Citation

Pate JW, Cole FH, Walker WA, Fabian TC. Ann. Thorac. Surg. 1993; 55(3): 586-592.

Affiliation

Section of Cardiothoracic Surgery, University of Tennessee, Memphis 38163.

Copyright

(Copyright © 1993, Society of Thoracic Surgeons, Publisher Elsevier Publishing)

DOI

unavailable

PMID

8452417

Abstract

Acute cardiac failure, pulmonary edema, and ischemia of the brain, cord, and other structures pose special problems with trauma to the aortic arch and its branches. Data on 93 such cases are reported. Diagnosis was made by clinical examination in hemodynamically unstable patients and led to immediate operation in 61.3%. Patients in stable condition had angiography, which localized the injury and allowed planning of incision and bypass shunts. In left subclavian artery injuries, anterior thoracotomy was best for proximal control regardless of wound entry sites; midline sternotomy with sternocleidomastoid extension was usually adequate for other vessels. Flow was reestablished in all carotid injuries; there were no neurological complications. Temporary or permanent bypass shunts during periods of proximal aortic occlusion were valuable in decreasing cardiac afterload, maintaining circulation to the brain, and allowing an unhurried methodical approach to the hematoma. Occlusion of one or more venae cavae alleviated acute cardiac dilatation during brief periods of ascending aortic clamping. Associated trauma contributed to the high mortality.

Language: en