Acute traumatic injury of the descending thoracic aorta: A limited experience

Background: Blunt injury of the descending thoracic aorta, in the isthmus, is relatively common due to deceleration accidents. Although spinal cord injury has been a well-documented complication of the surgical management, the use of the direct clamp and sew technique with preservation of the intercostals reduces the risk against spinal cord injury. Methods: From February 2005 to January 2010, fourteen patients with traumatic aortic injuries have been referred to us. They were all males with the mean age 29 years, range 22 to 34. Primary survey revealed associated injuries in all patients. Thirteen patients (92.85%) had the chance for immediate surgical management; one patient (7.1%) died during control of intra-abdominal life threatening bleeding. The 13 patients had been repaired by the direct clamp and sew technique, and the mean aortic cross clamp time was 35 min (range, 20-43 min). Results: There was one death in the surgical group in the immediate postoperative period due to profound hypotension and reperfusion injury. There was a case of persistent small false aneurysm postoperatively. There was no paraplegia in the survived group. There was no 30-day mortality. Conclusions: Spinal cord injury was avoided during the clamp and sew technique by the immediate surgical intervention, preservation of the intercostals and proper control of the blood pressure during application and removal of the aortic cross clamp. © 2011 Indian Association of Cardiovascular-Thoracic Surgeons.