Surgical Treatment of Lesions of the Thoracic Aorta in Patients with Multiorgan System Trauma

  • Aurel C. Cernaianu
  • Anthony J. DelRossi
  • Jonathan H. CilleyJr.
  • Richard K. Spence
  • Rudolph C. Camishion
Conference paper

Abstract

Thirty-six patients admitted at our Level I Trauma Center with multiorgan system injuries and acute lesions of the thoracic aorta have been studied. Mean Injury Severity Score (ISS) was 27 ± 4. Four patients underwent Emergency Department (ED) resuscitative thoracotomy. One survived and fully recovered. The remaining patients underwent concomitant surgical repair of the aortic lesions and treatment of other multiorgan systems. The overall mortality rate was 17%. ISS for survivors was significantly lower than for nonsurvivors (23 ± 4 vs 35 ± 5, p < 0.05). The survivors arrived faster from the accident scene than nonsurvivors (45 ±15 min vs 75 ± 10 min, p < 0.05). The time for survivors and nonsurvivors to arrive in the operating room for repair of the aortic injury was not different (13 ± 6 hrs. vs 14 ± 7, p > 0.05). All deaths occurred in the emergent or semiurgent groups. Four patients (two of whom presented with multiple lesions of the thoracic aorta) developed ischemia in distal organs. Two patients developed paralysis and two had lower limb spasticity. All discharged survivors were alive at 12 months follow-up. Sixty-four percent of the patients underwent aortic repair with “clamp/sew” technique. The rest were operated with either heparinized shunts or cardiopulmonary bypass (CPB). The type of surgical repair had no influence on the outcome of patients with single, uncomplicated aortic lesions, however, “clamp/sew” technique did not provide adequate protection when used for repair of multiple aortic tears.

Our study demonstrated that the outcome of surgical treatment of the traumatic aortic lesions of patients with multiorgan injury depends upon the time elapsed from the accident to the arrival to the ED, the severity of multiorgan system injury, the extent of thoracic aortic injury and appropriate timing of surgical repair of the aortic lesions and the surgical treatment of other injured organs.

Keywords

Ischemia Transportation Heparin Norepinephrine Thrombocytopenia 

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Copyright information

© Springer-Verlag New York Inc. 1992

Authors and Affiliations

  • Aurel C. Cernaianu
  • Anthony J. DelRossi
  • Jonathan H. CilleyJr.
  • Richard K. Spence
  • Rudolph C. Camishion

There are no affiliations available

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