Two Causes of Traumatic Aortic Injury

Dr. Robert Crawford, an MD graduate of the Medical College of Virginia, has been practicing medicine and vascular surgery for more than 20 years. The director of medical affairs at Basis Medical, he has held such titles as research associate at UC San Francisco, physician member of Emory University Healthcare, and member of several medical committees. Dr. Robert Crawford has also written several professional papers about aortic injuries.

Aortic injuries, or traumatic aortic injuries, denote when the aorta is bruised, punctured, or torn. This type of injury is a life-threatening medical condition that requires emergency care. It is characterized by low blood pressure resulting from a loss of blood due to the injury, along with pain at the injury site, difficult breathing, and hoarseness.

Traumatic aortic injury results from two main causes: blunt trauma and penetrating trauma. Blunt trauma is most often associated with motor vehicle accidents, but it can also happen when a person falls from a large height. When the aorta is affected by blunt trauma, it is usually in the form of severe deceleration that results in other chest traumas, like rib fractures. Further, injuries from this sort of trauma are predominantly in the upper chest.

Penetrating trauma, on the other hand, refers to a situation where the aorta is directly cut or punctured. This occurs due to such things as knife wounds. People are often more capable of seeing penetrating trauma since the injuries resulting from such an accident result in extensive bleeding. However, bleeding from the aorta is sometimes contained by the surrounding tissues, so the injury is not always noticeable at first.

What Are Vascular Emergencies?

A former member and co-chair of the Society for Vascular Surgery International Relations Committee, Dr. Robert Crawford possesses board certification in surgical critical care, general surgery, and vascular surgery. Dr. Robert Crawford combines his experience in vascular surgery and critical care as a proponent of the creation of stand alone, independent vascular acute care surgery (VACS) services.

Within the field of vascular surgery, vascular emergencies pose a particular challenge. The concept of time-sensitive disease applies to vascular emergencies as it applies to heart attacks, strokes and various other emergencies. Depending on the specific problem, without immediate medical attention, a patient may risk severe blood loss, limb loss, or death.

Limb loss from acute limb ischemia, cardiovascular collapse from acute pulmonary embolisms, aortic aneurysms resulting in life threatening blood loss, aortic dissections, acute deep venous thrombosis are some of the pathologies that can be categorized as vascular emergencies. These patients often require care that goes beyond the initial treatment of their vascular problem. These patients usually have long hospital stays, require repeat trips to the operating room and also require complicated intensive care unit admission. These patients tend to be critically ill and require constant evaluation and vigilance for possible repeat procedures. In order to improve care, the establishment of a separate team, one that is not burdened with the care of elective patients and other responsibilities has been advocated. Early data, published from aggregate databases support the idea that acute care vascular burden of disease is significant. It also further supports the idea that early transfer of these patients to referral centers that posses such services improves care. Finally, early data from Dr Crawford while at Maryland shows that the establishment of dedicated vascular service reduces length of stay and decreases cost in this population. This model, which mirrors what occurred when acute care general surgery separated as a stand alone service from general surgery, will need to evolve. It will include its own societal structure, research focus and validation of its effectiveness. Dr Crawford and colleagues argued, at a presentation at the American College of surgeons and in a review published in Current Surgery Reports that establishment of of Vascular Acute Care Surgery services will improve care for vascular patients going forward.

In order to better deal with these types of cases, a few major medical cxenters have established stand alone teams