Management of traumatic aortic rupture: a 30-year experience.
OBJECTIVE
To present the authors' 30-year experience with traumatic aortic rupture (TAR).


BACKGROUND
TAR is a highly lethal injury. Most institutions manage a small number of cases, and most surgeons receive only modest exposure during training.


METHODS
Between 1971 and 2001, the authors operated on 219 patients with a diagnosis of TAR. Diagnosis of TAR since 1994 has been based exclusively on the use of contrast-enhanced spiral computed tomography, with angiography reserved for equivocal cases (periaortic mediastinal hematoma without aortic wall abnormalities). Patients were divided according to surgical technique. Eighty-two patients (group A) were operated on with a clamp-and-sew technique. Sixty-four patients (group B) underwent surgery with the use of a passive shunt, and 73 patients (group C) were treated using heparin-less partial cardiopulmonary bypass.


RESULTS
Mortality was 18 patients for group A (21.9%), 23 patients for group B (35.9%), and 13 patients for group C (17.8%) (P =.03). Paraplegia occurred in 15 of 64 survivors in group A (23.4%), 7 of 41 survivors in group B (17%), and 0 of 60 survivors in group C ( P=.0005). Aortic occlusion without lower body perfusion for longer than 30 minutes (P =.004) and surgical technique without lower body bypass support (P =.0005) were associated with paraplegia.


CONCLUSIONS
Surgery for TAR based on spiral computed tomography screening and diagnosis is reliable. The use of heparin-less distal cardiopulmonary bypass in the authors' hands is safe and is associated with a reduced incidence of paraplegia.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010264:Paraplegia / Q000209:etiology* / Q000517:prevention & control; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*