Rottura traumatica dell’aorta
Table of Contents
Definizione
Larottura traumaticadell’aortaè un evento acuto conseguente a untraumada decelerazione perincidente stradale o caduta da altezze elevate. La possibilità di una rottura aortica deve essere sempre considerata in qualsiasi tipo di trauma da decelerazione. La lesione può essere parziale o interessare l’intera circonferenza della parete arteriosa. In genere essa si colloca, nel 90% dei casi, nel tratto prossimale dell’aorta toracica discendente, a pochi centimetri dall’ origine dell’arteria succlavia sinistra; nel restante 10% la rottura avviene nell’ aorta ascendente, nell’arco o nella zona diaframmatica. Nella lacerazione è spesso coinvolta l’origine dei grossi rami arteriosi e vi è un esteso ematoma dei tessuti mediastinici.
Prognosi della rottura traumatica dell’aorta
Larottura traumatica dell’aortahaprognosi infausta, l’80-90%dei pazienti muore immediatamente sul luogo del trauma. Anche nei sopravvissuti la prognosi non è favorevole, poichéil 50% di essi decede entro 24-48 ore. Nei pochi pazienti sopravvissuti e nei quali spesso non viene fatta la diagnosi, la lesione può andare incontro a unarottura tardiva o evolvere verso un aneurisma cronico.
Diagnosi
La radiografia standard del torace mostra in genere lo slargamento del mediastino, ma è laTC spirale multistrato con mezzi di contrastoa confermare la diagnosi. Diverse sono le morfologie che assume la rottura aortica, fra cui pseudoaneurisma, dissecazione localizzata, irregolarità dei margini dell’arteria, distorsione grossolana del lume, pseudocoaratazione.
Trattamento
Iltrattamento chirurgicoè, in linea di principio, sempre indicato. Tuttavia, la mortalità operatoria resta elevata (20-30% dei casi) e, per tale motivo si tende oggi a procrastinare quanto più possibile l’intervento, stabilizzando le condizioni del paziente politraumatizzato. Negli ultimi anni, al trattamento chirurgico tradizionale si è affiancato quelloendovascolareche, grazie alla minore invasività, trova spazio anche in fase post-traumatica precocissima.
Ti potrebbero interessare:
- Aneurisma
- Aneurisma dell’aorta addominale
- Dissezione aortica
- Diagnostica per immagini nella sospetta lesione aortica traumatica chiusa
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