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Acute Posttraumatic Rupture of the Thoracic Aorta: An Eleven-Year Experience

An 11-year experience with 17 acute traumatic ruptures of the thoracic aorta is reviewed. Superior mediastinal widening on initial chest X-ray (CXR) was present in 15 patients. In 2 patients the mediastinum on CXR was initially normal but became wider with regular subsequent films. The diagnosis was made by aortography in 16 patients. All ruptures involved the aortic isthmus although one extended into the distal aortic arch. Emergency aortic repair was performed in all cases. Two had direct suture repair, 1 had a Dacron® patch, and the others required interposition tube grafts. Techniques used to enhance repair varied from a simple cross-clamp without heparinization to total cardiopulmonary bypass, deep hypothermia, and circulatory arrest. Four patients underwent surgery for other conditions prior to aortic repair (2 craniotomies, 2 laparotomies). There was 1 postoperative death and 2 cases of permanent paraparesis, both of which had been documented preoperatively. Aortography is a reliable diagnostic investigation in this condition. Repair should be performed in a center equipped with cardiopulmonary bypass. Surgical priority over the aortic repair should be given only to intracranial hemorrhage or selected cases of intraabdominal bleeding. Paraplegia can result from the injury as well as being associated with the aortic repair.