True about Aoic transection:

Ans. is all Blunt Aoic injury * Main pathophysiological cause is sudden deceleration with creation of a shear force between the fixed and relatively mobile segment of aoa. The classic examples are frontal collision in motor vehicle injury or a fall from height. Most common site is --> proximal descending thoracic aoa Investigation - Spiral CT scan is used for screening, and if mediastinal hematoma found, an aoography or CT angiography is done to clearly define the site and extent of injury. Aoography is the gold standard imaging modality. - CT angiography is rapidly becoming an imaging modality that rivals aoography and as technology improves may soon replace aoography as the imaging modality of choice. Management The traditional management is prompt surgical repair of the injured aoic segmenet. However in some patients a purposeful delay or even non-operative management is done. Patients with associated severe head injury or other complex multisystem injury are unable to tolerate the aoic repair and reconstructive surgery. Use of early blood pressure control and afterload reduction conves these cases from urgent to delayed cases, and can be repaired next day or several days later and can be transferred to higher centres with expes. Non-operative management can be tried in minimal blunt aoic injury (such as small intimal flap or a small pseudoaneurysm). However long term behaviour of these minimal injuries managed non-operatively is not known and hence they must be monitored by serial imaging. Use of endovascular graft is fast gaining in popularity despite lack of controlled trials and long term follow-up. This is due to significantly decreased moality and morbidity associated with use of grafts in comparison to open thoracic aoic repair. Endovascular grafts are paicularly attractive for patients who are poor candidates for open thoracic aoic repairs such as those with multiple associated injuries or in whom systemic heparin is contraindicated.