The work-up for Blunt Aortic Injury is a CT Angio of the aorta. This will demonstrate an aortic injury in 99% of cases and has replaced angiography as the gold standard. Trans-esophageal echo may be useful in patients who cannot have a CT (too unstable to travel or dye allergy).
The majority of aortic injuries occur just below the take-off of the left subavian artery, although injury may occur anywhere in the aorta. This is a typical appearance of an aortic injury (on angiography) showing a pseudoaneurysm in that location.
Once the diagnosis is made, treatment should begin promptly. The first priority is control of blood pressure. Occasionally, the patient has other injuries or comorbidities that make the risk of thoracotomy too prohibitive. These patients may be managed for several days with strict blood pressure control.
Most patients are able to undergo open repair of their aortic injury. Many centers are moving from open repair to endovascular repair. This is an interventional angioigram showing deployment of an endovascular aortic stent.
Endovascular stents have less morbidity initially than open repairs, although the long-term data is not out yet.
http://www.east.org/research/treatment-guidelines/aortic-blunt-injury-diagnosis-and-management
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