Traumatic aortic transections: Eight-year experience with the “Clamp-Sew” technique

Sweeney, Michael S.; Young, David; Frazier, O.H.; Adams, Phillip R.; Kapusta, Mario O.; Macris, Michael P.

doi:10.1016/s0003-4975(97)00561-4

Cited by 60 publications

(35 citation statements)

References 24 publications

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“…We did not have any cases of paraplegia in our small series. This was also reported by many other authors [4,5]. We had one immediate postoperative mortality from profound shock and re-perfusion injury.…”

Section: Discussionsupporting

confidence: 88%

“…It is associated with high mortality rates and great debate exists about the appropriate operative technique [4]. Endovascular approaches are becoming increasingly worldwide, but they are not available in all facilities.…”

Section: Introductionmentioning

confidence: 99%

“…So one has to rely on open surgical techniques [5]. Although any of the several maneuvers may be appropriate in managing traumatic aortic injuries, the simple" clamp-sew technique" is a safe and effective method of treatment [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Acute traumatic injury of the descending thoracic aorta: a limited experience

Regal

Ghoneimy

El-Azab

2011

Indian J Thorac Cardiovasc Surg

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Background Blunt injury of the descending thoracic aorta, in the isthmus, is relatively common due to deceleration accidents. Although spinal cord injury has been a welldocumented complication of the surgical management, the use of the direct clamp and sew technique with preservation of the intercostals reduces the risk against spinal cord injury. Methods From February 2005 to January 2010, fourteen patients with traumatic aortic injuries have been referred to us. They were all males with the mean age 29 years, range 22 to 34. Primary survey revealed associated injuries in all patients. Thirteen patients (92.85%) had the chance for immediate surgical management; one patient (7.1%) died during control of intra-abdominal life threatening bleeding. The 13 patients had been repaired by the direct clamp and sew technique, and the mean aortic cross clamp time was 35 min (range, 20-43 min). Results There was one death in the surgical group in the immediate postoperative period due to profound hypotension and reperfusion injury. There was a case of persistent small false aneurysm postoperatively. There was no paraplegia in the survived group. There was no 30-day mortality. Conclusions Spinal cord injury was avoided during the clamp and sew technique by the immediate surgical intervention, preservation of the intercostals and proper control of the blood pressure during application and removal of the aortic cross clamp.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Acute traumatic injury of the descending thoracic aorta: a limited experience

Regal

Ghoneimy

El-Azab

2011

Indian J Thorac Cardiovasc Surg

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“…Mortality rates and incidence of paraplegia reported by supporters of a clampand-sew technique oscillate from 12% to 23% for the first and 1.5% to 13% for the second. 13,14 Simplicity is the major claim for proponents of a clamp-and-sew procedure. A basic requirement for low neurological morbidity when using this technique is an expeditious surgery with low cross-clamp times.…”

Section: Evolution Of Surgical Modalitymentioning

confidence: 99%

Management of Traumatic Aortic Rupture: A 30-Year Experience

et al. 2002

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ObjectiveTo present the authors' 30-year experience with traumatic aortic rupture (TAR). Summary Background DataTAR is a highly lethal injury. Most institutions manage a small number of cases, and most surgeons receive only modest exposure during training. MethodsBetween 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. ResultsMortality was 18 patients for group A (21.9%), 23 patients for group B (35.9%), and 13 patients for group C (17.8%) (P ϭ .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 ϭ .0005). Aortic occlusion without lower body perfusion for longer than 30 minutes (P ϭ .004) and surgical technique without lower body bypass support (P ϭ .0005) were associated with paraplegia.

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“…SWEENEY et al (43) reported a mortality rate of 12% and a permanent paraplegia rate of 1,3% with a mean cross-clamp time of 24 minutes. However a cross clamp time this brief cannot be guaranteed (9) and most surgical groups do not meet this mark (44,45).…”

Section: Clamp and Sewmentioning

confidence: 99%

Traumatic Rupture of the Thoracic Aorta

Chiesa

Moura

Lucci

et al. 2003

Acta Chirurgica Belgica

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Traumatic rupture of the thoracic aorta is a life threatening situation, and may be secondary to several mechanisms; mainly penetrating or iatrogenic lesions and blunt trauma. Although penetrating mechanisms predominate, the number of patients with aortic disruption due to blunt trauma has continued to increase. This paper shows an overview focusing on the pathogenesis, diagnosis, timing and type of treatment regarding traumatic injuries of the thoracic aorta; it also reports the experience of one single center that deals with these lesions. The major difficulty in the evaluation data on blunt aortic injury is that retrospective reviews often group together patients with all types of aortic lesions, comparing outcomes for injuries in different locations, with diverse methods of repair and different surgeons and/or institutions.

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Traumatic aortic transections: Eight-year experience with the “Clamp-Sew” technique

Cited by 60 publications

References 24 publications

Acute traumatic injury of the descending thoracic aorta: a limited experience

Acute traumatic injury of the descending thoracic aorta: a limited experience

Management of Traumatic Aortic Rupture: A 30-Year Experience

Traumatic Rupture of the Thoracic Aorta

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