title: Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma.
abstract: BACKGROUND
  Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years.
  
  
  METHODS
  This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma.
  
  
  RESULTS
  There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia.
  
  
  CONCLUSIONS
  Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.
authors.affiliation: University of Tennessee, Memphis, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Fabian
authors.forename: J D
authors.initials: JD
authors.lastname: Richardson
authors.forename: M A
authors.initials: MA
authors.lastname: Croce
authors.forename: J S
authors.initials: JS
authors.lastname: Smith
authors.forename: G
authors.initials: G
authors.lastname: Rodman
authors.forename: P A
authors.initials: PA
authors.lastname: Kearney
authors.forename: W
authors.initials: W
authors.lastname: Flynn
authors.forename: A L
authors.initials: AL
authors.lastname: Ney
authors.forename: J B
authors.initials: JB
authors.lastname: Cone
authors.forename: F A
authors.initials: FA
authors.lastname: Luchette
authors.forename: D H
authors.initials: DH
authors.lastname: Wisner
authors.forename: D J
authors.initials: DJ
authors.lastname: Scholten
authors.forename: B L
authors.initials: BL
authors.lastname: Beaver
authors.forename: A K
authors.initials: AK
authors.lastname: Conn
authors.forename: R
authors.initials: R
authors.lastname: Coscia
authors.forename: D B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: J D
authors.initials: JD
authors.lastname: Harviel
authors.forename: A B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: R P
authors.initials: RP
authors.lastname: Bynoe
authors.forename: D L
authors.initials: DL
authors.lastname: Diamond
authors.forename: M
authors.initials: M
authors.lastname: Wall
authors.forename: J D
authors.initials: JD
authors.lastname: Gates
authors.forename: J A
authors.initials: JA
authors.lastname: Asensio
authors.forename: B L
authors.initials: BL
authors.lastname: Enderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D002648:Child; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*