[Successful repair of traumatic aortic arch rupture]

The most common site of traumatic aortic tear is at the isthmus, and there have been few reports of successful surgical repair of traumatic rupture of the aortic arch. We have experienced a 18-year-old patient who sustained a blunt chest trauma in a traffic accident. After admission to our hospital, his general condition became stabilized by conservative therapy. But the chest X-ray showed widening of mediastinum and aortography demonstrated leakage of contrast media outside of the aortic arch lumen between the innominate and the left common carotid arteries. The patient underwent reconstructive surgery for the innominate artery with a part of the aortic arch using prosthetic graft with the aid of hypothermic retrograde total body perfusion. He has recovered without any neurological deficit, although the retrograde perfusion time exceeded 100 minutes. It is suggested that the technique of "retrograde total body perfusion" may provide longer time to perform aortic arch repairs than the conventional circulatory arrest does.