ORIGINAL ARTICLE Acute traumatic injury of the descending thoracic aorta: a limited experience Mohamed Abdel Hamied Regal & Yasser Ahmed El Ghoneimy & Samia El-Azab Received: 30 May 2010 / Revised: 21 December 2010 / Accepted: 28 December 2010 / Published online: 20 January 2011 # Indian Association of Cardiovascular-Thoracic Surgeons 2011 Abstract Background Blunt injury of the descending thoracic aorta, in the isthmus, is relatively common due to deceleration accidents. Although spinal cord injury has been a well- documented complication of the surgical management, the use of the direct clamp and sew technique with preservation of the intercostals reduces the risk against spinal cord injury. Methods From February 2005 to January 2010, fourteen patients with traumatic aortic injuries have been referred to us. They were all males with the mean age 29 years, range 22 to 34. Primary survey revealed associated injuries in all patients. Thirteen patients (92.85%) had the chance for immediate surgical management; one patient (7.1%) died during control of intra-abdominal life threatening bleeding. The 13 patients had been repaired by the direct clamp and sew technique, and the mean aortic cross clamp time was 35 min (range, 20–43 min). Results There was one death in the surgical group in the immediate postoperative period due to profound hypotension and reperfusion injury. There was a case of persistent small false aneurysm postoperatively. There was no paraplegia in the survived group. There was no 30-day mortality. Conclusions Spinal cord injury was avoided during the clamp and sew technique by the immediate surgical intervention, preservation of the intercostals and proper control of the blood pressure during application and removal of the aortic cross clamp. Keywords Traumatic . Aorta . Spinal cord Introduction Traumatic rupture of the thoracic aorta is a relatively common injury of deceleration accidents [1]. The arterial wall is damaged from inside to outside, from the intima towards the adventitia [2]. According to the literature the preferential site for aortic injuries is the aortic isthmus. After the aortic isthmus, the second most common location of aortic injuries is supravalvular part of the ascending aorta [2, 3]. These injuries were classified into three basic types: type I (intramural), type II (transmural) and type III (multiple) aortic ruptures [2]. It is associated with high mortality rates and great debate exists about the appropriate operative technique [4]. Endovascular approaches are becoming increasingly world- wide, but they are not available in all facilities. So one has to rely on open surgical techniques [5]. Although any of the several maneuvers may be appropriate in managing traumatic aortic injuries, the simple” clamp-sew technique” is a safe and effective method of treatment [4, 5]. Patients and methods This study is a retrospective one. Fourteen patients with acute traumatic injury of the descending thoracic aorta were diagnosed and referred to our team, between February 2005 and January 2010, for surgical intervention. M. A. H. Regal (*) : Y. A. El Ghoneimy Cardiothoracic Surgery Unit, King Fahd University Hospital, P. O. Box: 40233, Al-Khobar, Saudi Arabia 31952 e-mail: mohamedregal@yahoo.com Y. A. El Ghoneimy e-mail: yasser_farag@hotmail.com S. El-Azab Anaesthesia Department, King Fahd Specialist Hospital, Buridah, Kingdom of Saudi Arabia e-mail: samia87@hotmail.com Indian J Thorac Cardiovasc Surg (Jan–March 2011) 27:20–23 DOI 10.1007/s12055-010-0079-8