Repair of traumatic aortic transection: a management protocol and review of twenty-one patients.
Between 1970 and 1987, 21 patients at St. Vincent Hospital and Medical Center underwent surgery for repair of a transected descending aorta. Nineteen of the transections were a result of trauma secondary to motor vehicle accidents, 1 was secondary to compression injury of the chest, and 1 was the result of a fall. All of the patients had diagnostic chest X-rays and all but one X-ray showed a widened mediastinum. Aortography was carried out in 20 cases. Atrio-femoral bypass was used for all but 2 patients, who had femoro-femoral bypass. The mean cross-clamp time was 53 minutes. Interposition graft was used in 16 patients, an intraluminal graft in 1 patient, and primary repair was performed in 2 patients. Survival was 71%, with 4 of the 21 patients expiring in the operating room (2 before the repair could be undertaken), one patient expiring during a laparotomy 2 days after the aortic repair, and one patient expiring 4 days after the repair. Fifteen patients were discharged alive. Survival and patient care could be improved by careful diagnostic assessment and by following a protocol agreed upon by a team of surgeons.
Guvendik
L
L
Heart Institute St. Vincent Hospital and Medical Center, Portland, Oregon.
Davis
N R
NR
Starr
A
A
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*