Document Detail


Traumatic rupture of the aorta: immediate or delayed repair?
MedLine Citation:
PMID:  12035035     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether delay of the repair of the ruptured thoracic aorta in patients with other major injuries is safe and has a potential positive impact on survival.
SUMMARY BACKGROUND DATA: The accepted treatment for acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. This form of management, however, has been accompanied by a death rate of 0% to 54% mortality, often related to the presence of other injuries.
METHODS: The records of 30 consecutive patients with rupture of the thoracic aorta from blunt trauma treated from 1995 to 2001 were retrospectively reviewed. Two of them died shortly after admission and were excluded from further consideration. The remaining 28 patients were divided according to the time of the repair of the rupture into two groups. Group 1 patients underwent repair of the rupture immediately after the diagnosis was made. Group 2 patients, who had associated injuries that were likely to increase the risk of surgical death, had either repair more than 48 hours after injury (subgroup 2A) or had no repair (subgroup 2B). The patients in group 2 had their mean arterial pressure maintained at less than 70 mm Hg with medication to eliminate shear stress on the aortic tear while being observed.
RESULTS: Twenty-eight patients (22 men, 6 women) with an average age of 36 years (range 19-76) were treated. Twenty-five had rupture of the descending thoracic aorta and three had rupture in the ascending thoracic aorta. Group 1 comprised 14 patients, 5 of whom died during surgery or in the early postoperative period. Group 2 comprised 14 patients, 9 in subgroup 2A and 5 in subgroup 2B. Two patients in subgroup 2A and three patients in subgroup 2B died of associated injuries or illnesses. Rupture of the traumatic pseudoaneurysm of the thoracic aorta did not occur in any of the patients in group 2.
CONCLUSIONS: Delayed repair of acute traumatic aortic rupture is safe under appropriate treatment and should be considered in selected patients.
Authors:
Panagiotis N Symbas; Andrew J Sherman; Jeffery M Silver; John D Symbas; Jodi J Lackey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  235     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-05-29     Completed Date:  2002-06-19     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  796-802     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia, USA. psymbas@emory.org
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic / mortality
Adult
Aged
Aneurysm, False / radiography,  surgery*
Aorta, Thoracic / injuries*
Aortic Aneurysm, Thoracic / radiography,  surgery*
Aortic Rupture / mortality,  radiography,  surgery*
Aortography
Female
Hemothorax / mortality
Humans
Male
Middle Aged
Multiple Trauma / complications,  surgery*
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
Wounds, Nonpenetrating / mortality,  radiography,  surgery*
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