Can aortic repair be delayed in the case of severe head trauma or other serious injuries?
The high mortality rate of blunt aortic injury worsens with time. Nearly 80% of aortic ruptures are fatal at the scene. In survivors, the aortic adventitia and mediastinal structures contain the bleeding initially, but frank rupture commonly occurs within 24 hours if the injury goes undiagnosed and untreated. Once aortic injury has been diagnosed, prompt surgical repair is generally the best approach. However, immediate repair may not be possible in all patients, such as those with severe intra-abdominal or head injuries who require other operative procedures. In patients with severe comorbidities, medical management can be initiated immediately and delayed surgical repair should not adversely affect mortality. Although prospective data are lacking, multiple case series have demonstrated similar or even improved mortality and morbidity rates with delayed repair of blunt aortic injury. Delayed repair, however, mandates strict medical control of aortic wall stress by lowering heart rate
