Surgical management of traumatic aortic disruption

Background Acute traumatic disruption of the descending thoracic aorta is a life-threatening injury that requires emergent operative intervention. From May 1988 to August 1996, 27 patients have undergone surgical repair at our institution. Methods Diagnosis of aortic disruption was confirmed in all patients by aortogram prior to aortic repair. A Gott shunt was used in 24 patients (89%) and partial femoral-femoral bypass in 1 patient (4%) for distal perfusion. A clamp-and-sew technique was used in 2 patients (7%). Results Mean aortic clamp time was 44 ± 3 minutes (range 22 to 80 minutes) in patients with distal perfusion via a Gott shunt. One patient (4%) died within 30 days of aortic repair due to multisystem organ failure. Paraplegia occurred in 1 patient (4%). Conclusions With a disciplined, diagnostic and surgical approach for patients with traumatic disruption of the descending thoracic aorta, it is possible to achieve excellent outcomes. The use of a Gott shunt is a simple and effective method for distal perfusion during the repair of traumatic aortic rupture.