[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
October 1990

Treatment of Traumatic Rupture of the Thoracic AortaA 15-Year Experience

Author Affiliations

From the Divisions of Cardiothoracic Surgery and Trauma, Department of Surgery, Harborview Medical Center, University of Washington, Seattle.

Arch Surg. 1990;125(10):1351-1356. doi:10.1001/archsurg.1990.01410220135019
Abstract

• Traumatic rupture of the thoracic aorta is increasing in incidence and remains a highly lethal injury. The morbidity associated with this injury also remains high. We retrospectively reviewed the records of all patients admitted to our emergency department with ruptured thoracic aortas during a 15-year period to determine the reason for this persistently high morbidity and mortality and to identify any factors that might improve the outcome. We found that patients who are in unstable condition on arrival in the emergency department or who become unstable before reaching the operating room are not likely to survive. Patients who are injured in automobile accidents have a greater chance of survival than do those injured in motorcycle accidents or car-pedestrian accidents. Patients who are in hemodynamically stable condition after aortic injury survive only if diagnosis and treatment are prompt. Major complications of repair following thoracic aortic injury relate primarily to the length of cross-clamp time, and every effort should be devoted to keeping the cross-clamp time less than 30 minutes.

(Arch Surg. 1990;125:1351-1356)

References
1.
Parmley LF, Mattingly TW, Manion WC, Jahnke EJ.  Nonpenetrating traumatic injury of the thoracic aorta . Circulation . 1958;17:1086-1101.Article
2.
Greendylke RM.  Traumatic rupture of the aorta: special reference to automobile accidents . JAMA . 1956;195:527-530.
3.
Svensson LG, Antunes MD, Kinsley RH.  Traumatic rupture of the thoracic aorta . SAMJ . 1985;67:853-857.
4.
Fisher RG, Hadlock F, Ben-Menachem Y.  Laceration of the thoracic aorta and brachiocephalic arteries by blunt trauma : Radiol Clin North Am . 1981;19:91-110.
5.
Eddy AC, Rusch VW, Fligner CL, et al. The epidemiology of traumatic rupture of the aorta in the pediatric patient: a thirteen year review. J Trauma. In press.
6.
Stark P.  Traumatic rupture of the thoracic aorta: a review . Crit Rev Diagn Imaging . 1984;22:239-255.
7.
Ramewofsky ML, Aprahamian C, Brown R, et al. Advanced Trauma Life Support Program . Chicago, Ill: American College of Surgeons.
8.
Yearly Death Summary, Medical Examiners Office, King County, Washington.
9.
Wilson RF, Murray C, Antonenko DR.  Nonpenetrating thoracic injuries . Surg Clin North Am . 1977;57:17-36.
10.
Hood RM, Boyd AD, Culliford AT. Thoracic Trauma . Philadelphia, Pa: WB Saunders Co; 1989:234-244.
11.
Symbas PN, Tyras DH, Ware RE, Diorio DA.  Traumatic rupture of the aorta . Ann Surg . 1973;178:6-12.Article
12.
Ayella RS, Hankins J, Turney SZ, Cowley RA.  Ruptured thoracic aorta due to blunt trauma . J Trauma . 1977;17:199-215.Article
13.
Hartford JM, Fayer RL, Shaver TE, et al.  Transection of the thoracic aorta: assessment of a trauma system . Am J Surg . 1986;151:224-229.Article
14.
Smith RS, Chang FC.  Traumatic rupture of the aorta: still a lethal injury . Am J Surg . 1986;152:660-663.Article
15.
Sturm JT, Billiar TR, Dorsey JS, Luxenberg MG, Perry JF,  Risk factors for survival following surgical treatment of traumatic aortic rupture . Ann Thorac Surg . 1985;39:418-421.Article
16.
Luna GK, Eddy AC, Copass MK.  The sensitivity of vital signs in identifying major thoraco-abdominal hemorrhage . Am J Surg . 1989;157:512-515.Article
17.
Bodai BJ, Smith JP, Ward RE, et al.  Emergency thoracotomy in the management of trauma . JAMA . 1983;249:1891-1894.Article
18.
Hoyt DB, Shackford SR, Davis JW, et al.  Thoracotomy during trauma resuscitations: an appraisal by board-certified general surgeons . J Trauma . 1989;29:1318-1321.Article
19.
Eddy AC, Nance DR, Goldman MA, et al.  Transection of the thoracic aorta after blunt thoracic trauma: rapid assessment using intravenous digital subtraction angiography . Am J Surg . 1990;159:500-503.Article
20.
Mirvis SE, Pais SO, Gens DR.  Thoracic aortic rupture: advantages of intraarterial digital subtraction angiography . Am J Radiol . 1986;146:987-991.
21.
Svensson LG, Loop FD.  Prevention of spinal cord ischemia in aortic surgery . In: Arterial Surgery: New Diagnostic and Operative Techniques . New York, NY: Grune & Stratton; 1988.
22.
Svensson LG, Von Ritter CM, Groeneveld HT, et al.  Cross-clamping of the thoracic aorta . Ann Surg . 1986;204:38-46.Article
23.
McCullough JL, Hollier LH, Nugent M.  Paraplegia after thoracic aortic occlusion: influence of cerebrospinal fluid drainage . J Vasc Surg . 1988;7:153-160.Article
24.
Svensson LG, Rickards E, Coull A, Rogers G, Fimmel CJ, Hinder RA.  Relationship of spinal cord blood flow to vascular anatomy during aortic cross-clamping and shunting . J Thorac Cardiovasc Surg . 1986;91:71-78.
25.
Crawford ES, Crawford JL, Safi HJ, et al.  Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients . J Vasc Surg . 1986;3:389-403.Article
26.
Katz NM, Blackstone EH, Kirklin JW, Karp RB.  Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection . J Thorac Cardiovasc Surg . 1981;81:669-674.
27.
Antunes MJ.  Acute traumatic rupture of the aorta: repair by simple aortic cross-clamping . Ann Thorac Surg . 1987;44:257-259.Article
28.
Mattox KL, Holzman M, Pickard LR, Beal AC, DeBakey ME.  Clamp/repair: a safe technique for treatment of blunt injury to the descending thoracic aorta . Ann Thorac Surg . 1985;40:456-463.Article
29.
Crawford ES, Rubio PA.  Reappraisal of adjuncts to avoid ischemia in the treatment of aneurysm of the descending thoracic aorta . J Thorac Cardiovasc Surg . 1973;66:693-704.
30.
Molina JE, Cogordan J, Einzig S, et al.  Adequacy of ascending aorta–descending aorta shunt during cross-clamping of the thoracic aorta for prevention of spinal cord injury . J Thorac Cardiovasc Surg . 1985;90:126-136.
31.
Sturm JT, Billiar TR, Luxenberg MG, Perry JF.  Risk factors for the development of renal failure following the surgical treatment of traumatic aortic rupture . Ann Thorac Surg . 1987;43:425-427.Article
32.
Van Norman G, Pavlin EG, Eddy AC, Pavlin DJ. Hemodynamic and metabolic effects of aortic unclamping in surgery for traumatic thoracic aortic tears. J Trauma. In press.
33.
Diehl JT, Payne DD, Rastegar H, Cleveland RJ.  Arterial bypass of the descending thoracic aorta with the BioMedicus centrifugal pump . Ann Thorac Surg . 1987;44:422-423.Article
34.
Oliver HF, Maher TD, Liebler GA, Park SB, Burkholder JA, Magovern GJ.  Use of the BioMedicus centrifugal pump in traumatic tears of the thoracic aorta . Ann Thorac Surg . 1985;38:586-591.Article
35.
McBride LR, Tidik S, Stothert JC, Lewis L, Codd JE.  Primary repair of traumatic aortic disruption . Ann Thorac Surg . 1987;43:65-67.Article
36.
Orringer MB, Kirsh MM.  Primary repair of acute traumatic aortic disruption . Ann Thorac Surg . 1983;53:672-675.Article
×