title: Small vessel avulsion and acute aortic syndrome: a putative aetiology for initiation and propagation of blunt traumatic aortic injury at the isthmus.
abstract: Based on literature, clinical observation and the analysis of material properties of the aorta, we hypothesize that the aortic isthmus is intrinsically susceptible to blunt trauma because it has a higher density of tributary vessels than other elements of the aortic tree, the avulsion of which during trauma, is a contributory factor in the development of an acute aortic syndrome resulting from intra-mural haematoma, localized dissection and ultimately rupture. This hypothesis provides putative explanations for several aspects of the injury profile including: localized peri-isthmus injuries, inside out injury profiles and the concept of initiation versus propagation of blunt traumatic aortic injury.
authors.affiliation: The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK. mlfield@doctors.net.uk
authors.forename: Mark L
authors.initials: ML
authors.lastname: Field
authors.forename: Priya
authors.initials: P
authors.lastname: Sastry
authors.forename: Aihong Rachel
authors.initials: AR
authors.lastname: Zhao
authors.forename: David
authors.initials: D
authors.lastname: Richens
mesh_terms: D000208:Acute Disease; D001011:Aorta / Q000293:injuries* / Q000473:pathology; D001019:Aortic Rupture / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008955:Models, Cardiovascular; D013577:Syndrome; D014949:Wounds, Nonpenetrating / Q000209:etiology* / Q000473:pathology*