Impact of Presenting Physiology and Associated Injuries on Outcome Following Traumatic Rupture of the Thoracic Aorta

Karmy-Jones, Riyad; Carter, Yvonne M.; Nathens, Avery; Brundage, Susan; Meissner, Mark H.; Demirer, Seher; Jurkovich, Gregory; Borsa, John
January 2001
American Surgeon;Jan2001, Vol. 67 Issue 1, p61
Academic Journal
We hypothesized that the predominant factor influencing outcome of traumatic rupture of the thoracic aorta (TRA) was the degree of shock on presentation and associated injuries. We reviewed our experience with TRA over a 15-year period. Patients were classified as "unstable" if presenting systolic blood pressure was <90 mm Hg or if it decreased to <90 mm Hg after admission. We determined the presence of closed head injury, cardiac risk factors, a preoperative acute lung injury (ALI). The influence of these factors on mortality, postoperative adult respiratory distress syndrome (ARDS), and paralysis was analyzed. One hundred thirty-six patients were admitted with TRA. One hundred twenty underwent operative repair with a mortality of 31 per cent. Operative mortality was significantly higher in unstable patients (62%) versus stable patients (17%, P = 0.001), in patients with cardiac risk factors (71%) versus those without (24%, P = 0.001), and in patients with preoperative free rupture (83%) with versus those without (19%, P = 0.001). Free rupture was the cause of hypotension in only 10 of 42 unstable patients, with the remainder being due to other causes. Preoperative ALI was associated with a marked increase in postoperative ARDS (47% with vs 9% without, P = 0.001) but not operative mortality. Mechanical circulatory support (MCS) was used in 59 cases, none of whom experienced paralysis, whereas eight of 61 operated on without MCS developed paralysis (P = 0.001). When logistic regression was applied the use of MCS was not determined to be statistically significant. However, preoperative instability was found to be a significant predictor of postoperative paralysis with the risk being increased 5.5 times (confidence interval 3.3-10). The predominant factor influencing mortality, postoperative ARDS, and paralysis was preoperative instability and associated injuries. In patients who are hypotensive, other injuries should take precedence over repair of TRA. Pat...


Related Articles

  • Dorsal vein tear during radical total penectomy. Satheesan, B.; Kathiresan, N.; Siddhappa, K. T. // Indian Journal of Urology;Oct2009, Vol. 25 Issue 4, p548 

    A letter to the editor is presented in response to an article on dorsal vein tear during radical total penectomy.

  • Trends of cardiothoracic trauma at new trauma centre. Mhandu, P.; Chaubby, S.; Robb, D.; Uzzaman, M.; Khan, H.; Whitaker, D. // Journal of Cardiothoracic Surgery;2013, Vol. 8 Issue Suppl 1, p1 

    An abstract of the article "Trends of cardiothoracic trauma at new trauma centre" by P. Mhandu and colleagues are presented.

  • Prospective Evaluation of Early Follow-up Chest Radiography after Penetrating Thoracic Injury. Berg, Regan; Inaba, Kenji; Recinos, Gustavo; Barmparas, Galinos; Teixeira, Pedro; Georgiou, Chrysanthos; Shatz, David; Rhee, Peter; Demetriades, Demetrios // World Journal of Surgery;Jun2013, Vol. 37 Issue 6, p1286 

    Background: In asymptomatic patients with penetrating thoracic trauma and a normal initial chest x-ray, successive prospective trials have decreased the minimum observation period required for exclusion of significant injury from 6 to 3 h. Despite the quality of these studies, this interval...

  • Spinal cord infarction secondary to intervertebral foraminal disease. Ram, S.; Osman, A.; Cassar-Pullicino, V. N.; Short, D. J.; Masry, W. E. // Spinal Cord;Aug2004, Vol. 42 Issue 8, p481 

    STUDY DESIGN:: The 5 year review of patients referred to one center. OBJECTIVE:: To report spinal cord infarction secondary to vascular occlusion from disease in a lower thoracic intervertebral foramen. METHOD:: The clinical and imaging findings of two cases with acute spinal cord dysfunction...

  • "Acute Appendicitis" Secondary to Traumatic Dissecting Aneurysm of the Thoracic Aorta. Zuckerbraun, Lionel; Masters, Harold; Morgenstern, Leon // American Journal of Gastroenterology;Jan1968, Vol. 49 Issue 1, p71 

    The case of a 34-year old male who was operated upon for acute appendicitis, is retrospectively analyzed in light of the autopsy findings of a traumatic dissecting aneurysm of the thoracic aorta. Either due to a transient episode of hypotension or cardiac arrhythmia, the patient sustained a...

  • Iatrogenic Injury to the Long Thoracic Nerve: An Underestimated Cause of Morbidity after Cardiac Surgery. Bizzarri, Federico; Davoli, Giuseppe; Bouklas, Dimitri; Oricchio, Luca; Frati, Giacomo; Neri, Eugenio // Texas Heart Institute Journal;2001, Vol. 28 Issue 4, p315 

    Describes an incidence of iatrogenic injury to the long thoracic nerve following cardiac surgery. Background of the patient; Role of traumatic and non-traumatic events in the damage of the nerve; Importance of informed consent in any medical procedure.

  • Diagnosis of Thoracic Aorta Dissection. Crawford, Michael H. // Internal Medicine Alert;7/15/2011, Vol. 33 Issue 13, p98 

    The article presents a reprint of the article "Diagnosis of Thoracic Aorta Dissection," by Michael H. Crawford, which appeared in the July 2011 issue of "Clinical Cardiology Alert."

  • THORACIC TRAUMA--I. Westaby, Stephen; Brayley, Nigel // BMJ: British Medical Journal (International Edition);6/23/90, Vol. 300 Issue 6740, p1639 

    Focuses on issues concerning thoracic trauma. Mechanisms of blunt thoracic trauma; Enumeration of clinical predictors of major chest injuries; Presentation of radiologic features suggesting aortic rupture.

  • Remnant of a non-patent ductus arteriosus mimicking traumatic thoracic aorta transection: a case report. Apostolakis, Efstratios E.; Baikoussis, Nikolaos G.; Kalogeropoulou, Christina; Koletsis, Efstratios; Koniari, Ioanna; Karnabatidis, Dimitrios; Karanikolas, Menelaos // Journal of Cardiothoracic Surgery;2010, Vol. 5, p24 

    We present an interesting case of a 53-year-old man with a non-patent ductus arteriosus erroneously diagnosed as acute thoracic aorta transection after a car accident. The aortography revealed a "rupture" of the linear inner curve of the aorta in the isthmus area, as well as a protrusion of the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics