Use of Carmeda-Coated Femoral-Femoral Bypass During Repair of Traumatic Aortic Pseudoaneurysms

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Abstract
Objective: 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. Design: Retrospective series. Setting: A university-based, level 1 trauma center. Patients: Forty-two consecutive patients treated for posttraumatic aortic pseudoaneurysm whose mean (±SEM) Injury Severity Score was 37± 1.7. Intervention: Methods of repair included clamp and sew in nine patients, left heart bypass in 24 patients, and cardiopulmonary support in nine patients. Methods: 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. Results: 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. Conclusion: 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)