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Experience with four surgical techniques to repair traumatic aortic pseudoaneurysm
J T Walls1, T M Boley, J J Curtis
1University of Missouri, Columbia 65212.
The Journal of Thoracic and Cardiovascular Surgery
|August 1, 1993
Summary
Surgical repair of traumatic thoracic aortic pseudoaneurysms using a centrifugal pump without heparinization is favored. This technique offers advantages in operative field exposure and distal aortic perfusion, potentially reducing complications.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Vascular Surgery
Background:
- Traumatic pseudoaneurysms of the thoracic aorta are serious injuries resulting from blunt trauma.
- Surgical repair is necessary to prevent rupture and associated mortality.
Purpose of the Study:
- To evaluate the outcomes of different surgical techniques for traumatic thoracic aortic pseudoaneurysms.
- To identify the optimal surgical approach based on patient outcomes and complications.
Main Methods:
- Retrospective review of 27 patients undergoing surgical repair for traumatic thoracic aortic pseudoaneurysms.
- Comparison of four repair methods: roller pump with heparin, Gott shunt, clamp-and-sew, and centrifugal pump without heparin.
- Analysis of postoperative complications, hospital mortality, and long-term follow-up.
Main Results:
- Hospital mortality was 19% (5 of 27 patients).
- Significant postoperative complications included paraplegia, spinal cord syndrome, renal failure, and vocal cord paralysis.
- The centrifugal pump without heparin group showed favorable outcomes with no graft-related issues at long-term follow-up.
Conclusions:
- Repair with shunting using a centrifugal pump without heparin is favored for traumatic thoracic aortic pseudoaneurysms.
- This technique potentially improves operative field exposure, reduces afterload, avoids clamp injury, and maintains stable distal aortic perfusion.
- While patient numbers are small, the findings suggest a beneficial approach for managing these complex injuries.