Management of ruptured thoracic aortic aneurysms

Nine cases of emergency resection of the thoracic aorta without temporary shunt or cardiopulmonary bypass are presented. Five were acute traumatic transections of the descending thoracic aorta secondary to blunt trauma. All five patients survived without sequelae. Four of the patients had ruptured arteriosclerotic aneurysms, including one aortobronchial fistula and one aortobronchial esophageal fistula. Two of these four patients survived without sequelae and two died in the postoperative period. One of the two latter patients had paraplegia. A review of the different methods of prevention of ischemic damage to the spinal cord and abdominal viscera is presented. Use of simple aortic cross clamping in the emergency situation for both acute traumatic transections of the aorta and ruptured arteriosclerotic aneurysms of the thoracic aorta is justified.