A recent experience in the management of a rapidly expanding pulsating hematoma prompted this experimental study. A false aneurysm of the descending aorta had ruptured into a left pleural space and it was obvious that any conventional approach would likely terminate in exsanguination before the aorta could be brought under control. Through a median sternotomy incision, extended down almost to the level of the umbilicus, a bypass graft was sutured end-to-side to the ascending aorta above and the distal portion of the thoracic aorta below. After dividing and closing the aortic arch beyond the origin of the left carotid and the descending thoracic aorta above the insertion of the graft, the hematoma no longer pulsated and could be approached through the left thorax. This experience led us to believe that a similar permanent intramediastinal bypass might find usefulness in the treatment of other pulsating hematomas and certain mature thoracic aneurysms.
JONTZ JG, KING H, SHUMACKER HB. Permanent Bypass Grafting of the Thoracic AortaAn Experimental Study. AMA Arch Surg. 1960;80(4):578-579. doi:10.1001/archsurg.1960.01290210046009