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European Journal of Cardio-Thoracic Surgery, Vol 8, 30-33, Copyright © 1994 by European Association for Cardio-thoracic Surgery
B Kipfer, F Leupi, P Schuepbach, D Friedli and U Althaus
The appropriate management of traumatic aortic rupture is often difficult
to determine, particularly if the rupture is associated with severe
additional lesions. Between 1986 and 1991, ten consecutive patients with
acute traumatic rupture of the thoracic aorta (ATRTA) and concomitant
injuries were initially treated medically and submitted to delayed aortic
repair. Within the same period no other patient had emergency
reconstruction of the thoracic aorta. Diagnosis of ATRTA was established
immediately after admission in eight patients. Five patients underwent
emergency surgery for severe concomitant injuries. With regard to the
aortic lesion, all patients were managed medically and submitted to
pharmacological treatment in an attempt to reduce cardiac shear forces.
None of the patients developed clinical signs of imminent free rupture
while waiting for aortic surgery. In the absence of a significant
hemothorax and when no coarctation syndrome is evident, the risk of free
aortic rupture is considered to be rather low if the patient reaches the
hospital in a stable circulatory condition. Postponement of aortic
reconstruction is particularly indicated when severe concomitant lesions
preclude safe immediate repair of the aortic tear. Following the patient's
recovery from associated major injury, aortic surgery can be performed as a
low risk procedure using cardiopulmonary bypass which is recognised as the
most effective technique to prevent spinal cord ischemia and to reduce the
risk of paraplegia.
ARTICLES
Acute traumatic rupture of the thoracic aorta: immediate or delayed surgical repair?
Clinic for Thoracic and Cardiovascular Surgery, University Hospital, Bern, Switzerland.
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