Surgery of the thoracic aorta can be divided into elective and emergency interventions. Emergency operations are usually for acute aortic dissection, but may also be for rupture of an atherosclerotic aneurysm. Occasionally, patients with traumatic transection survive to hospital and may be treated surgically. They often have associated injuries – particularly to the head, spine and abdomen – that may require prompt intervention. A thorough evaluation and multidisciplinary approach is therefore essential.

Preoperative management

Emergency aortic surgery patients are often received by the cardiothoracic critical care unit from the referring hospital before operation, so some preoperative critical care may be needed. Although there should not be any unnecessary delay in definitive therapy, those who reach a tertiary centre have already self-selected for immediate survival. A period of focused assessment and stabilization is beneficial as theatre staff and resources are coordinated. It is worthwhile to remember that every organ in the body derives its blood supply from the aorta, so that the injured aorta can place any organ at risk. This is especially true of acute aortic dissection where any organ system can be compromised at any time in the evolution of the condition.

A brief history should be obtained including symptoms, time since onset, past medical history, medication and allergies, if not previously documented. Recurrence or worsening of pain in a patient with dissection is suggestive of extension and potential rupture.