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June 1976

Traumatic Rupture of Thoracic AortaDiagnosis and Management

Arch Surg. 1976;111(6):697-702. doi:10.1001/archsurg.1976.01360240077014

• Of six cases of thoracic aortic rupture, four were acute and two were chronic. In the four acute cases, suspicious findings were an appreciably widened mediastinum, upper-extremity hypertension, change in pulse amplitude, or, more hopefully, generalized hypertension, left infraclavicular systolic murmur, and loss of posterior aortic shadow on chest x-ray film. Preoperative angiography was essential. Three of four acute aortic transections (one with aortic arch involvement) had complicated associated injuries that necessitated delay in aortic surgical repair; antihypertensive drugs, including propranolol hydrochloride, were used for support in the interval. Perfusion by femoral vein-femoral artery cardiopulmonary bypass was used. All four patients were operated on successfully without residual complications. Two patients with chronic conditions were recommended for surgery; one was successfully operated on, using aorto-aortic bypass. Another patient, 27 years postinjury, refused operation. Postoperative arteriograms were performed for baseline observations of graft and suture-line characteristics in all cases.

(Arch Surg 111:697-702, 1976)