REEVALUATION OF SURGICAL-TREATMENT DURING THE ACUTE PHASE OF TRAUMATIC RUPTURE OF THE AORTIC ISTHMUS, BASED ON A SERIES OF 47 CASES

From 1976 to 1989, 47 patients with traumatic aortic rupture in the ar ea of the isthmus were seen in our institution; 4 patients died from e xsanguination before definitive repair. Forty-three patients were oper ated on. Most of them (n:41) underwent repair using partial bypass wit h pump oxygenator. There were 3 postoperative deaths. No patient devel oped postoperative paraplegia; 2 patients presented totally regressive spinal disturbances 5 and 8 days after surgery. Two of the 38 survivo rs were lost to follow-up. Postoperative angiography revealed an excel lent aortic result in all cases especially in young patients, except t wo (1 stenosis, 1 aneurysm). Our experience and a review of the litera ture indicate some observations: despite rapid transport and evaluatio n, some patients died from exsanguination before definite repair. Card iopulmonary bypass and correction of metabolic disturbances may decrea se the probability of paraplegia and heparinisation did not increase t he risk when orthopedic or abdominal lesions were treated before aorti c lesion. Direct repair is recommended as the procedure of choice, esp ecially in young patients. angiographic controls showed excellent resu lts and long term follow-up is very satisfactory.