Surgical treatment for closed thoracic aortic injuries

Eighteen patients with acute aortic tear secondary to nonpenetrating thoracic trauma and seven with chronic tears have been operated upon. Of the patients with acute injury, 28% had normal chest x-ray on admission. The diagnosis of acute aortic tear was made by aortography in all patients. Two patients died from causes unrelated to the aortic injury. In the group of 18 patients in which some method of perfusing the distal aorta was used, two developed paraplegia; in the group of 7 treated with simple aortic cross-clamping none occurred. The average aortic cross-clamp time 69 and 23 minutes, respectively, and average blood administration 3,139 and 1,700 ml., respectively. We conclude that the diagnosis of acute aortic tear cannot be reliably made on clinical grounds, and that with properly trained personnel the method of choice is usually simple aortic cross-clamping during repair.