[Acute traumatic rupture of the thoracic aorta. Role of delayed surgical treatment]

Acute traumatic rupture of the thoracic aorta (ATRTA) is considered to be an emergency which requires immediate surgery. However surgical mortality is high with an average of 20% in the literature. Twenty-seven patients were observed from 1973 to 1986. Three patients were not operated on (Group I). Twenty patients had immediate surgery (group II) with 60% deaths, 4 patients underwent delayed surgery (Group III) with 25% deaths. Analysis of causes of deaths shows that mortality is mainly due to the severity of associated lesions. Associated lesions were present in 72% of patients who did not survive and in only 37% of the survivors. Associated lesions may be lethal initially (E.G. Brain trauma) or they may be aggravated by the thoracic procedure. Complications from associated lesions may also compromise the outcome of the thoracic procedure. It is well known that the majority of deaths from ATRTA are observed within 24 hours. Immediate repair of the aortic lesion should remain the rule when aortic rupture is isolated or associated with moderate injuries. However, in some cases with severe and multiple associated lesions who survive the initial aortic injury, delayed repair of ATRTA could be considered.