Guidelines for the diagnosis and management of blunt aortic injury: An EAST practice management guidelines work group

Journal of Trauma - Injury, Infection and Critical Care

Volumn 48, Issue 6, 2000, Pages 1128-1143

  Nagy, Kimberly ^a,g   Fabian, Timothy ^b   Rodman, George ^c   Fulda, Gerard ^d   Rodriguez, Aurelio ^e   Mirvis, Stuart ^f  

^a Jr Hospital of Cook County   (United States)

^b UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER   (United States)

^c METHODIST HOSPITAL   (United States)

^d MEDICAL CENTER OF DELAWARE   (United States)

^e UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE   (United States)

^f UNIVERSITY OF MARYLAND   (United States)

^g M3241   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AORTA INJURY; ARTICLE; BLUNT TRAUMA; CLINICAL EXAMINATION; DISEASE SEVERITY; HUMAN; PATIENT CARE; PRACTICE GUIDELINE; PRIORITY JOURNAL; THORAX RADIOGRAPHY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY;

EID: 0033932988     PISSN: 00225282     EISSN: 15298809     Source Type: Journal    
DOI: 10.1097/00005373-200006000-00021     Document Type: Article

References (144)

1. Dalldorf PG, McCarthy MC, Tarver RD, et al. Traumatic rupture of the aorta: indications for aortography. Am Surg: 1990;56:500-503.
2. 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.
3. Gundry SR, Burney RE, MacKenzie JR, et al. Assessment of mediastinal widening associated with traumatic rupture of the aorta. J Trauma. 1983;23:293-299.
4. Heystraten FM, Rosenbusch G, Kingma LM, et al. Chest radiography in acute traumatic rupture of the thoracic aorta. Acta Radiol. 1988;29:411-417.
5. Katyal D, McLellan BA, Brenneman FD, et al. lateral impact motor vehicle collisions: significant cause of blunt traumatic rupture of the thoracic aorta. J Trauma. 1997;42:769-772.
6. Marnocha KE, Maglinte DD. Plain-film criteria for excluding aortic rupture in blunt chest trauma. AJR Am J Roentgenol. 1985;144:19-21.
7. Marsh DG, Sturm JT. Traumatic aortic rupture: roentgenographic indications for angiography. Ann Thorac Surg. 1976;21:337-340.
8. Plewa MC, Stavros M, Boorstein JM, Weaver E. Cervical prevertebral soft-tissue measurements and chest radiographic findings in acute traumatic aortic injury. Am J Emerg Med. 1997;15:256-259.
9. Shackford SR, Virgilio RW, Smith DE, et al. The significance of chest wall injury in the diagnosis of traumatic aneurysms of the thoracic aorta. J Trauma. 1978;18:493-497.
10. Vignon P, Lagrange P, Boncoeur MP, et al. Routine transesophageal echocardiography for the diagnosis of aortic disruption in trauma patients without enlarged mediastinum. J Trauma. 1996;40:422-427.
11. Woodring JH, King JG. Determination of normal transverse mediastinal width and mediastinal-width to chest-width (M/C) ratio in control subjects: implications for subjects with aortic or brachiocephalic arterial injury. J Trauma. 1989;29:1268-1272.
12. Woodring JH, Pulmano CM, Stevens RK. The right paratracheal stripe in blunt chest trauma. Radiology. 1982; 143:605-608.
13. Ayella RJ, Hankins JR, Turney SZ, Cowley RA. Ruptured thoracic aorta due to blunt trauma. J Trauma. 1977; 17:199-205.
14. Barcia TC, Livioni JP. Indications for angiography in blunt thoracic trauma. Radiology. 1983;147:15-19.
15. Ben-Menachem Y. Rupture of the thoracic aorta by broadside impacts in road traffic and other collisions: further angiographic observations and preliminary autopsy findings. J Trauma. 1993;35:363-367.
16. Clark DE, Zeiger MA, Wallace KL, et al. Blunt aortic trauma: signs of high risk. J Trauma. 1990;30:701-705.
17. DeMeules JE, Cramer G, Perry JF. Rupture of aorta and great vessels due to blunt thoracic trauma. J Thorac Cardiovasc Surg. 1971;61:438-442.
18. Feczko JD, Lynch L, Pless JE, et al. An autopsy case review of 142 nonpenetrating (blunt) injuries of the aorta. J Trauma. 1992;33:846-849.
19. Gerlock AJ, Muhletaler CA, Coulam CM, Hayes PT. Traumatic aortic aneurysm: validity of esophageal tube displacement sign. AJR Am J Roentgenol. 1980;135:713-718.
20. Gundry SR, Williams S, Burney RE, et al. Indications for aortography in blunt thoracic trauma: a reassessment. J Trauma. 1982;22:664-671.
21. Kram HB, Wohlmuth DA, Appel PL, Shoemaker WC. Clinical and radiographic indications for aortography in blunt chest trauma. J Vasc Surg. 1987;6:168-176.
22. Kram HB, Appel PL, Wohlmuth DA, Shoemaker WC. Diagnosis of traumatic thoracic aortic rupture: a 10-year retrospective analysis. Ann Thorac Surg. 1989;47:282-286.
23. Lee J, Harris JH, Duke JW, Williams JS. Noncorrelation between thoracic skeletal injuries and acute traumatic aortic tear. J Trauma. 1997;43:400-404.
24. Mattox KL, Pickard L, Allen MK, Garcia-Rinaldi R. Suspecting thoracic aortic transection. JACEP. 1978;7:12-15.
25. Mirvis SE, Bidwell JK, Buddemeyer EU, et al. Value of chest radiography in excluding traumatic aortic rupture. Radiology. 1987;163:487-493.
26. Pastershank SP, Chow KC. Blunt trauma to the aorta and its major branches. J Can Assoc Radiol. 1974;25:202-210.
27. Petty SM, Parker LS, Mauro MA, et al. Chronic posttraumatic aortic pseudoaneurysm: recognition before rupture. Postgrad Med. 1991;89:173-178.
28. Richardson RL, Khandekar A, Moseley PW. Traumatic rupture of the thoracic aorta. South Med J. 1979;72:300-301.
29. Richardson JD, Wilson ME, Miller FB. The widened mediastinum: diagnostic and therapeutic priorities. Ann Surg. 1990;211:731-736.
30. Shaikh KA, Schwab CW, Camishion RC. Aortic rupture in blunt trauma. Am Surg. 1986;52:47-48.
31. Smith RS, Chang FC. Traumatic rupture of the aorta: still a lethal injury. Am J Surg. 1986;152:660-663.
32. Spouge AR, Burrows PE, Armstrong D, Daneman A. Traumatic aortic rupture in the pediatric population: role of plain film, CT and angiography in the diagnosis. Pediatr Radiol. 1991;21:324-328.
33. Sturm JT, Perry JF. Olson FR, Cicero JJ. Significance of symptoms and signs in patients with traumatic aortic rupture. Ann Ernerg Med. 1984;13:876-878.
34. Sturm JT, Marsh DG, Bodily KC. Ruptured thoracic aorta: evolving radiological concepts. Surgery. 1979;85:363-367.
35. Sturm JT, Olson FR, Cicero JJ. Chest roentgenographic findings in 26 patients with traumatic rupture of the thoracic aorta. Ann Emerg Med. 1983;12:598-600.
36. Trachiotis GD, Sell JE, Pearson GD, et al. Traumatic thoracic aortic rupture in the pediatric patient. Ann Thorac Surg. 1996;62:724-731.
37. Vloeberghs M, Duinslaeger M, Van den Brande P, et al. Posttraumatic rupture of the thoracic aorta. Acta Chir Belg. 1988;88:33-38.
38. Woodring JH, King JG. The potential effects of radiographic criteria to exclude aortography in patients with blunt chest trauma: results of a study of 32 patients with proved aortic or brachiocephalic arterial injury. J Thorac Cardiovasc Surg. 1989;97:456-460.
39. Mirvis SE, Pais SO, Gens DR. Thoracic aortic rupture: advantages of intraarterial digital subtraction angiography. AJR Am J Roentgenol. 1986;146:987-991.
40. Eddy AC, Nance DR, Goldman MA, et al. Rapid diagnosis of thoracic aortic transection using intravenous digital subtraction angiography. Am J Surg. 1990;159:500-503.
41. Sturm JT, Hankins DG, Young G. Thoracic aortography following blunt chest trauma. Am J Emerg Med. 1990; 8:92-96.
42. Morse SS, Glickman MG, Greenwood LH, et al. Traumatic aortic rupture: false-positive aortographic diagnosis due to atypical ductus diverticulum. AJR Am J Roentgenol. 1988; 150:793-796.
43. Pozzato C, Gedriga E, Donatelli F, Gattoni F. Acute posttraumatic rupture of the thoracic aorta: the role of angiography in a 7-year review. Cardiovasc Intervent Radiol. 1991;14:338-341.
44. Fisher RG, Chasen MH, Lamki N. Diagnosis of injuries of the aorta and brachiocephalic arteries caused by blunt chest trauma: CT vs aortography. AJR Am J Roentgenol. 1994; 162:1047-1052.
45. Gavant ML, Menke PG, Fabian T, et al. Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology. 1995;197:125-133.
46. Gavant ML, Flick P, Menke P, Gold RE. CT aortography of thoracic aortic rupture. AJR Am J Roentgenol. 1996; 166:955-961.
47. Madayag MA, Kirshenbaum KJ, Nadimpalli SR, et al. Thoracic aortic trauma role of dynamic CT. Radiology. 1991;179:853-855.
48. Durham RM, Zuckerman D, Wolverson M, et al. Computed tomography as a screening exam in patients with suspected blunt aortic injury. Ann Surg. 1994; 220:699-704.
49. Miller RB, Richardson JD, Thomas HA, et al. Role of CT in diagnosis of major arterial injury after blunt thoracic trauma. Surgery. 1989;106:596-603.
50. Mirvis SE, Shanmuganathan K, Miller BH, et al. Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT - five-year experience at a major trauma center. Radiology. 1996;200:413-422.
51. Richardson P, Mirvis SE, Scorpio R, Dunham CM. Value of CT in determining the need for angiography when findings of mediastinal hemorrhage on chest radiographs are equivocal. AJR Am J Roentgenol. 1991;156:273-279.
52. Agee CK, Metzler MH, Churchill RJ, Mitchell FL. Computed tomographic evaluation to exclude traumatic aortic disruption. J Trauma. 1992;33:876-881.
53. Biquet JF, Dondelinger RF, Roland D. Computed tomography of thoracic aortic trauma. Eur Radiol. 1996;6:25-29.
54. Brooks AP, Olson LK, Shackford SR. Computed tomography in the diagnosis of traumatic rupture of the thoracic aorta. Clin Radiol. 1989;40:133-138.
55. Franchello A, Olivero G, DiSumma M, et al. Rupture of thoracic aorta resulting from blunt trauma. Int Surg. 1997; 82:79-84.
56. Heiberg E, Wolverson MK, Sundaram M, Shields JB. CT in aortic trauma. AJR Am J Roentgenol. 1983;140:1119-1124.
57. Hills MW, Thomas SG, McDougall PA, et al. Traumatic thoracic aortic rupture: investigation determines outcome. Aust N Z J Surg. 1994;64:312-318.
58. Kawada T, Mieda T, Abe H, et al. Surgical experience with traumatic rupture of the thoracic aorta. J Cardiovasc Surg (Torino). 1990;31:359-363.
59. Mirvis SE, Kostrubiak I, Whitley NO, et al. Role of CT in excluding major arterial injury after blunt thoracic trauma. AJR Am J Roentgenol. 1987;149:601-605.
60. Morgan PW, Goodman LR, Aprahamian C, et al. Evaluation of traumatic aortic injury: does dynamic contrast-enhanced CT play a role? Radiology. 1992; 182:661-666.
61. Raptopolous V, Sheiman RG, Phillips DA, et al. Traumatic aortic tear: screening with chest CT. Radiology. 1992; 182:667-673.
62. Wilson D, Voystock JF, Sariego J, Kerstein MD. Role of computed tomography scan in evaluation the widened mediastinum. Am Surg. 1994;60:421-423.
63. Brooks SW, Young JC, Cmolik B, et al. The use of transesophageal echocardiography in the evaluation of chest trauma. J Trauma. 1992;32:761-768.
64. Buckmaster MJ, Kearney PA, Johnson SB, et al. Further experience with transesophageal echocardiography in the evaluation of thoracic aortic injury. J Trauma. 1994; 37:989-995.
65. Catoire P, Orliaguet G, Liu N, et al. Systematic transesophageal echocardiography for detection of mediastinal lesions in patients with multiple injuries. J Trauma. 1995;38:96-102.
66. Cohn SM, Burns GA, Jaffe C, et al. Exclusion of aortic tear in the unstable trauma patient: the utility of transesophageal echocardiography. J Trauma. 1995; 39:1087-1090.
67. Kearney PA, Smith DW, Johnson SB, et al. Use of transesophageal echocardiography in the evaluation of traumatic aortic injury. J Trauma. 1993;34:696-703.
68. Minard G, Schurr MJ, Croce MA, et al. A prospective analysis of transesophageal echocardiography in the diagnosis of traumatic disruption of the aorta. J Trauma. 1996;40:225-230.
69. Saletta S, Lederman E, Fein S, et al. Transesophageal echocardiography for the initial evaluation of the widened mediastinum in trauma patients. J Trauma. 1995;39:137-141.
70. Shapiro MJ, Yanofsky SD, Trapp J, et al. Cardiovascular evaluation in blunt thoracic trauma using transesophageal echocardiography (TEE). J Trauma. 1991;31:835-840.
71. Smith MD, Cassidy JM, Souther S, et al. Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. N Engl J Med. 1995;9:356-362.
72. Vignon P, Gueret P, Vedrinne JM, et al. Role of transesophageal echocardiography in the diagnosis and management of traumatic aortic disruption. Circulation. 1995;15:2959-2968.
73. Ahrar K, Smith DC, Bansal RC, et al. Angiography in blunt thoracic aortic injury. J Trauma. 1997;42:665-669.
74. Mollod M, Felner JM. Transesophageal echocardiography in the evaluation of cardiothoracic trauma. Am Heart J. 1996;132:841-849.
75. Sparks MB, Burchard KW, Marrin CA, et al. Transesophageal echocardiography. preliminary results in patients with traumatic aortic rupture. Arch Surg. 1991; 126:711-713.
76. Borman KR, Aurbakken CM, Weigelt JA. Treatment priorities in combined blunt abdominal and aortic trauma. Am J Surg. 1982;144:728-732.
77. Camp PC, Shackford SR. Outcome after blunt traumatic thoracic aortic laceration: identification of a high-risk cohort. J Trauma. 1997;43:413-422.
78. Kirsh MM, Behrendt DM, Orringer MB, et al. The treatment of acute traumatic rupture of the aorta: a 10-year experience. Ann Surg. 1976;184:308-316.
79. Akins CW, Buckley MJ, Daggett W, et al. Acute traumatic disruption of the thoracic aorta: a ten-year experience. Ann Thorac Surg. 1981;31:305-309.
80. Bodily K, Perry JF, Strate RG, Fischer RP. The salvageability of patients with post-traumatic rupture of the descending thoracic aorta in a primary trauma center. J Trauma. 1977;17:754-760.
81. Camp PC, Rogers RB, Shackford SR, et al. Blunt traumatic thoracic aortic lacerations in the elderly: an analysis of outcome. J Trauma. 1994;37:418-423.
82. Fisher RG, Oria RA, Mattox KL, et al. Conservative management of aortic lacerations due to blunt trauma. J Trauma. 1990;30:1562-1566.
83. Fleming AW, Green DC. Traumatic aneurysms of the thoracic aorta: report of 43 patients. Ann Thorac Surg. 1974;18:91-101.
84. Hudson HM, Woodson J, Hirsch E. The management of traumatic aortic tear in the multiply-injured patient. Ann Vasc Surg. 1991;5:445-448.
85. Kram HB, Appel PL. Shoemaker WC. Increased incidence of cardiac contusion in patients with traumatic thoracic aortic rupture. Ann Surg. 1988;208:615-618.
86. Maggisano R. Nathens A, Alexandrova NA, et al. Traumatic rupture of the thoracic aorta: should one always operate immediately? Ann Vasc Surg. 1995;9:44-52.
87. McCollum CH, Graham JM, Noon GP, DeBakey ME. Chronic traumatic aneurysms of the thoracic aorta: an analysis of 50 patients. J Trauma. 1979;19:248-252.
88. Pezzella AT, Todd EP, Dillon ML, et al. Early diagnosis and individualized treatment of blunt thoracic aortic trauma. Am Surg. 1978;44:699-703.
89. Plume S, DeWeese JA. Traumatic rupture of the thoracic aorta. Arch Surg. 1979;114:240-243.
90. Sharma S, Reddy V, Ott G, Cobanoglu A. Surgical management of traumatic aortic disruption. Am J Surg. 1997;173:416-418.
91. Warren RL, Akins CW, Conn AKT, et al. Acute traumatic disruption of the thoracic aorta: emergency department management. Ann Emerg Med. 1992;21:391-396.
92. Albrink MH, Rodriguez E, England GJ, et al. Importance of designated thoracic trauma surgeons in the management of traumatic aortic transection. South Med J. 1994;87:498-501.
93. Allmendinger PD, Low HB, Takata H, et al. Deceleration injury: laceration of the thoracic aorta. Arn J Surg. 1977; 133:490-491.
94. Antunes MJ. Acute traumatic rupture of the aorta: repair by simple aortic cross-clamping. Ann Thorac Surg. 1987; 44:257-259.
95. Appelbaum A, Karp RB, Kirklin JW. Surgical treatment for closed thoracic aortic injuries. J Thorac Cardiovasc Surg. 1976;71:458-460.
96. Avery JE, Hall DP, Adams JE, et al. Traumatic rupture of the thoracic aorta. South Med J. 1979;72:1238-1240.
97. Cernaianu AC, Cilley JH, Baldino WA, et al. Determinants of outcome in lesions of the thoracic aorta in patients with multiorgan system trauma. Chest. 1992;101:331-335.
98. Chalant CH, Ponlot R, Tremouroux J, et al. Surgical treatment of post-traumatic aneurysms of the thoracic aorta. J Cardiovasc Surg (Torino). 1971;12:108-112.
99. Contino JP, Follette DM, Berkoff HA, et al. Use of carmeda-coated femoral-femoral bypass during repair of traumatic aortic pseudoaneurysms. Arch Surg. 1994; 129:933-939.
100. Cowley RA, Turney SZ, Hankins JR, et al. Rupture of thoracic aorta caused by blunt trauma: a fifteen-year experience. J Thorac Cardiovasc Surg. 1990;100:652-660.
101. DelRossi AJ, Cernaianu AC, Madden LD, et al. Traumatic disruptions of the thoracic aorta: treatment and outcome. Surgery. 1990;108:864-870.
102. Eddy AC, Rusch VW, Marchioro T, et al. Treatment of traumatic rupture of the thoracic aorta: a 15-year experience. Arch Surg. 1990;125:1351-1356.
103. Forbes AD, Ashbaugh DG. Mechanical circulatory support during repair of thoracic aortic injuries improves morbidity and prevents spinal cord injury. Arch Surg. 1994;129:494-497.
104. Frick EJ, Cipolle MD, Pasquale MD, et al. Outcome of blunt thoracic aortic injury in a Level I trauma center: an 8-year review. J Trauma. 1997;43:844-851.
105. Higgins RS, Sanchez JA, DeGuidis L, et al. Mechanical circulatory support decreases neurologic complications in the treatment of traumatic injuries of the thoracic aorta. Arch Surg. 1992;127:516-519.
106. Hilgenberg AD, Logan DL, Akins CW, et al. Blunt injuries of the thoracic aorta. Ann Thorac Surg. 1992;53:233-238.
107. Hunt JP, Baker CC, Lentz CW, et al. Thoracic aortic injuries: management and outcome of 144 patients. J Trauma. 1996;40:547-555.
108. Kim FJ, Moore EE, Moore FA, et al. Trauma surgeons can render definitive surgical care for major thoracic injuries. J Trauma. 1994;36:871-875.
109. Kirsh MM, Kahn DR, Crane JD, et al. Repair of acute traumatic rupture of the aorta without extracorporeal circulation. Ann Thorac Surg. 1970;10:227-236.
110. Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF. Traumatic rupture of the thoracic aorta: a 20-year review: 1969-1989. Circulation. 1991;84(suppl):III40-III46.
111. Mattox KL, Holzman M, Pickard LR, et al. Clamp/repair: a safe technique for treatment of blunt injury to the descending thoracic aorta. Ann Thorac Surg. 1985;40:456-463.
112. McCroskey BL, Moore EE, Moore FA, Abernathy CM. A unified approach to the torn thoracic aorta. Am J Surg. 1991;162:473-476.
113. Mernll WH, Lee RB, Hammon JW, et al. Surgical treatment of acute traumatic tear of the thoracic aorta. Ann Surg. 1988;207:699-706.
114. Nicolosi AC, Almassi GH, Bousamra M, et al. Mortality and neurologic morbidity after repair of traumatic aortic disruption. Ann Thorac Surg. 1996;61:875-878.
115. Orringer MB, Kirsh MM. Primary Repair of acute-traumatic aortic disruption. Ann Thorac Surg. 1983;35:672-675.
116. Pate JW. Traumatic rupture of the aorta: emergency operation. Ann Thorac Surg. 1985;39:531-537.
117. Pickard LR, Mattox KL, Espada R, Beall AC Jr, DeBakey ME. Transection of the descending thoracic aorta secondary to blunt trauma. J Trauma. 1977;17:749-753.
118. Read RA, Moore EE, Moore FA, Haenel JB. Partial left heart bypass for thoracic aorta repair: survival without paraplegia. Arch Surg. 1993;128:746-750.
119. Reul GJ, Rubio PA, Beall AC. The surgical management of acute injury to the thoracic aorta. J Thorac Cardiovasc Surg. 1974;67:272-281.
120. Saylam A, Melo JQ, Ahmad A, et al. Early surgical repair in traumatic rupture of the thoracic aorta. J Cardiovasc Surg (Torino). 1980;21:295-302.
121. Schmidt CA, Jacobson JG. Thoracic aortic injury: a ten-year experience. Arch Surg. 1984;119:1244-1246.
122. Schmidt CA, Wood MN, Razzouk AJ, et al. Primary repair of traumatic aortic rupture: a preferred approach. J Trauma. 1992;32:588-592.
123. Stiles QR, Cohlmia GS, Smith JH, et al. Management ot injuries of the thoracic and abdominal aorta. Am J Surg. 1985;150:132-140.
124. VanNorman GA, Pavlin EG, Eddy AC, Pavlin DJ. Hemodynamic and metabolic effects of aortic unclamping following emergency surgery for traumatic thoracic aortic tear in shunted and unshunted patients. J Trauma. 1991;31:1007-1016.
125. Vasko JS, Raess DH, Williams TE, et al. Nonpenetrating trauma to the thoracic aorta. Surgery. 1977;82:400-406.
126. Vaughn GD, Crawford FA, Heath BJ. Blunt thoracic aortic injuries. J Miss State Med Assoc. 1983;24:4-7.
127. Verdant A, Mercier C, Page A, et al. Major mediastinal vascular injuries. Can J Surg. 1983;26:38-42.
128. Von Oppell UO, Brink J, Hewitson J, et al. Acute traumatic rupture of the thoracic aorta: a comparison of techniques. S Afr J Surg. 1996;34:19-24.
129. Wallenhaupt SL, Hudspeth AS, Mills SA, et al. Current treatment of traumatic aortic disruptions. Am Surg. 1989; 55:316-320.
130. Walls JT, Boley TM, Curtis JJ, Schmaltz RA. Experience with four surgical techniques to repair traumatic aortic pseudoaneurysm. J Thorac Cardiovasc Surg. 1993; 106:283-287.
131. Weimann S, Balogh D, Furtwangler W, et al. Graft replacement of post-traumatic thoracic aortic aneurysm: results without bypass or shunting. Eur J Vasc Surg. 1992; 6:381-385.
132. Young JN, Stallone RJ, Iverson LI, et al. Surgical management of traumatic disruption of the descending aorta. West J Med. 1989;150:662-624.
133. Zeiger A, Clark DE, Morton JR. Reappraisal of surgical treatment of traumatic transection of the thoracic aorta. J Cardiovasc Surg (Torino). 1990;31:607-610.
134. Hartford JM, Payer RL, Shaver TE, et al. Transection of the thoracic aorta: assessment of a trauma system. Am J Surg. 1986;151:224-229.
135. Pezella AT. Blunt traumatic injury of the thoracic aorta following commercial airline crashes. Tex Heart Inst J. 1996;23:65-67.
136. Hill DA, Duflou J, Delaney LM, Blunt traumatic rupture ot the thoracic aorta: an epidemiological perspective. J R Coll Surg Edinb. 1996;41:84-87.
137. Stallone RJ. Management of ruptured thoracic aortic aneurysms. Am J Surg. 1978;136:162-164.
138. Johnson MS, Shah H, Harris VJ, et al. Comparison of digital subtraction and cut film arteriography in the evaluation of suspected thoracic aortic injury. J Vasc Interv Radiol. 1997;8:799-807.
139. Wicky S, Capasso P, Meuli R, et al. Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury. Eur Radiol. 1998;8:828-833.
140. Goarin JP, Catoire P, Jacquens Y, et al. Use of transesophageal echocardiography for diagnosis of traumatic aortic injury. Chest. 1997;112:71-80.
141. Cameron PA, Dziukas L, Hadj A, et al. Aortic transection. Aust N Z J Surg. 1998;68:264-267.
142. Tripp HF, Robicsek F, Thomason M, Thubnkar M. Transected thoracic aorta: age-specific differences in incidence and possible reasons. Cardiovasc Surg. 1997; 5:291-294.
143. Fabian TC, Davis KA, Gavant ML, et al. Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg. 1998; 227:666-677.
144. Mirvis SE, Kathirkamuganathan S, Buell J. Rodriguez A. Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury. J Trauma. 1998;45:922-930.