Original ArticlesTraumatic aortic rupture: diagnosis and management
Section snippets
Material and methods
Between January 1988 and June 1997 we treated 42 patients with blunt injuries to the thoracic aorta. There were 32 male and 10 female patients. Age ranged from 15 to 83 years, with a mean of 34 years. Three patients sustained falls, 1 patient was a pedestrian struck by a car, 1 patient was hit by a falling tree, and the remaining 37 patients were involved in motor vehicle crashes.
Means are reported with standard deviations. Comparison of continuous variables was with Student’s t test.
Results
Multiple injuries were the rule: injury severity scores ranged from 26 to 59, with a mean of 40 ± 9 (an injury severity score of 40 predicts a mortality of 41%). Nine patients arrived without vital signs. Eight of them underwent emergency thoracotomy in the emergency department and 1 had bilateral chest tubes placed; none survived. Families of 3 elderly patients with multiple injuries and substantial comorbidities declined operative intervention.
Four of 30 patients (13%) admitted with vital
Comment
This report details a recent clinical experience with traumatic rupture of the thoracic aorta. This is an uncommon injury: among an average of 1,600 blunt trauma admissions per year at our center during the study period, 4.4 TRAs were diagnosed and 3.2 were repaired. A recent survey of 50 trauma centers in North America documented an average of 2.2 cases of TRA per center per year [9]. The relatively infrequent occurrence of this entity means that few surgeons are able to accrue large personal
References (24)
- et al.
Blunt injuries of the thoracic aorta
Ann Thorac Surg
(1992) - et al.
Experience with four surgical techniques to repair traumatic aortic pseudoaneurysm
J Thorac Cardiovasc Surg
(1993) - et al.
Traumatic tears of the thoracic aortaimproved results using the Bio-Medicus pump
Ann Thorac Surg
(1989) - et al.
Acute traumatic rupture of the aortic isthmusrepair with cardiopulmonary bypass
Ann Thorac Surg
(1995) - et al.
Traumatic aortic rupturetwenty-year metaanalysis of mortality and risk of paraplegia
Ann Thorac Surg
(1994) - et al.
Traumatic aortic transectionseight-year experience with the “clamp-sew” technique
Ann Thorac Surg
(1997) - et al.
The potential effects of radiographic criteria to exclude aortography in patients with blunt chest traumaResults of a study of 32 patients with proved aortic or brachiocephalic arterial injury
J Thorac Cardiovasc Surg
(1989) - et al.
Traumatic rupture of the thoracic aortashould one always operate immediately?
Ann Vasc Surg
(1995) Heparinized shunts for thoracic vascular operations
Ann Thorac Surg
(1972)- et al.
Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection
J Thorac Cardiovasc Surg
(1981)