Surgery of chronic traumatic aneurysm of the aortic isthmus: benefit of direct suture.
OBJECTIVE
Retrospective evaluation of long term results after direct suture repair of chronic traumatic aneurysm of the aortic isthmus.


METHODS
From March 1979 to June 1998, a total of 19 patients with chronic traumatic aneurysm of the aortic isthmus were operated on, among whom 12 (63%) underwent direct suture. These 12 patients (age ranging from 19 to 68 years; mean 34.2 years) constitute the subject of this study. All but one suffered traffic accidents. Mean delay between trauma and surgery was 4 years (range 3 months to 12 years). All patients underwent a left posterolateral thoracotomy through the fourth intercostal space. Extracorporeal circulation for spinal cord protection was installed in six patients (five ilio-iliac shunts, one atrio-iliac shunt). Aortic rupture was partial in five and circumferential in seven patients. The mean clamping time was 25 min. The absence of loss of aortic substance and a careful mobilization of the aorta made the repair by direct suture easier; this technique could thus be achieved in 63.2% of all 19 patients operated on of chronic traumatic aneurysm within the same period.


RESULTS
There was no in-hospital death and no postoperative paraplegia. With a median follow-up of 15 years 3 months (ranging from 22 to 10 years), there were no late complications. Chest X-ray was normal in all patients; eight of them underwent a control angiography between 18 and 72 postoperative months; all these angiographies but one (20% stenosis without gradient) demonstrated a normal appearance of aortic isthmus.


CONCLUSIONS
Direct suture for repair of chronic traumatic thoracic aneurysm is a safe procedure: long-term outcome was excellent and the complications observed with prosthetic grafts or with aortic endoprosthetic stent-grafts were avoided.
Roques
X
X
Department of Cardiovascular and Paediatric Cardiac Surgery, Bordeaux Heart University Hospital, Hôpital Haut-Lévêque, F-33604 Pessac, France. xavier.roques@chu-bordeaux.fr
Remes
J
J
Laborde
M N
MN
Guibaud
J P
JP
Rosato
F
F
MacBride
T
T
Baudet
E
E
D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D013908:Thoracotomy; D016896:Treatment Outcome