| Abstract
| - The appropriate management of traumatic aortic rupture is oftendifficult to determine, particularly if the rupture is associated withsevere additional lesions. Between 1986 and 1991, ten consecutive patientswith acute traumatic rupture of the thoracic aorta (ATRTA) and concomitantinjuries were initially treated medically and submitted to delayed aorticrepair. Within the same period no other patient had emergencyreconstruction of the thoracic aorta. Diagnosis of ATRTA was establishedimmediately after admission in eight patients. Five patients underwentemergency surgery for severe concomitant injuries. With regard to theaortic lesion, all patients were managed medically and submitted topharmacological treatment in an attempt to reduce cardiac shear forces.None of the patients developed clinical signs of imminent free rupturewhile waiting for aortic surgery. In the absence of a significanthemothorax and when no coarctation syndrome is evident, the risk of freeaortic rupture is considered to be rather low if the patient reaches thehospital in a stable circulatory condition. Postponement of aorticreconstruction is particularly indicated when severe concomitant lesionspreclude safe immediate repair of the aortic tear. Following the patient'srecovery from associated major injury, aortic surgery can be performed as alow risk procedure using cardiopulmonary bypass which is recognised as themost effective technique to prevent spinal cord ischemia and to reduce therisk of paraplegia.
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