Traumatic rupture of thoracic aorta. Diagnosis and management

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 intraclavicular 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.