To compare the results and outcomes of three different approaches to posttraumatic pseudoaneurysm repair: clamp and sew, left heart bypass, and the most recent approach, cardiopulmonary support using femoral-femoral bypass.
A university-based, level 1 trauma center.
Forty-two consecutive patients treated for posttraumatic aortic pseudoaneurysm whose mean (±SEM) Injury Severity Score was 37± 1.7.
Methods of repair included clamp and sew in nine patients, left heart bypass in 24 patients, and cardiopulmonary support in nine patients.
Student's t test was used to compare intraoperative blood loss, need for blood transfusion, and aortic cross-clamp time. Complications and mortality were also reviewed.
Mean (±SEM) aortic cross-clamp time for clamp and sew was 28.1±3.3 minutes vs 52.5±3.7 for left heart bypass and 49.3±5.6 for cardiopulmonary support. Blood loss and the need for transfusion were comparable between groups. Complications were also comparable.
Femoral-femoral cardiopulmonary support is safe to use, has a very low risk of complications, and should provide protection for the spinal cord during aortic repair. We encourage a randomized prospective trial to determine if cardiopulmonary support has a significantly lower rate of paraplegia than the clamp-and-sew technique.(Arch Surg. 1994;129:933-939)