Repair of Acute Traumatic Rupture of the Aorta Without Extracorporeal Circulation

Kirsh, Marvin M.; Kahn, Donald R.; Crane, James; Anastasia, Louis F.; Lui, Alfred H.F.; Moores, William Y.; Vathayanon, Sathaporn; Bookstein, Joseph J.; Sloan, Herbert

doi:10.1016/s0003-4975(10)65593-2

Cited by 46 publications

(4 citation statements)

References 24 publications

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“…It should be emphasized that total cardiopulmonary or left-heart bypass with systemic heparinization is not well tolerated in patients with polytrauma, because it may produce profound hemorrhage from brain, pulmonary, retroperitoneal, or extremity injuries. When clamping without shunt is possible, intraoperative blood loss is reduced, cross-clamping time is shorter, and complications are less frequent [48,52,54]. There is good agreement in the literature that these better results are attributed to minor dissection, absence of cannulation site hemorrhage, faster control of the aortic tear, intact coagulation, and "the impetus of the surgeon to get the job done more quickly in the absence of the apparent security of a shunt" [52].…”

Section: Discussionmentioning

confidence: 99%

Vascular injuries in polytrauma

et al. 1983

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In our surgical clinic, from January 1, 1978, to May 15, 1982, a total of 41 patients with polytrauma exhibited 45 concomitant vascular injuries requiring operation. This group of patients represents 10% of the 407 multiple trauma patients treated during this period. The incidence of vascular lesions of shoulder, neck, and upper extremities was 2.7% (n=11); lower extremities, 4.7% (n=19); within the abdominal cavity, 1% (n=4); and of acute thoracic aortic rupture, 2.7% (n=11). Seven patients (17%) died: 4 from additional brain trauma, 3 from hemorrhage by aortic ruptures. There were 6 major amputations (2 primary, 4 secondary) and 2 borderline amputations. In the remaining 26 patients, a good result following vascular repair was achieved. Angiologic examination, including computed tomography and angiography, is of great importance. Vascular repair deserves high priority since bleeding and/or ischemia threatens the patient's limbs, organs, or even life. This is especially true for the acute thoracic aortic rupture as a typical vascular injury in polytrauma. The incidence of peripheral vascular injuries in polytrauma is twice as high (7.3%) as in isolated extremity fractures (3.6%).

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Section: Discussionmentioning

confidence: 99%

Vascular injuries in polytrauma

et al. 1983

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“…De-Meester et al (1973) used a heparinized polyvinyl shunt between the ascending aorta and the left femoral artery in the operative treatment of a through and through gunshot wound of the arch of the aorta with avulsion of the origin of the left common carotid artery. Kirsh et al (1970) used a non-heparinized shunt in patients with acute traumatic rupture of the aorta. They state that total heparinization is not needed and clotting does not occur in the shunt once flow has started in it.…”

Section: Discussionmentioning

confidence: 99%

Successful repair of a penetrating wound of the thoracic aorta.

Ramanathan¹,

Somasundaram²,

Yong³

1975

Thorax

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“…Der Vergleich verschiedener Statistiken wird aber auch durch die Tatsache erschwert, dab zahlreiche Autoren die Begleitverletzungen vielfach fiberhaupt nicht beriicksichtigten [15,16,20] oder abet chronisch-stabilisierte traumatische Aortenaneurysmen in ihre Auswertung mit einbezogen. Die erheblichen Unterschiede hinsichtlich der chirurgischen Behandlungsergebnisse bei der traumatischen Aortenruptur werden aber gerade durch Zahl, Art und Schwere derartiger Begleitverletzungen entscheidend beeinflugt.…”

Section: Diskussionunclassified

Traumatische Rupturen der thorakalen Aorta

Vollmar

Kogel

Cyba-Altunbay

et al. 1987

Langenbecks Arch Chiv

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1) Traumatic rupture of the thoracic aorta is most frequently caused by a traffic accident with deceleration. Approximately 80% of these patients die immediately. In 29 patients (1973-1986) reaching surgical treatment, all aortic lesions were located at the aortic isthmus (28 covered and 1 free rupture). 25 (86%) of them had serious associated injuries of the head, other thoracic or intraabdominal organs and/or the extremities. A seat belt could not prevent the deceleration injury of the aorta but reduced associated injuries of the head and the intraabdominal organs. 2) The widely accepted surgical rule that every diagnosed traumatic aortic rupture should have an immediate surgical repair is no longer acceptable. In all patients with a clinically and angiographically stable covered rupture of the aorta with serious associated injuries and symptoms of shock the surgical treatment of the aortic lesion should be undertaken with delayed emergency after some hours or several days. This changed surgical concept is based both on the rarity of secondary free rupture of the aortic lesion and on the chance to stabilize the circulatory condition by a primary shock treatment including the surgical elimination of other sources of blood loss. The group with such a delayed aortic vascular repair (n = 12) showed a remarkably improved outcome with reduced operative mortality and reduced risk of paraplegia (47% vs. 25% respectively 35% vs. ca. 10%). None of these patients with a delay up to 17 days for vascular repair developed a secondary free aortic rupture. Up to recently this risk has been obviously overestimated on the basis of earlier studies in the sixties. 3) The immediate repair of the aortic rupture with its high operative mortality and high rate of ischemic paraplegia can be restricted to a few exceptional cases with a secondary free rupture in the hospital. The transvenous DSA is the best approach for an early diagnosis and for the surgical decision to perform vascular repair immediately or with delay.

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Repair of Acute Traumatic Rupture of the Aorta Without Extracorporeal Circulation

Cited by 46 publications

References 24 publications

Vascular injuries in polytrauma

Vascular injuries in polytrauma

Successful repair of a penetrating wound of the thoracic aorta.

Traumatische Rupturen der thorakalen Aorta

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