Surgical management of hemorrhage from rupture of the aortic arch.

Details

Serval ID
serval:BIB_5840CEBC4F79
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Surgical management of hemorrhage from rupture of the aortic arch.
Journal
Annals of Thoracic Surgery
Author(s)
Prêtre R., Murith N., Delay D., Kalonji T.
ISSN
0003-4975
Publication state
Published
Issued date
1998
Peer-reviewed
Oui
Volume
65
Number
5
Pages
1291-1295
Language
english
Notes
Publication types: Journal Article
Abstract
BACKGROUND: Control of hemorrhage in patients with active bleeding from rupture of the aortic arch is difficult, because of the location of the bleeding and the impossibility of cross-clamping the aorta without interfering with cerebral perfusion. A precise and swift plan of management helped us salvage some patients and prompted us to review our experience. METHODS: Six patients with active bleeding of the aortic arch in the mediastinum and pericardial cavity (5 patients) or left pleural cavity (1 patient), treated between 1992 and 1996, were reviewed. Bleeding was reduced by keeping the mediastinum under local tension (3 patients) or by applying compression on the bleeding site (2 patients), or both (1 patient) while circulatory support, retransfusion of aspirated blood, and hypothermia were established. The diseased aortic arch was replaced during deep hypothermic circulatory arrest, which ranged from 25 to 40 minutes. In 3 patients, the brain was further protected by retrograde (2 patients) or antegrade (1 patient) cerebral perfusion. RESULTS: Hemorrhage from the aortic arch was controlled in all patients. Two patients died postoperatively, one of respiratory failure and the other of abdominal sepsis. Recovery of neurologic function was assessed and complete in all patients. The 4 survivors are well 8 to 49 months after operation. CONCLUSIONS: An approach relying on local tamponade to reduce bleeding, rapid establishment of circulatory support and hypothermia, retransfusion of aspirated blood, and swift repair of the aortic arch under circulatory arrest allows salvage of patients with active bleeding from an aortic arch rupture.
Keywords
Aged, Aged, 80 and over, Aneurysm, Dissecting, Aneurysm, False, Aortic Aneurysm, Thoracic, Aortic Rupture, Assisted Circulation, Blood Transfusion, Autologous, Cardiopulmonary Bypass, Cause of Death, Cerebrovascular Circulation, Follow-Up Studies, Heart Arrest, Induced, Hemorrhage, Hemothorax, Humans, Hypothermia, Induced, Male, Mediastinum, Middle Aged, Neurologic Examination, Pericardial Effusion, Pleural Effusion, Pressure, Respiratory Insufficiency, Retrospective Studies, Sepsis, Survival Rate, Time Factors
Pubmed
Web of science
Create date
28/01/2008 9:14
Last modification date
20/08/2019 14:12
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