Multiple traumatic disruptions of the thoracic aorta

Surgical therapy for acute traumatic transection of the thoracic aorta is widely debated in the literature. However, little is published regarding therapy for unusual intraoperative findings, especially when the existence of multiple tears of the aortic wall would increase the operative difficulties and the associated risks. Our report concerns the presentation of three consecutive cases where multiple traumatic transections of the thoracic aorta could not be diagnosed by standard preoperative techniques. Our attention is focused on different technical options and their outcome when unusual intraoperative findings are present. We concluded that the event of unusual intraoperative findings may change the initial surgical management in favor of a more definitive procedure which usually carries a longer aortic cross-clamp time. In this instance, the availability of cardiopulmonary bypass (CPB) techniques is warranted.