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JOURNAL ARTICLE
MULTICENTER STUDY

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

T C Fabian, J D Richardson, M A Croce, J S Smith, G Rodman, P A Kearney, W Flynn, A L Ney, J B Cone, F A Luchette, D H Wisner, D J Scholten, B L Beaver, A K Conn, R Coscia, D B Hoyt, J A Morris, J D Harviel, A B Peitzman, R P Bynoe, D L Diamond, M Wall, J D Gates, J A Asensio, B L Enderson
Journal of Trauma 1997, 42 (3): 374-80; discussion 380-3
9095103

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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