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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Hartford JM, Fayer RL, Shaver TE: Transection of the thoracic aorta: Assessment of a trauma system. Am J Surg. 1986;151:224–229.
Avery JE, Hall DP, Adams JE, Headrick JR, Nipp RE: Traumatic rupture of the thoracic aorta. South Med J. 1979;72:1238–1240.
Ross SE, Cernaianu AC: Epidemiology of thoracic injuries: Mechanism of injury and pathophysiology. Top Emerg Med. 1990;12(1):1–6.
Hanschen S, Snow NJ, Richardson JD: Thoracicaortic rupture in patients with multisystem injuries. South Med J. 1985;75(6):653–656.
DelRossi AJ, Cernaianu AC, Cilley JH Jr, Madden L, Spence RK: Multiple traumatic disruptions of the thoracic aorta. Chest 1990;97:1207–1209.
Pate JW: Traumatic rupture of the aorta: Emergency operation. Ann Thorac Surg. 1985;39:531–537.
Spence RK, Alexander JB, Camishion RC: Blunt rupture of the thoracic great vessels. Trauma Q. 1990;6(6):27–41.
Richardson DJ, Wilson ME, Miller FB. The widened mediastinum: diagnostic and therapeutic priorities. Ann Surg. 1990;6:731–737.
Crawford ES, Walker HSJ, Saleh DA, Normann NA: Graft replacement of aneurysm in descending thoracic aorta: Results without bypass or shunting. Surgery 1981; 89:73–85.
Najafi H, Javid H, Hunter J, Serry C, Monson D: Descending aortic aneurysmectomy without adjuncts to avoid ischemia. Ann Thorac Surg. 1980;30:326–335.
Mattox KL, Holzman M, Pickard LR, Beali AC Jr, DeBakey MD: Clamp/repair: A safe technique for treatment of blunt injury to the descending thoracic aorta. Ann Thorac Surg. 1985;40:456–463.
Marvasti MA, Meyer JA, Ford BE, Parker FB Jr: Spinal cord ischemia following operation for traumatic aortic transection. Ann Thorac Surg. 1986;42:425–428.
Orringer MB, Krisch MM: Primary repair of acute traumatic aortic disruption. Ann Thorac Surg. 1983;35:672–675.
McBride LR, Tidik S, Stothert JC, Barner HB, Kaiser GC, Willman VL, et al: Primary repair of traumatic aortic disruption. Ann Thorac Surg. 1987;43:65–67.
Antunes JM: Acute traumatic rupture of the aorta: Repair by simple aortic cross-clamping. Ann Thorac Surg. 1987;44:257–259.
Donahoo JS, Brawley RK, Gott VL: The heparin-coated vascular shunt for thoracic aortic and great vessel procedures: A ten year experience. Ann Thorac Surg. 1977;23:507–513.
Gott VL: Heparinized shunts for thoracic vascular operations. Ann Thorac Surg. 1972;14:219–220.
Murray GF, Young WG: Thoracic aneurysmectomy utilizing direct left ventricu-lofemoral shunt (TDMAC-heparin) bypass. Ann Thorac Surg. 1976;21:26–29.
Wolfe WG, Kleinman LH, Wechsler AS, Sabiston DC Jr: Heparin-coated shunts for lesions of the descending thoracic aorta. Arch Surg. 1977;112:1481–1487.
Cooley DA, DeBakey ME, Morris GC: Controlled extracorporeal circulation in surgical treatment of aortic aneurysm. Ann Surg. 1957;146:473–486.
Oliver HF Jr, Maher TD, Liebler GA, Park SB, Burkholder JA, Magovern GJ: Use of the BioMedicus centrifugal pump in traumatic tears of the thoracic aorta. Ann Thorac Surg. 1984;38:586–591.
Katz NM, Blackstone EH, Kirkland JW, Karp RB: Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection. J Thorac Car-diovasc Surg. 1981;81:669–674.
Rent R, Eitel N, Eisenstein R, Gewurz H: Complement activation by interaction of polyanions and polycations: Heparin-protamine induced consumption of complement. J Immunol. 1975;114:120–124.
Carreras LO: Thrombosis and thrombocytopenia induced by heparin. Scan J Haematol. 1980;36:64–80.
Chong BH, Pitney WAR, Castaldi PA: Heparin-induced thrombocytopenia: Association of thrombotic complications with heparin dependent IgG antibody that induces thromboxane synthesis and platelet aggregation. Lancet 1982;2:1246–1248.
Olinger GN, Hussey CV, Olive JA, Malik MI: Cardiopulmonary bypass for patients with previously documented heparin-induced platelet aggregation. J Thorac Cardio-vasc Surg. 1984;87:673–677.
Prater RVM, Oka Y, Hong Y, Tsubo T, Loubser PG, Masone R: Protamine induced circulatory changes. J Thorac Cardiovasc Surg. 1984;87:687–692.
Lawrence GH, Hessel EA, Sauvage LR, Krause AH: Results of the use of TDMAC-heparin shunt in the surgery of aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg. 1977;73:393–398.
Crawford ES, Waler HS, Salch SA, Normann NA: Graft replacement of aneurysm in descending thoracic aorta: Results without bypass or shunting. Surgery 1981; 89:73–85.
White RJ, Albin MS, Harris LS, Yashon D: Spinal cord injury: Sequential morphology and hypothermic stailization. Surg Forum 1969;20:432–434.
Osterholm JL, Mathews GJ: Altered norepinephrine metabolism following experimental spinal cord injury. Part 2. Protection against traumatic spinal cord hemorrhagic necrosis by norepinephrine synthesis blockade with alpha methyl tyrosin. J Neuro-surg. 1972;36:395–401.
Osterholm JL, Mathews GJ, Irvin JD, Calesnick B: Antinorepinephrine therapy against traumatic hemorrhagic necrosis of the spinal cord. Preliminary report. Clin Neurosurg. 1973;20:382–399.
Naftchi NE: Functional restoration of the traumatically injured spinal cord in cats by Clonidine. Science 1982;217:1042–1044.
Hall ED: Effects of the 21-aminosteroid U74006F on posttraumatic spinal cord ischemia in cats. J Neurosurg. 1988;68:462–465.
DelRossi AJ, Cernaianu AC, Cilley JH Jr, et al.: Preventive effect of Fluosol-DA for paraplegia encountered after surgical treatment of thoracicaorta. J Thorac Cardiovasc Surg. 1990;99:(4):665–669.
Cunningham JN Jr, Laschinger JC, Merkin HA, Nathan IM, Colvin S, Ransohoff J, et al: Measurement of spinal cord ischemia during operations on the thoracic aorta. Ann Surg. 1982;196:285–296.
Godwin JD, Korobkin M: Acute disease of the aorta: Diagnosis by computed tomography and ultrasonography. Radiol Clin N Am. 1983;21:551–554.
Boldman AP, Kotier MN, Scanlon MH, Ostrum B, Parameswara R, Parry WR: The complementary role of magnetic resonance imagining, Doppler echocardiography, and computed tomography in the diagnosis of dissecting thoracic aneurysms. Am Heart J. 1986;111:970–981.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer-Verlag New York Inc.
About this paper
Cite this paper
Cernaianu, A.C., DelRossi, A.J., Cilley, J.H., Spence, R.K., Camishion, R.C. (1992). Surgical Treatment of Lesions of the Thoracic Aorta in Patients with Multiorgan System Trauma. In: Chang, J.B. (eds) Modern Vascular Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2946-9_18
Download citation
DOI: https://doi.org/10.1007/978-1-4612-2946-9_18
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4612-7731-6
Online ISBN: 978-1-4612-2946-9
eBook Packages: Springer Book Archive