Morphometric analysis of torso arterial anatomy with implications for resuscitative aortic occlusion

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Abstract

BACKGROUND

Hemorrhage is a leading cause of death in military and civilian trauma. Despite the importance of the aorta as a site of hemorrhage control and resuscitative occlusion, detailed knowledge of its morphometry is lacking. The objective of this study was to characterize aortic morphometry in a trauma population, including quantification of distances as well as and diameters and definition of relevant aortic zones.

METHODS

Center line measures were made (Volume Viewer) from contrast computed tomography (CT) scans of male trauma patients (18–45 years). Aortic zones were defined based on branch arteries. Zone I includes left subclavian to celiac; Zone II includes celiac to caudal renal; Zone III includes caudal renal to aortic bifurcation. Zone lengths were calculated and correlated to a novel external measure of torso extent (symphysis pubis to sternal notch).

RESULTS

Eighty-eight males (mean [SD], 28 [4] years) had CT scans for the study. The median (interquartile range) lengths (mm) of Zones I, II, and III were 210 mm (202–223 mm), 33 mm (28–38 mm), and 97 mm (91–103 mm), respectively. Median aortic diameters at the left subclavian, celiac, and lowest renal arteries were 21 mm (20–23 mm), 18 mm (16–19 mm), and 15 mm (14–16 mm), respectively, and the terminal aortic diameter was 14 mm (13–15 mm). The correlation of determination for descending aortic length (all zones) against torso extend was r = 0.454.

CONCLUSION

This study provides a morphometric analysis of the aorta in a male population, demonstrating consistency of length and diameter while defining distinct axial zones. Findings suggest that center line aortic distances correlate with a simple, external measure of torso extent. Morphometric study of the aorta using CT data may facilitate the development and implementation of occlusion techniques to manage noncompressible torso, pelvic, and junctional femoral hemorrhage.

LEVEL OF EVIDENCE

Diagnostic study, level III.

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