The descending thoracic aorta provides the intercostal arteries, bronchial arteries, and oesophageal branches. The aortic isthmus (just distal to the left subclavian origin) is the most common site of traumatic aortic injury from deceleration trauma — the relatively fixed isthmus tears when the mobile arch decelerates abruptly. Thoracic endovascular aortic repair (TEVAR) is the standard treatment for descending thoracic aortic aneurysm.
| Origin | Continuation of the aortic arch at the level of T4-T5 (the aortic isthmus — just distal to the left subclavian artery origin) |
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Traumatic aortic injury at the isthmus from high-speed deceleration (MVA, fall) is a radiological emergency — widened mediastinum on chest X-ray prompts CT aortic angiography. Contained injuries are managed by TEVAR (endograft stenting); free rupture is immediately fatal. The intercostal arteries from T8-T12 must be preserved where possible during thoracic aortic repair to prevent spinal cord ischaemia.
Aortic isthmus tear from deceleration trauma producing mediastinal widening managed with TEVAR endovascular repair.
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