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Between 1974 and 1989, 42 patients have been operated on at the Istituto di Chirurgia Generale e Cardiovascolare of University of Milan, for traumatic pathology of the thoracic aorta: in 14 cases it occurred an acute rupture at the level of aortic isthmus and in 28 cases a posttraumatic fals aneurysm. We had an operative mortality of 28% (4 cases) in the acute rupture: 3 patients died for neurological complications which were present at hospitalization. In one case appeared a serious ARDS. We had no surgical deaths in patients operated on for the posttraumatic false aneurysm. In 15 cases, the patients suffered for a postoperative paraplegia. Surgical indications are discussed, overall for the posttraumatic false aneurysms. The authors consider the advantage and the risks of the use of ECC and of total heparinization of the patients.

Extension into vena cava and right atrium of tumor thrombus from a renal cell carcinoma presents a surgical challenge. The use of cardiopulmonary by-pass, hypothermia and cardiac arrest with temporary exsanguination has allowed the successful surgical excision of this tumor. During 1986 and 1987 3 patients with cancer of kidney invading the vena cava were operated on with this surgical technique. No deaths occurred. The possibility of curing this type of cancer with minimal operative risk and good results is discussed.