[Delayed surgical therapy of acute aortic rupture]

Immediate surgical treatment of traumatic aneurysms of the aorta is in our point of view in most cases problematic, also because of the combination with life threatening injuries of other organ systems. In our own patient-collection seven patients out of 44 with traumatic transsection were immediately operated. Six patients died in tabula, three of them due to uncontrollable hemorrhage. An analysis of over 5,000 post mortem findings from the department of forensic medicine in Hamburg revealed that injuries of the aorta lead in 98.3% to death in the first two hours after the accident. This shows that only a small number of injured victims survive. The danger of a two stage rupture is judged differently. We did not observe this problem in the patients with aortic lesion following blunt chest trauma and stable conditions who had first undergone treatment for other injuries and therefore operated in the interval period after two to ten weeks. With this strategy the lethality involving surgical management of aortic injuries in our unit decreased to 13%.