Morphology and Risk Factors for Blunt Aortic Trauma in Car Accidents - An Autopsy Study
Background: Blunt aortic trauma (BAT) includes
various morphological changes that occur during deceleration,
acceleration and/or body compression in traffic accidents. The
various forms of BAT, from limited laceration of the intima to
complete transection of the aorta, depends on the force acting on the
vessel wall and the tolerance of the aorta to injury. The force depends
on the change in velocity, the dynamics of the accident and of the
seating position in the car. Tolerance to aortic injury depends on the
anatomy, histological structure and pathomorphological alterations
due to aging or disease of the aortic wall.
An overview of the literature and medical documentation reveals
that different terms are used to describe certain forms of BAT, which
can lead to misinterpretation of findings or diagnoses. We therefore,
propose a classification that would enable uniform systematic
screening of all forms of BAT. We have classified BAT into three
morphologycal types: TYPE I (intramural), TYPE II (transmural) and
TYPE III (multiple) aortic ruptures with appropriate subtypes.
Methods: All car accident casualties examined at the Institute of
Forensic Medicine from 2001 to 2009 were included in this
retrospective study. Autopsy reports were used to determine the
occurrence of each morphological type of BAT in deceased drivers,
front seat passengers and other passengers in cars and to define the
morphology of BAT in relation to the accident dynamics and the age
of the fatalities.
Results: A total of 391 fatalities in car accidents were included in
the study. TYPE I, TYPE II and TYPE III BAT were observed in
10,9%, 55,6% and 33,5%, respectively. The incidence of BAT in
drivers, front seat and other passengers was 36,7%, 43,1% and
28,6%, respectively. In frontal collisions, the incidence of BAT was
32,7%, in lateral collisions 54,2%, and in other traffic accidents
29,3%. The average age of fatalities with BAT was 42,8 years and of
those without BAT 39,1 years.
Conclusion: Identification and early recognition of the risk factors
of BAT following a traffic accident is crucial for successful treatment
of patients with BAT. Front seat passengers over 50 years of age who
have been injured in a lateral collision are the most at risk of BAT.
[1] Moar JJ. Traumatic rupture of the thoracic aorta. An autopsy and
histopathological study. S Afr Med J 1985;6:383-385.
[2] Ben-Menachem Y, Handel SF. The mechanism of injury. Angiography
in trauma. A work atlas. London: WB Saunders, 1981.
[3] Richens D, Field M, Neale M, Oakley C. The mechanism of injury in
blunt traumatic rupture of the aorta. Eur J CardiothoracSurg
2002;21:288-293.
[4] Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta. Br J
Surg 1977;64:166-173.
[5] PierangeliA et al. Delayed treatment of isthmic aortic rupture.
Cardiovascular Surgery, 2000;8:280-283.
[6] Stemper BD, Yoganandan N, Pintar FA, Brasel KJ. Multiple subfailures
characterize blunt aortic injury. J Trauma 2007;62:1171-1174.
[7] Parmly LF, Mattingly TW, Manion WC, Jahnke EJ Jr. Nonpenetrating
traumatic injury of the aorta. Circulation 1958;17:1086-1101.
[8] Feczko JD et al. An autopsy case review of 142 nonpenetrating (blunt)
injures of the aorta. J Trauma 1990;30:1294-1297.
[9] Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal
blunt aortic injuries: a review of 242 autopsy cases. J Trauma
2001;50:113-115.
[10] Ermenc B, Prijon T, Hočevar Z. Pathoanatomy and histology of
traumatic aortic ruptures- an attempt of classification. In: International
meeting on forensic medicine Alpe-Adria-Pannonia. Whiplash injury.
Proceedings. Department of Forensic Medicine and Criminology Scool
of Medicine, University of Zagreb. Croatian Medical Association.
Opatija, Croatia, 23-26 May, 2001;212-218.
[11] Prijon T, Ermenc B, Balažic J, Štefanič B, Šerko A, Kralj E.
Classification of blunt injuries to the thoracic aorta. Archive of
Oncology 2002;10:10-11.
[12] Prijon T, Ermenc B. A systematic interpretation of aortic trauma and a
proposed new classification of blunt aortic injuries. In: XXth Congress
of International Academy of Legal Medicine, Budaperst 23-26 Avgust
2006. Editor Peter Sotony. Free papers proceedings; 87-91.
[13] Prijon T, Ermenc B. Classification of blunt aortic injuries - a new
systematic overview of aortic trauma. Forensic Sci Int. 2010;195:6-9.
[14] Fitzharris M, Franklyn M, Frampton R, Yang K, Morris A, Fildes B.
Thoracic aortic injury in motor vehicle crashes: the effect of impact
direction, side of body struck, and seat belt use. J Trauma 2004;57:582-
590.
[15] Richens D, Kotidis K, Neale M, Oakley C, Fails A. Rupture of the aorta
following road traffic accidents in the United Kingdom 1992-1999. The
results of the co-operative cresh injury study. Eur J cardiothoracSurg
2003;23:143-148.
[16] Viano DC. Biomechanics of non-penetrating aortic trauma: a review.
27th Stapp car crash conference, 1983.
[17] Steenburg SD, Ravenel JG, Ikonomidis JS, Schönholz C, Reeves S.
Acute Traumatic Aortic Injury: Imaging Evuluation and Managment.
Radiology 2008; 248:748-762.
[18] Nienaber CA, Eagle KA. Aortic dissection; New frontiers in diagnosis
and management. Part II: Therapeutic management and follow-up.
Circulation 2003;108:772-778.
[19] Nienaber CA, Eagle KA. Aortic dissection; New frontiers in diagnosis
and management. Part I: from etiology to diagnostic strategies.
Circulation 2003;108:628-635.
[20] Siegal EM. Acute aortic dissection. J hosp Med 2006;1:94-105.
[21] Williams JS, Graff JA, Uku IM, Steinig JP. Aortic injury in vehicular
trauma. Ann ThoracSurg 1994;57:762-730.
[22] Chiesa R, Liberato de Moura MR, Lucci C, Castellano R, Civilini E,
Melissano G, Tshomba Y. Blunt trauma of the thoracic aorta:
mechanisms involed, diagnosis and managment. J Vasc Br 2003;2
(3):197-210.
[23] Isselbacher EM. Disease of the aorta. In: Libby P, Bonow RO, Mann
DL, Zipws DP, eds. Braunwald's Heart disease. A textbook of
cardiovascular medicine. 8th ed. Philadelphia: Saunders Elsevier; 2008:
1457-1490.
[24] Dosios TJ, Salemis N, Angouras D, Nonas E. Blunt and penetranting
trauma of the thoracic aorta and aortic arch branches: an autopsy study. J
Trauma. 2000; 49: 696-703.
[25] Greendyke RM. Traumatic rupture of aorta; special reference to
automobile accidents. JAMA 1966;195:527-530.
[26] Haunt RC. Biomechanics of soft tissues. In: Nahum AM, Melvin JW
Editors, Accidental injury, Springer-Verlag, New York¸1993:224-246.
[27] Tanak TT, Fung YC. Elastic and inelastic properties of the canine aorta
and their variation along the aortic tree. J Biomech. 1974; 7:357-370.
[28] Gotzen L, Flory PJ, Otte D. Biomechanics of aortic rupture at classical
location in traffic accidents. ThoracCardiovascSurg 1980;28:64-68.
[29] McGwin G, Reiff DA, Moran SG, Rue LW. Incidence and
characteristics of motor vehicle collision – related blunt thoracic injury
according to age.
[30] Bertrand S, Cuny S, Petit P, Trosseille X, Page P, Guillemot H, et al.
Traumatic rupture of thoracic aorta in real-world motor vehicle crashes.
Traffic Injury Prevention. 2008:9;153-161.
[31] Newman RJ, Rastogi S. Rupture of the thoracic aorta and its relationship
to road traffic accident characteristics. Injury.1984;15:296-299.
[32] Fabian TC, Richardson JD, Croce MA, et.al. prospective study of blunt
aortic injury: multicenter trial of the American Association for the
Surgery of Trauma. J Trauma 1997;42:374-380.
[33] Strassman G. Traumatic rupture of the aorta. Am Heart J, 1947; 33: 508.
[34] Lundervall J. The mechanism of traumatic rupture of the aorta.
ActaPatholMicrobiolScand 1964;62:34-46.
[35] Horton TG, Cohn SM, Heid MP, et al. Indentification of trauma patients
at risc of thoracic aortic tear by mechanism of injury. J Trauma
2000;48:1008-1013.
[36] Schulman CI, Carvajal D, Lopez PP, Soffer D, Habib F, Augenstein J.
Incidence and crash mechanisms of aortic injury during the past decade.
J Trauma 2007;62:664-667.
[37] Katyal D, McLellan BA, Brenneman FD, Boulanger BR, Sharkey PW,
Waddell JP. Lateral impact motor vehicle collisions: significant cause of
blunt traumatic rupture of the thoracic aorta. J Trauma 1997;42:769-772.
[38] Nikolic S, Atanasijević T, Mihalović Z, Babic D, Popovic-Loncar T.
Mechanism of aortic blunt in fatally injured front-seat passengers in
frontal car collisions: an autopsy study. Am J Forensic Med Pathol 2006;
27:292-295.
[1] Moar JJ. Traumatic rupture of the thoracic aorta. An autopsy and
histopathological study. S Afr Med J 1985;6:383-385.
[2] Ben-Menachem Y, Handel SF. The mechanism of injury. Angiography
in trauma. A work atlas. London: WB Saunders, 1981.
[3] Richens D, Field M, Neale M, Oakley C. The mechanism of injury in
blunt traumatic rupture of the aorta. Eur J CardiothoracSurg
2002;21:288-293.
[4] Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta. Br J
Surg 1977;64:166-173.
[5] PierangeliA et al. Delayed treatment of isthmic aortic rupture.
Cardiovascular Surgery, 2000;8:280-283.
[6] Stemper BD, Yoganandan N, Pintar FA, Brasel KJ. Multiple subfailures
characterize blunt aortic injury. J Trauma 2007;62:1171-1174.
[7] Parmly LF, Mattingly TW, Manion WC, Jahnke EJ Jr. Nonpenetrating
traumatic injury of the aorta. Circulation 1958;17:1086-1101.
[8] Feczko JD et al. An autopsy case review of 142 nonpenetrating (blunt)
injures of the aorta. J Trauma 1990;30:1294-1297.
[9] Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal
blunt aortic injuries: a review of 242 autopsy cases. J Trauma
2001;50:113-115.
[10] Ermenc B, Prijon T, Hočevar Z. Pathoanatomy and histology of
traumatic aortic ruptures- an attempt of classification. In: International
meeting on forensic medicine Alpe-Adria-Pannonia. Whiplash injury.
Proceedings. Department of Forensic Medicine and Criminology Scool
of Medicine, University of Zagreb. Croatian Medical Association.
Opatija, Croatia, 23-26 May, 2001;212-218.
[11] Prijon T, Ermenc B, Balažic J, Štefanič B, Šerko A, Kralj E.
Classification of blunt injuries to the thoracic aorta. Archive of
Oncology 2002;10:10-11.
[12] Prijon T, Ermenc B. A systematic interpretation of aortic trauma and a
proposed new classification of blunt aortic injuries. In: XXth Congress
of International Academy of Legal Medicine, Budaperst 23-26 Avgust
2006. Editor Peter Sotony. Free papers proceedings; 87-91.
[13] Prijon T, Ermenc B. Classification of blunt aortic injuries - a new
systematic overview of aortic trauma. Forensic Sci Int. 2010;195:6-9.
[14] Fitzharris M, Franklyn M, Frampton R, Yang K, Morris A, Fildes B.
Thoracic aortic injury in motor vehicle crashes: the effect of impact
direction, side of body struck, and seat belt use. J Trauma 2004;57:582-
590.
[15] Richens D, Kotidis K, Neale M, Oakley C, Fails A. Rupture of the aorta
following road traffic accidents in the United Kingdom 1992-1999. The
results of the co-operative cresh injury study. Eur J cardiothoracSurg
2003;23:143-148.
[16] Viano DC. Biomechanics of non-penetrating aortic trauma: a review.
27th Stapp car crash conference, 1983.
[17] Steenburg SD, Ravenel JG, Ikonomidis JS, Schönholz C, Reeves S.
Acute Traumatic Aortic Injury: Imaging Evuluation and Managment.
Radiology 2008; 248:748-762.
[18] Nienaber CA, Eagle KA. Aortic dissection; New frontiers in diagnosis
and management. Part II: Therapeutic management and follow-up.
Circulation 2003;108:772-778.
[19] Nienaber CA, Eagle KA. Aortic dissection; New frontiers in diagnosis
and management. Part I: from etiology to diagnostic strategies.
Circulation 2003;108:628-635.
[20] Siegal EM. Acute aortic dissection. J hosp Med 2006;1:94-105.
[21] Williams JS, Graff JA, Uku IM, Steinig JP. Aortic injury in vehicular
trauma. Ann ThoracSurg 1994;57:762-730.
[22] Chiesa R, Liberato de Moura MR, Lucci C, Castellano R, Civilini E,
Melissano G, Tshomba Y. Blunt trauma of the thoracic aorta:
mechanisms involed, diagnosis and managment. J Vasc Br 2003;2
(3):197-210.
[23] Isselbacher EM. Disease of the aorta. In: Libby P, Bonow RO, Mann
DL, Zipws DP, eds. Braunwald's Heart disease. A textbook of
cardiovascular medicine. 8th ed. Philadelphia: Saunders Elsevier; 2008:
1457-1490.
[24] Dosios TJ, Salemis N, Angouras D, Nonas E. Blunt and penetranting
trauma of the thoracic aorta and aortic arch branches: an autopsy study. J
Trauma. 2000; 49: 696-703.
[25] Greendyke RM. Traumatic rupture of aorta; special reference to
automobile accidents. JAMA 1966;195:527-530.
[26] Haunt RC. Biomechanics of soft tissues. In: Nahum AM, Melvin JW
Editors, Accidental injury, Springer-Verlag, New York¸1993:224-246.
[27] Tanak TT, Fung YC. Elastic and inelastic properties of the canine aorta
and their variation along the aortic tree. J Biomech. 1974; 7:357-370.
[28] Gotzen L, Flory PJ, Otte D. Biomechanics of aortic rupture at classical
location in traffic accidents. ThoracCardiovascSurg 1980;28:64-68.
[29] McGwin G, Reiff DA, Moran SG, Rue LW. Incidence and
characteristics of motor vehicle collision – related blunt thoracic injury
according to age.
[30] Bertrand S, Cuny S, Petit P, Trosseille X, Page P, Guillemot H, et al.
Traumatic rupture of thoracic aorta in real-world motor vehicle crashes.
Traffic Injury Prevention. 2008:9;153-161.
[31] Newman RJ, Rastogi S. Rupture of the thoracic aorta and its relationship
to road traffic accident characteristics. Injury.1984;15:296-299.
[32] Fabian TC, Richardson JD, Croce MA, et.al. prospective study of blunt
aortic injury: multicenter trial of the American Association for the
Surgery of Trauma. J Trauma 1997;42:374-380.
[33] Strassman G. Traumatic rupture of the aorta. Am Heart J, 1947; 33: 508.
[34] Lundervall J. The mechanism of traumatic rupture of the aorta.
ActaPatholMicrobiolScand 1964;62:34-46.
[35] Horton TG, Cohn SM, Heid MP, et al. Indentification of trauma patients
at risc of thoracic aortic tear by mechanism of injury. J Trauma
2000;48:1008-1013.
[36] Schulman CI, Carvajal D, Lopez PP, Soffer D, Habib F, Augenstein J.
Incidence and crash mechanisms of aortic injury during the past decade.
J Trauma 2007;62:664-667.
[37] Katyal D, McLellan BA, Brenneman FD, Boulanger BR, Sharkey PW,
Waddell JP. Lateral impact motor vehicle collisions: significant cause of
blunt traumatic rupture of the thoracic aorta. J Trauma 1997;42:769-772.
[38] Nikolic S, Atanasijević T, Mihalović Z, Babic D, Popovic-Loncar T.
Mechanism of aortic blunt in fatally injured front-seat passengers in
frontal car collisions: an autopsy study. Am J Forensic Med Pathol 2006;
27:292-295.
@article{"International Journal of Medical, Medicine and Health Sciences:58943", author = "Ticijana Prijon and Branko Ermenc", title = "Morphology and Risk Factors for Blunt Aortic Trauma in Car Accidents - An Autopsy Study", abstract = "Background: Blunt aortic trauma (BAT) includes
various morphological changes that occur during deceleration,
acceleration and/or body compression in traffic accidents. The
various forms of BAT, from limited laceration of the intima to
complete transection of the aorta, depends on the force acting on the
vessel wall and the tolerance of the aorta to injury. The force depends
on the change in velocity, the dynamics of the accident and of the
seating position in the car. Tolerance to aortic injury depends on the
anatomy, histological structure and pathomorphological alterations
due to aging or disease of the aortic wall.
An overview of the literature and medical documentation reveals
that different terms are used to describe certain forms of BAT, which
can lead to misinterpretation of findings or diagnoses. We therefore,
propose a classification that would enable uniform systematic
screening of all forms of BAT. We have classified BAT into three
morphologycal types: TYPE I (intramural), TYPE II (transmural) and
TYPE III (multiple) aortic ruptures with appropriate subtypes.
Methods: All car accident casualties examined at the Institute of
Forensic Medicine from 2001 to 2009 were included in this
retrospective study. Autopsy reports were used to determine the
occurrence of each morphological type of BAT in deceased drivers,
front seat passengers and other passengers in cars and to define the
morphology of BAT in relation to the accident dynamics and the age
of the fatalities.
Results: A total of 391 fatalities in car accidents were included in
the study. TYPE I, TYPE II and TYPE III BAT were observed in
10,9%, 55,6% and 33,5%, respectively. The incidence of BAT in
drivers, front seat and other passengers was 36,7%, 43,1% and
28,6%, respectively. In frontal collisions, the incidence of BAT was
32,7%, in lateral collisions 54,2%, and in other traffic accidents
29,3%. The average age of fatalities with BAT was 42,8 years and of
those without BAT 39,1 years.
Conclusion: Identification and early recognition of the risk factors
of BAT following a traffic accident is crucial for successful treatment
of patients with BAT. Front seat passengers over 50 years of age who
have been injured in a lateral collision are the most at risk of BAT.
", keywords = "Aorta, blunt trauma, car accidents, morphology, risk
factors.", volume = "8", number = "8", pages = "498-4", }
