Blunt aortic injury (BAI) refers to aortic injury caused by a sudden and powerful external force acting on the human body, and its type can be manifested as intermural hematoma, dilatation lesions such as aortic coarctation and pseudo aneurysm, etc., which can be fatal immediately, or can develop several years after the injury. With the development of society, BAI caused by traffic accidents has been on the rise in recent years, with an incidence rate of up to 1.5-1.9%, leading to a mortality rate of up to 15%, which is the second leading cause of death in car accidents after craniocerebral injury. 8 cases of BAI patients admitted to our hospital from 2008 to 2011 are reported and analyzed as follows, with the aim of summarizing the experience of diagnosis and treatment and improving the efficiency of rescue treatment. DATA AND METHODS The patients in this group were 6 males and 2 females, aged 16-45 years old (26.8±9.9 years old), all of them suffered from blunt chest injuries after car accidents, and 6 of them suffered from acute injuries (the time between the injury and hospital admission was 20 hours-5 days), and 2 of them suffered from chronic injuries (1 case 3 years after the car accident, and the other case 4 years after the car accident). There were 4 cases of combined clavicle fracture and rib fracture, 1 case of combined hemothorax, and 1 case of combined craniocerebral trauma. All patients were clearly diagnosed by CTA of the aorta, including 1 case of intermural hematoma of the aorta, 3 cases of Debakey type I aortic coarctation, 2 cases of Debakey type III aortic coarctation, and 2 cases of chronic injuries, both of which were pseudoaneurysms of the thoracic descending aorta. All patients were given metoprolol tablets orally to control heart rate, reduce dp/dt, and control systolic blood pressure below 120 mmHg. 3 patients with type I aortic coarctation were operated under extracorporeal circulation, and 2 cases were operated with ascending aortic replacement, total arch replacement, and stenting of the elephant trunk. 1 case was found to have mild aneurysmal dilatation of the aortic root and enlarged aortic annulus on probing and the patient had suffered from spontaneous pneumothorax for several times in the past, and had tall and thin stature. The patient was considered to have Marfan’s syndrome, and Bentall, total arch replacement, and stent elephant nose surgery were performed. Of the 2 patients with type III aortic coarctation, 1 underwent descending aortic overlay stent implantation, and 1 underwent arch descending stent implantation under extracorporeal circulation. 2 patients with descending aortic pseudoaneurysm underwent descending aortic prosthetic vascularization under left heart diversion. 1 patient with intermural hematoma of the aorta was treated conservatively because of the limited hematoma, and was discharged from the hospital without surgery after a review of the aortic CTA two weeks later because of a reduction in the intermural hematoma compared with the previous one, and was discharged. The aortic CTA was reviewed 3 months later and the hematoma was absorbed. There was no death in the whole group. Complications: 2 cases of transient mental disorder, 1 case of acute renal impairment, 1 case of acute hepatic impairment, all of which were cured after active treatment. Follow-up 10-39 months, all 8 patients survived with good quality of life and could engage in daily activities. Review of aortic CTA suggested that: three patients with type I aortic coarctation had patent artificial blood vessels, distal coarctation had been chronic, and the false lumen was reduced compared with the preoperative period; two patients with descending aortic pseudoaneurysm had patent artificial blood vessels. The distal and proximal vessels were normal; 2 patients with type III aortic coarctation had good stent expansion without complications such as displacement and internal leakage. Discussion: There is no clear theory to explain the mechanism of BAI; sudden deceleration of blood during a car accident, reflex high pressure wave generation, and extrusion of the sternum and spine are considered to be the most likely causes of BAI [3]. The aortic isthmus, with its relatively fixed location, is the most frequent site of lacerations. Of course pathology of the aorta itself is also an important cause of aortic injury, and in our group, aortic injury occurred in one patient with Marfan’s syndrome related to aortic wall dysplasia. Diagnosis of BAI Since almost every patient with BAI is combined with other traumatic injuries, the complaints of chest and back pain in patients with BAI are often overlooked. Aortic injury should be highly suspected in the presence of signs such as sternal trauma, shock, heart murmur, asymmetric blood pressure in the extremities, hemiparesis, and hoarseness; however, the definitive diagnosis is still based on imaging. Although aortography is the gold standard for the diagnosis of aortic injury, due to its invasive and time-consuming examination, it is not suitable for patients with multiple injuries in car accidents, so our recommendation is to routinely perform a general CT examination in trauma patients to assess the whole body injury, focusing on the mediastinum, thoracic cavity, cardiac shape, etc., and suspect the mediastinum is obviously widened, the thoracic cavity – a large number of effusions, pericardial effusions, etc. Aortic injury should be suspected, and color ultrasound and aortic CTA should be performed to further clarify the diagnosis, especially aortic CTA, which is close to 100% accurate and has the advantages of convenience and rapidity. Once BAI is clearly diagnosed, unless there is hypotension, β-blockers should be given immediately to reduce dp/dt, decrease the stress on the vessel wall, and reduce the risk of rupture. In patients with BAI, the degree of aortic injury and the risk of rupture should be assessed, and the timing and type of surgery should be determined in conjunction with other injuries. For patients who have a combination of other serious life-threatening injuries such as intracranial hemorrhage, hepatic and splenic rupture, and active hemorrhage, the life-threatening injury should be treated first. Our experience is that except for a few patients with limited intermural hematomas who can be treated medically and followed closely, most patients with BAI require surgical or overlying stenting. In patients with type I or II aortic coarctation, surgery is required to replace the diseased vessel. For type III aortic coarctation, most patients can be implanted with an overlying stent to close the breach and expand the true lumen; however, in some patients with type III aortic coarctation, the false lumen is severely enlarged and filled with thrombus, and it is difficult for the overlying stent to completely close the breach and expand the true lumen, so we recommend surgical implantation of distal stents in a transaortic line. The patient’s aorta should be implanted with a distal stent. The incidence of blunt aortic injury is gradually increasing, timely diagnosis and treatment can improve the patient’s prognosis, improve the effectiveness of treatment, the timing of the operation and surgical methods should be based on the specific conditions of the patient.