Management of traumatic aortic rupture: a 30-year experience

• Published in: Annals of surgery 2002-10, Vol.236 (4), p.465-470
• Main Authors: Cardarelli, Marcelo G, McLaughlin, Joseph S, Downing, Stephen W, Brown, James M, Attar, Safuh, Griffith, Bartley P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aortic Rupture - diagnosis; Aortic Rupture - etiology; Aortic Rupture - surgery; Cardiopulmonary Bypass; Female; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Paraplegia - etiology; Paraplegia - prevention & control; Reproducibility of Results; Risk Factors; Scientific Papers of the American Surgical Association; Time Factors; Wounds and Injuries - complications
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200210000-00009

To present the authors' 30-year experience with traumatic aortic rupture (TAR). TAR is a highly lethal injury. Most institutions manage a small number of cases, and most surgeons receive only modest exposure during training. Between 1971 and 2001, the authors operated on 219 patients with a diagnosis of TAR. Diagnosis of TAR since 1994 has been based exclusively on the use of contrast-enhanced spiral computed tomography, with angiography reserved for equivocal cases (periaortic mediastinal hematoma without aortic wall abnormalities). Patients were divided according to surgical technique. Eighty-two patients (group A) were operated on with a clamp-and-sew technique. Sixty-four patients (group B) underwent surgery with the use of a passive shunt, and 73 patients (group C) were treated using heparin-less partial cardiopulmonary bypass. Mortality was 18 patients for group A (21.9%), 23 patients for group B (35.9%), and 13 patients for group C (17.8%) (P =.03). Paraplegia occurred in 15 of 64 survivors in group A (23.4%), 7 of 41 survivors in group B (17%), and 0 of 60 survivors in group C ( P=.0005). Aortic occlusion without lower body perfusion for longer than 30 minutes (P =.004) and surgical technique without lower body bypass support (P =.0005) were associated with paraplegia. Surgery for TAR based on spiral computed tomography screening and diagnosis is reliable. The use of heparin-less distal cardiopulmonary bypass in the authors' hands is safe and is associated with a reduced incidence of paraplegia.