[Traumatic isthmic ruptures of the aorta during the acute phase. Reevaluation of surgical treatment. Thoughts apropos of 47 cases].

From 1976 to 1989, 47 patients with traumatic aortic rupture in the area of the isthmus were seen in our institution; 4 patients died from exsanguination before definitive repair. Forty-three patients were operated on. Most of them (n: 41) underwent repair using partial bypass with pump oxygenator. There were 3 postoperative deaths. No patient developed postoperative paraplegia; 2 patients presented totally regressive spinal disturbances 5 and 8 days after surgery. Two of the 38 survivors were lost to follow-up. Postoperative angiography revealed an excellent aortic result in all cases especially in young patients, except two (1 stenosis, 1 aneurysm). Our experience and a review of the literature indicate some observations: despite rapid transport and evaluation, some patients died from exsanguination before definite repair. Cardiopulmonary bypass and correction of metabolic disturbances may decrease the probability of paraplegia and heparinisation did not increase the risk when orthopedic or abdominal lesions were treated before aortic lesion. Direct repair is recommended as the procedure of choice, especially in young patients, angiographic controls showed excellent results and long term follow-up is very satisfactory.