Use of sutureless intraluminal aortic prostheses in traumatic rupture of the aorta.

Despite wide acceptance of use of sutureless intraluminal prosthetic grafts in surgical management of acute and chronic aortic dissection, their use in traumatic aortic rupture appears not to have been specifically addressed. This report describes the use of intraluminal prostheses in two cases of aortic disruption due to blunt trauma. Aortic cross-clamp times were 21 and 28 minutes, respectively. Both patients have recovered without sequelae from their aortic injuries. Although not all traumatic aortic disruptions are suitable for repair with intraluminal prostheses, the ease and safety with which this device may be employed recommends consideration of their use in appropriate cases of traumatic rupture of the aorta.

Intravenous rupture of arteriosclerotic aneurysms of the abdominal aorta.

Intravenous rupture of abdominal aortic aneurysms occurs infrequently but should be considered with the coexistence of severe congestive failure, anasarca, and abdominal bruits. Six patients are presented with four survivors. In only two patients was the diagnosis considered preoperatively without angiography. Two were variants in that thrombus occluded the fistula, thereby negating findings usually manifested clinically. Diagnosis of this type can be made only during operation when copious venous bleeding ensues with evacuation of the aortic thrombus. Careful fluid management and prompt surgery are prerequisites to obtaining a successful outcome. Repair is accomplished easily by suturing the fistula from the aortic aspect, but care is required to avoid dislodgement of thrombus and atherosclerotic debris resulting in pulmonary embolism.