Traumatic rupture of the descending thoracic aorta

The management of acute traumatic rupture of the descending thoracic aorta at Groote Schuur Hospital between January 1984 and December 1989 is reviewed. Aortic rupture was diagnosed angiographically in 18 of 150 patients (12%), who underwent aortography because this injury was suspected. However, 3 of these patients had false-positive angiograms. The diagnosis was initially missed in 31% of patients, and this contributed to morbidity and mortality. Simple aortic cross-clamping (N = 8) was used before September 1988 and 3 patients died--1 intra-operatively from cardiac arrhythmia and 2 postoperatively, where major peri-operative haemorrhage had occurred. In contrast, partial heparin-less bypass (N = 5) using a centrifugal vortex pump was used after September 1988, and there were no haemorrhagic or paraplegic complications or mortality in this group. This technique is safe and appears to be superior to simple aortic cross-clamping in managing this condition.