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Surgical treatment for closed thoracic aortic injuries
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 1976
Summary
Diagnosing acute aortic tears from nonpenetrating trauma is challenging; aortography is essential. Simple aortic cross-clamping during repair showed better outcomes than distal perfusion, with no paraplegia.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Acute aortic tears are serious injuries resulting from nonpenetrating thoracic trauma.
- Diagnosis can be difficult, with normal chest X-rays in a significant percentage of acute cases.
- Chronic tears also present management challenges.
Purpose of the Study:
- To evaluate diagnostic methods for acute aortic tears.
- To compare surgical outcomes between different aortic repair techniques.
- To assess the incidence of complications, such as paraplegia, associated with each technique.
Main Methods:
- Retrospective review of 18 patients with acute aortic tears and 7 with chronic tears.
- Diagnosis confirmed by aortography for all acute cases.
- Surgical repair comparison: distal aortic perfusion versus simple aortic cross-clamping.
Main Results:
- Aortography was crucial for diagnosing acute aortic tears.
- Two patients (11%) in the distal perfusion group developed paraplegia.
- No paraplegia occurred in the simple aortic cross-clamping group.
- Average cross-clamp times were 69 minutes (distal perfusion) vs. 23 minutes (simple cross-clamping).
- Average blood administration was 3,139 ml (distal perfusion) vs. 1,700 ml (simple cross-clamping).
Conclusions:
- Clinical diagnosis of acute aortic tears is unreliable.
- Simple aortic cross-clamping is a preferred method for repair in experienced hands, associated with lower complication rates.
- Distal aortic perfusion may increase the risk of paraplegia.