Blunt thoracic aortic injuries from falls at the United States–Mexico Border: A case series

Following executive order 13,767, the United States border wall height was nearly doubled to 30-feet (9.1 meters). Touted as “unclimbable,” the structure has led to an increase in fall-related trauma. Since 2019, our level 1 trauma center has noted a rise in blunt aortic injuries (BAI) from border wall falls. We aimed to characterize these injuries and their management. We performed a retrospective review of the University of California, San Diego level 1 trauma center registry, capturing patients from San Diego and Imperial Counties who sustained BAI due to border wall falls (2015–2024). Institutional review board exemption was granted. No BAIs were recorded from border wall falls before 2019. Since then, three cases have occurred. One patient sustained a grade I BAI and was managed non-operatively. Two patients had grade III BAI requiring emergent thoracic endovascular aortic repair (TEVAR). Both suffered multiple system injuries and required prolonged hospitalization and ultimate discharge to rehabilitation facilities. BAIs from border wall falls emerged only after the wall height increase of 2019. The need for complex vascular intervention underscores the severe injury burden. Awareness of this mechanism is critical for timely diagnosis and intervention.