Penetrating injuries of the aortic arch and its branches

James W. Pate, F. Hammond Cole, William A. Walker, Timothy Fabian

Research output: Contribution to journalArticle

53 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)586-592
Number of pages7
JournalThe Annals of Thoracic Surgery
Volume55
Issue number3
DOIs
StatePublished - Jan 1 1993

Fingerprint

Thoracic Aorta
Wounds and Injuries
Venae Cavae
Subclavian Artery
Sternotomy
Pulmonary Edema
Thoracotomy
Brain Ischemia
Constriction
Hematoma
Dilatation
Angiography
Heart Failure
Mortality
Brain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Penetrating injuries of the aortic arch and its branches. / Pate, James W.; Cole, F. Hammond; Walker, William A.; Fabian, Timothy.

In: The Annals of Thoracic Surgery, Vol. 55, No. 3, 01.01.1993, p. 586-592.

Research output: Contribution to journalArticle

Pate, James W. ; Cole, F. Hammond ; Walker, William A. ; Fabian, Timothy. / Penetrating injuries of the aortic arch and its branches. In: The Annals of Thoracic Surgery. 1993 ; Vol. 55, No. 3. pp. 586-592.
@article{bcc0234935a64670ae28125998fe438c,
title = "Penetrating injuries of the aortic arch and its branches",
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.",
author = "Pate, {James W.} and Cole, {F. Hammond} and Walker, {William A.} and Timothy Fabian",
year = "1993",
month = "1",
day = "1",
doi = "10.1016/0003-4975(93)90255-G",
language = "English (US)",
volume = "55",
pages = "586--592",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Penetrating injuries of the aortic arch and its branches

AU - Pate, James W.

AU - Cole, F. Hammond

AU - Walker, William A.

AU - Fabian, Timothy

PY - 1993/1/1

Y1 - 1993/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0027416908&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027416908&partnerID=8YFLogxK

U2 - 10.1016/0003-4975(93)90255-G

DO - 10.1016/0003-4975(93)90255-G

M3 - Article

VL - 55

SP - 586

EP - 592

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 3

ER -