Operation for chronic traumatic aortic aneurysm: when and how?

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.