Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma

• Published in: The journal of trauma Vol. 42; no. 3; p. 374
• Main Authors: Fabian, T C, Richardson, J D, Croce, M A, Smith, Jr, J S, Rodman, Jr, G, Kearney, P A, Flynn, W, Ney, A L, Cone, J B, Luchette, F A, Wisner, D H, Scholten, D J, Beaver, B L, Conn, A K, Coscia, R, Hoyt, D B, Morris, Jr, J A, Harviel, J D, Peitzman, A B, Bynoe, R P, Diamond, D L, Wall, M, Gates, J D, Asensio, J A, Enderson, B L
• Format: Journal Article
• Language: English
• Published: United States 01.03.1997
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aorta, Thoracic - injuries; Aorta, Thoracic - surgery; Child; Diagnostic Imaging; Female; Humans; Male; Middle Aged; Paraplegia - etiology; Postoperative Complications; Prospective Studies; Treatment Outcome; Vascular Surgical Procedures - methods; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - surgery
• ISSN: 0022-5282
• DOI: 10.1097/00005373-199703000-00003

Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.