Combined Trauma with Thoracic Aortic Rupture
Diagnosis of a thoracic aortic rupture in cases of combined trauma is carried out by prioritizing life‑threatening conditions based on a multidisciplinary approach, taking into account the patient’s individual characteristics. The decision on the method of restoring the aorta in the isthmus area in the event of its rupture was based on early diagnosis using computed tomography angiography, performed as soon as possible. When planning treatment tactics, not only the characteristics and degree of aortic damage were taken into account, but also the time to delivery and the capabilities of the medical facility, the patient’s general condition, concomitant injuries, and hemodynamic stability. In cases of type I–III thoracic aortic injuries, the priority is given to delayed endovascular reconstruction, taking into account the location and condition of the proximal stent‑graft fixation zone. In this case, in the event of a type IV thoracic aortic isthmus rupture combined with intrapleural bleeding, mediastinal hematoma, and unstable hemodynamics, open surgery is preferred. For other injuries that do not require emergency care, all radical surgical interventions are performed in a delayed manner.
Romanov M.D., Davydkin V.I., Romanova E.M., Pigachev A.V., Demidov D.V., Goryachkin M.V. 2026. Combined Trauma with Thoracic Aortic Rupture. Challenges in Modern Medicine, 49(3): 309–320 (in Russian). DOI: 10.52575/2687-0940-2026-49-3-309-320. EDN: THPBNC
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Bu Y.Z., Liu X.Z., Zhou T.N., Liu X.D., Jin H.X., Liu X.J., Wang X.Z. 2022. Clinical Characteristics and Diagnosis and Treatment Strategies of Patients with Severe Traumatic Aortic Injury. Zhonghua Xin Xue Guan Bing Za Zhi. 50(8): 767–773. doi: 10.3760/cma.j.cn112148-20220430-00333
Cambria R.P., Crawford R.S., Cho J.S., Bavaria J., Farber M., Lee W.A., Ramaiah V., Kwolek C.J. 2009. GORE TAG Investigators. A Multicenter Clinical Trial of Endovascular Stent Graft Repair of Acute Catastrophes of the Descending Thoracic Aorta. Journal of Vascular Surgery. 50(6): 1255–1264.e1-4. doi: 10.1016/j.jvs.2009.07.104
Carter R., Wee I.J.Y., Petrie K., Syn N., Choong A.M. 2019. Chimney Parallel Grafts and Thoracic Endovascular Aortic Repair for Blunt Traumatic Thoracic Aortic Injuries: A Systematic Review. Vascular. 27(2): 204–212. doi: 10.1177/1708538118812548
Harik L., Lau C. 2023. Open and Endovascular Repair of Thoracoabdominal Aortic Aneurysm-A Narrative Review. Journal of Thoracic Disease. 15(7): 3984–3997. doi: 10.21037/jtd-22-1880
Martinelli O., Faccenna F., Malaj A., Jabbour J., Venosi S., Gattuso R., Gossetti B., Irace L. 2018. Hypertension, Acute Stent Thrombosis, and Paraplegia 6 Months after Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury in a 22-Year-Old Patient. Annals of Vascular Surgery. 47(281): e5–281.e10. doi: 10.1016/j.avsg.2017.08.041
Mazzaccaro D., Righini P., Fancoli F., Giannetta M., Modafferi A., Malacrida G., Nano G. 2023. Blunt Thoracic Aortic Injury. Journal of Clinical Medicine. 12: 2903. doi: 10.3390/jcm12082903
Romagnoli A.N., Dubose J. 2019. Is Endovascular Repair the First Choice for all Blunt Aortic Injury? A Real-World Assessment. Journal of Cardiovascular Surgery (Torino). 60(3): 289–297. doi: 10.23736/S0021-9509.19.10909-3
Song Q., Bao L., Wu X., Liu B., Wang M. 2025. Two Cases of Complex Traumatic Aortic Dissection Combined with Multiple Organ Injuries. Chinese Journal of Traumatology. 28(1): 29–34. doi: 10.1016/j.cjtee.2024.08.001
Sun J., Ren K., Zhang L., Xue C., Duan W., Liu J., Cong R. 2022. Traumatic Blunt Thoracic Aortic Injury: A 10-Year Single-Center Retrospective Analysis. Journal of Cardiothoracic Surgery. 17(1): 335. doi: 10.1186/s13019-022-02094-0
Yamasaki G., Sugimoto M., Kondo T., Takahashi M., Morichika M., Kuse A., Nakagawa K., Ueno Y., Asano M. 2023. Blunt Traumatic Aortic Dissection Death by Falling: An Autopsy Case Report. Forensic Science Medicine and Pathology. 19(3): 388–392. doi: 10.1007/s12024-022-00527-9