Management of XXXX : a 30-year experience.

@entity1 @entity1755 @entity1410 @entity432 @entity2333 @entity451
OBJECTIVE: To present the authors' 30-year experience with @entity1755 ( @entity1755 ). SUMMARY BACKGROUND DATA: @entity1755 is a highly lethal injury. Most institutions manage a small number of cases, and most surgeons receive only modest exposure during training. METHODS: Between 1971 and 2001, the authors operated on 219 @entity1 with a diagnosis of @entity1755 . Diagnosis of @entity1755 since 1994 has been based exclusively on the use of contrast-enhanced spiral computed tomography, with angiography reserved for equivocal cases (periaortic mediastinal @entity1410 without @entity2333 ). @entity1 were divided according to surgical technique. Eighty-two @entity1 (group A) were operated on with a clamp-and-sew technique. Sixty-four @entity1 (group B) underwent surgery with the use of a passive shunt, and 73 @entity1 (group C) were treated using heparin-less partial cardiopulmonary bypass. RESULTS: Mortality was 18 @entity1 for group A (21.9%), 23 @entity1 for group B (35.9%), and 13 @entity1 for group C (17.8%) (P =.03). @entity451 occurred in 15 of 64 survivors in group A (23.4%), 7 of 41 survivors in group B (17%), and 0 of 60 survivors in group C ( P=.0005). @entity432 without lower body perfusion for longer than 30 minutes (P =.004) and surgical technique without lower body bypass support (P =.0005) were associated with @entity451 . CONCLUSIONS: Surgery for @entity1755 based on spiral computed tomography screening and diagnosis is reliable. The use of heparin-less distal cardiopulmonary bypass in the authors' hands is safe and is associated with a reduced incidence of @entity451 .
