirurg 2021-08, Vol.124 (8), p.601-609
• Main Authors: Benz, R M, Makaloski, V, Brönnimann, M, Mertineit, N, von Tengg-Kobligk, H
• Format: Article
• Language: ger
• Subjects: Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Aorta, Thoracic - surgery; Endovascular Procedures; Humans; Retrospective Studies; Thoracic Injuries - diagnostic imaging; Thoracic Injuries - surgery; Treatment Outcome; Vascular System Injuries - diagnostic imaging; Vascular System Injuries - surgery; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy
• ISSN: 1433-044X
• DOI: 10.1007/s00113-021-01044-0

Traumatic aortic injuries (TAI) are rare injuries in blunt thoracic trauma, which have a high morbidity and mortality. Rapid and accurate diagnosis as well as the correct choice of treatment are elementary for patient survival. Determination of the current standards for diagnostics of TAI in the acute trauma setting and evaluation of the current guidelines for treatment. A literature search was carried out for articles describing diagnostics of TAI. Furthermore, the guidelines for treatment and follow-up of TAI were summarized. Despite the low specificity conventional chest X‑ray is still named in the literature as initial diagnostic procedure. Primarily, computed tomography (CT) should follow as the method of choice for diagnostics and treatment stratification due to the high sensitivity and specificity. Thoracic endovascular aortic repair (TEVAR) is recommended by all guidelines as first line treatment of higher grades of TAI (grades II-IV) and has replaced open surgery in most cases. After rapid diagnosis and classification of TAI with CT, in most cases TEVAR has become the preferred treatment over open surgery.