The controversy continues regarding the use of the "clamp-and-sew" (C&S) technique vs distal aortic perfusion (DAP). While many agree in light of ample supportive data that minimization of aortic cross-clamp time reduces the risk of the disastrous complication of paraplegia, the benefit of DAP continues to be debated. Razzouk and colleagues weigh in on the side of C&S. Much of the confusion in the literature results from the taint of selection bias that results in inappropriate comparisons between the 2 techniques. The American Association for the Surgery of Trauma multi-institutional study of TAR1 was conducted prospectively to maximize complete and accurate data collection and to minimize bias. While not an ideal study, the results from the American Association for the Surgery of Trauma study of 274 aortic injuries reported during a 2½-year period clearly demonstrated a reduction in paraplegia with the use of DAP.
Fabian TC. Repair of Traumatic Aortic Rupture—Invited Critique. Arch Surg. 2000;135(8):919. doi:10.1001/archsurg.135.8.919