Graft replacement of post-traumatic thoracic aortic aneurysm: results without bypass or shunting.

From 1986 to 1991 13 cases of post-traumatic thoracic aneurysm were treated at our department. All patients had apparent thoracic injury at the time of trauma, and their mean age was 35 years. The mean time between trauma and operation was 3 years and six patients were asymptomatic. In all patients the diagnosis was made by computed tomography and angiography and all post-traumatic thoracic aneurysms were located at the aortic isthmus. No spinal cord protection by bypass or shunting was used during surgery and the clamp-and-repair method with a mean clamping time of 38 min was used in all 13 patients. No renal or neurological complications were observed postoperatively and there were no hospital deaths. The data of 202 patients who had been operated upon for post-traumatic thoracic aneurysms since 1981 have been reviewed with regard to the relationship between spinal cord protection and the incidence of postoperative paraplegia. Different methods of spinal cord protection were used in 121 patients resulting in paraplegia rate of 1.6%. In 81 patients the clamp-and-repair method was used and no case of paraplegia was observed in this group.