[Two cases of complete transection of the thoracic aorta caused by blunt chest trauma]

Two patients with complete transection of the thoracic aorta, caused by blunt chest trauma, were survived after successful surgical repair. Only seven such cases are reported in the Japanese literature. The present cases were 52- and 28-year-old males injured in different accidents by rapid deceleration, both at collision with the rear of a parked trunk. The first case, on the fifth day of hospitalization, suddenly went into shock with severe thoracodorsal pain. The second case developed hemothorax soon after the accident. Both cases were diagnosed with angiography. The lesions were located in the upper portion of the descending aorta. The operations, performed on the 13th and 34th days after the respective accidents, combined median sternotomy with left thoracotomy through the 3rd intercostal space. The first case suffered complete transection of the aorta at the ductal ligament. In the second case, the intima and media of the descending aorta, at 8 cm below the branching of the left subclavian artery, were affected by complete transection. We operated with a V-A bypass of which cannulation was performed to right atrium and left femoral artery in the first case, and with an ascending aorta-left femoral artery bypass with a centrifugal pump in the second case. The lesions were repaired with 26 mm and 20 mm woven Dacron grafts, respectively. The patients have recovered sufficiently to do normal daily lives. In cases with circumferential transection of the thoracic aorta caused by blunt chest trauma, only those with pseudoaneurysm formation, who remain in a hemostatic state can be saved by surgery, We conclude that if the hemodynamic state is stable and blood pressure is strictly controlled in such cases, the elective operation can be performed.