Surgical Treatment of Traumatic Rupture of Thoracic Aorta

Hahm, Shee Young; Choo, Suk Jung; Song, Hyun; Lee, Jae Won; Song, Meong Gun

Abstract

Background
Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardiopulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result: Major concomitant injuries (n=83) were noted in all of the reviewed patients. Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries. Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6+/-12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695+/-1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period There were no operative deaths and no major postoperative complications.
Conclusion
Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity.