Acute or delayed surgical treatment of traumatic rupture of the descending aorta

During a 20 year period, 33 patients with traumatic rupture of the descending thoracic aorta were operated upon. In the absence of an indication for acute surgery our policy was to defer operation at least 4 weeks after the trauma. Six patients were operated upon within 24 hours (Group I), 5 after 4-13 days due to suspected expansion of mediastinal widening (Group IIa), 10 were operated upon electively after 4-12 weeks (Group IIb), and 12 were operated upon for chronic traumatic aneurysms (Group III). The number of operative deaths/reoperations due to bleeding were: Group I, 2/1; Group IIa, 1/2; Group IIb, 0/0; and Group III, 1/0. There were no late deaths related to the operation or the inserted prosthesis. Of 26 survivors, 21 underwent a follow-up study 1.5-20 years (mean 8.2 years) postoperatively. Except for 6 patients with paralysis of the left recurrent laryngeal nerve none of the patients had sequelae which could be related to the operation or the inserted prosthesis. CT-scanning of the chest revealed neither pseudoaneurysms nor significant stenosis in the suture lines or prosthetic areas. The results indicate that delayed operation of traumatic thoracic aortic ruptures on selected patients may be performed with acceptable results.