Operative Stress of Clamp-and-Sew Technique in Traumatic Aortic Rupture

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Traumatic aortic rupture, also called traumatic aortic damage or transection, is a condition in which, as a result of trauma to the body, the aorta, the main artery in the body, is broken or ruptured. The condition is often fatal because of the profuse bleeding caused by the rupture, Because the aorta branches directly from the heart to supply blood to the rest of the body, the pressure inside it is very high, and the blood in the blood vessel may be squeezed out of a tear very rapidly. That can cause shock and death quickly. Traumatic aortic rupture is thus a common killer in traffic crashes and other traumas

Symptoms Traumatic Aortic Rupture:

Symptoms are frequently inconsistent but include extreme chest pain; cough; dyspnea (shortness of breath); dysphagia (swallowing difficulty); back pain; and heaviness. Blood pressure in the upper body is normally elevated while in the lower body is low. The X-ray also shows a expanded mediastinum and a huge left hemothorax.

Traumatic damage of the aortic is treated with surgery. Morbidity and mortality rates for surgical aorta reconstruction for this condition are, however, among the highest in any cardiovascular surgery, For example, surgery is associated with a high paraplegia rate because the spinal cord is very vulnerable to ischemia (lack of blood supply), and the nerve tissue can be weakened or destroyed by blood supply interruption during surgery.

Untreated, approximately 30% of surviving patients admitted to a hospital for traumatic thoracic aortic injury (TTAI) die within the first 24 hr. Despite the increased use of restraint systems, the overall incidence of fatal vehicular crash associated TTAIs and diagnostic rates of aortic injury have begun to increase owing to the commercialization of computed tomography. For such a fatal damage, immediate operative repair used to be the rule. However, the use of cardiopulmonary bypass with a significant amount of heparin immediately after trauma can exacerbate other accompanying injuries. To reduce this risk, here we discuss our experience with performing traumatic aortic repair as early as possible using the clamp-and-sew technique but without administering intravenous heparin and initiating distal aortic perfusion

Surgical repair in our study required intubation with a double lumen endotracheal tube and placement of the patients in the left decubitus position. After exposing the site of aortic injury through an incision in the left third or fourth intercostal space and removing the accompanying hemothorax, the site of aortic injury was identified. The proximal aorta was clamped between the origin of the common carotid artery and Left Subclavian Artery (LSA), and the distal aorta was clamped more distal to the damaged aorta. Irrigation was performed with heparinized saline to reduce microvascular thrombosis event while manipulating the injured aorta. For saving time, primary closure with 4-0 prolene was ruled out for the injured aorta

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Editorial Team