Original article: cardiovascularNatural history of traumatic rupture of the thoracic aorta managed nonoperatively: a longitudinal analysis
Section snippets
Material and methods
Patients admitted to Harborview Medical Center, a regional level I trauma center, between March 1985 and August 2000 with the diagnosis of TRA were identified by the trauma registry. Medical, operative, and all radiology records were reviewed. Injury Severity Score (ISS) and demographic data were also abstracted. Chest computed tomography (CT) scans and aortic angiograms were independently reviewed by one of the authors (RDB) who was blinded to outcomes. Injuries were radiographically graded as
Results
Over the approximately 16-year study period, 145 patients were admitted to Harborview Medical Center with TRA. Urgent operative repair was performed in 107, with 34 deaths (32%). Recognizing that this population was extremely heterogeneous, among patients who survived long enough to have a neurologic examination the incidence of paralysis was none of 48 when mechanical circulatory support was used and 7 of 34 when the “clamp-and-sew” technique was utilized. Endovascular stent grafts were used
Comment
In the past decade there has been a change in the philosophy of managing TRA with emphasis on blood pressure control and assessing the need for emergent repair against the risks of operation due to associated injuries or premorbid conditions [3]. Certain patients appear to be at acute risk of free rupture [16]. On the other hand concomitant injuries, in particular intraabdominal solid organ injuries associated with frank bleeding, often take precedence over the immediate repair of an aortic
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