Traumatic rupture of the aortic isthmus

Program of selective management

James W. Pate, Morris L. Gavant, Darryl S. Weiman, Timothy Fabian

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Two hypotheses were investigated: (1) helical computed tomography (CT) of the chest on victims of decelerating trauma can yield a diagnosis of, or 'rule out,' a traumatic rupture of the aorta (TRA) without the need for an aortogram; and (2) selective delay of aortic repair can be safely accomplished through a medical management protocol. Screening helical CT examinations were done on 6169 victims of blunt thoracic trauma; 47 were found to have TRA; in 8, indirect but nondiagnostic findings not clarified by an aortogram led to surgical exploration. The sensitivity of helical CT was higher than that of aortograms, and a 'normal' helical CT scan was never associated with a proved TRA. It is estimated that the use of helical CT has resulted in at least a 40% to 50% decrease in the need for aortograms, in addition to yielding rapid, noninvasive valuable information about other injuries. Drugs (β-blockers ± vasodilators) to decrease the stress in the aortic wall were used in 93 patients when the diagnosis was suspected and were continued as necessary through the evaluation, stabilization, and until the aorta was cross-clamped at operation. Elective, delayed operation was done between 2 days and 25 months in 15 patients who were deemed to be excessive risks for emergency aortic repair; there were 2 deaths (13.3%). Eleven patients never had aortic repair. No patient maintained on this protocol, whether repaired emergently, electively, or not at all, developed free rupture of the periaortic hematoma and death from TRA.

Original languageEnglish (US)
Pages (from-to)59-63
Number of pages5
JournalWorld Journal of Surgery
Volume23
Issue number1
DOIs
StatePublished - Jan 1 1999

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Aortic Rupture
Spiral Computed Tomography
Aorta
Rupture
Wounds and Injuries
Thorax
Vasodilator Agents
Hematoma
Emergencies

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Traumatic rupture of the aortic isthmus : Program of selective management. / Pate, James W.; Gavant, Morris L.; Weiman, Darryl S.; Fabian, Timothy.

In: World Journal of Surgery, Vol. 23, No. 1, 01.01.1999, p. 59-63.

Research output: Contribution to journalArticle

Pate, James W. ; Gavant, Morris L. ; Weiman, Darryl S. ; Fabian, Timothy. / Traumatic rupture of the aortic isthmus : Program of selective management. In: World Journal of Surgery. 1999 ; Vol. 23, No. 1. pp. 59-63.
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