Use of Carmeda-coated femoral-femoral bypass during repair of traumatic aortic pseudoaneurysms.
OBJECTIVE
To compare the results and outcomes of three different approaches to posttraumatic pseudoaneurysm repair: clamp and sew, left heart bypass, and the most recent approach, cardiopulmonary support using femoral-femoral bypass.


METHODS
Retrospective series.


METHODS
A university-based, level 1 trauma center.


METHODS
Forty-two consecutive patients treated for posttraumatic aortic pseudoaneurysm whose mean (+/- SEM) Injury Severity Score was 37 +/- 1.7.


METHODS
Methods of repair included clamp and sew in nine patients, left heart bypass in 24 patients, and cardiopulmonary support in nine patients.


METHODS
Student's t test was used to compare interoperative blood loss, need for blood transfusion, and aortic cross-clamp time. Complications and mortality were also reviewed.


RESULTS
Mean (+/- SEM) aortic cross-clamp time for clamp and sew was 28.1 +/- 3.3 minutes vs 52.5 +/- 3.7 for left heart bypass and 49.3 +/- 5.6 for cardiopulmonary support. Blood loss and the need for transfusion were comparable between groups. Complications were also comparable.


CONCLUSIONS
Femoral-femoral cardiopulmonary support is safe to use, has a very low risk of complications, and should provide protection for the spinal cord during aortic repair. We encourage a randomized prospective trial to determine if cardiopulmonary support has a significantly lower rate of paraplegia than the clamp- and -sew technique.
Contino
J P
JP
Department of Surgery, University of California-Davis, Medical Center, Sacramento.
Follette
D M
DM
Berkoff
H A
HA
Pollock
M E
ME
Bogren
H
H
Wisner
D H
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D002648:Child; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*