Operation for chronic traumatic aortic aneurysm: when and how?

Abstract

Background: There are few guidelines for surgical intervention late after unoperated traumatic aortic rupture. We reviewed our experience and the literature to determine when and how to operate.

Methods: Between 1987 and 1997, we treated 9 patients aged 22 to 82 years with chronic traumatic aneurysm. Seven patients underwent aneurysm resection. Two patients have not been operated on. The injury-to-operation interval ranged from 8 weeks to 18 years (mean, 4.1 years). One patient underwent median sternotomy and patch repair during hypothermic circulatory arrest. Six patients underwent left thoracotomy: 2 were operated on with left atrio-femoral bypass, and 4 with hypothermic circulatory arrest and ascending aortic cannulation.

Results: There was no surgical mortality or morbidity. The 2 patients who were not operated on remained asymptomatic without radiologic change in the aneurysm after follow-up of 2 and 9 years.

Conclusions: From this limited experience and literature review, we make the following subjective observations: (1) all patients with new symptoms should be operated on promptly, and (2) asymptomatic densely calcified aneurysms detected more than 2 years after the accident can be observed by repeated tomography unless new symptoms arise.