ACUTE TRAUMATIC RUPTURE OF THE THORACIC AORTA - IMMEDIATE OR DELAYED SURGICAL REPAIR

The appropriate management of traumatic aortic rupture is often diffic ult to determine, particularly if the rupture is associated with sever e additional lesions. Between 1986 and 1991, ten consecutive patients with acute traumatic rupture of the thoracic aorta (ATRTA) and concomi tant injuries were initially treated medically and submitted to delaye d aortic repair. Within the same period no other patient had emergency reconstruction of the thoracic aorta. Diagnosis of ATRTA was establis hed immediately after admission in eight patients. Five patients under went emergency surgery for severe concomitant injuries. With regard to the aortic lesion, all patients were managed medically and submitted to pharmacological treatment in an attempt to reduce cardiac shear for ces. None of the patients developed clinical signs of imminent free ru pture while waiting for aortic surgery. In the absence of a significan t hemothorax and when no coarctation syndrome is evident, the risk of free aortic rupture is considered to be rather low if the patient reac hes the hospital in a stable circulatory condition. Postponement of ao rtic reconstruction is particularly indicated when severe concomitant lesions preclude safe immediate repair of the aortic tear. Following t he patient's recovery from associated major injury, aortic surgery can be performed as a low risk procedure using cardiopulmonary bypass whi ch is recognised as the most effective technique to prevent spinal cor d ischemia and to reduce the risk of paraplegia.