Major mediastinal vascular injuries.

Surgical repair was carried out in 37 patients who had rupture of the thoracic aorta or major branches. The survival rate was 90% (33 of 37). Three deaths occurred in the acute phase, giving a survival rate of 87% (19 of 22). Two patients had severe coexisting brain trauma and the other had profuse intrathoracic hemorrhage before thoracotomy could be carried out. One death occurred in a chronic case (an arch aneurysm) for a survival rate of 94% (14 of 15). A massive air embolism to the brain caused this fatal outcome. There were no instances of left heart failure or renal shutdown in our series. One case of paraplegia occurred because a shunt was inserted erroneously in the distended adventitia from an enormous surrounding hematoma. The distal end of the shunt was not in the aortic lumen so there was no distal perfusion during the period of aortic clamping.