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https://www.readbyqxmd.com/read/28893706/hypertension-acute-stent-thrombosis-and-paraplegia-6-months-after-tevar-for-blunt-thoracic-aortic-injury-in-a-22-year-old-patient
#1
O Martinelli, F Faccenna, A Malaj, J Jabbour, S Venosi, R Gattuso, B Gossetti, L Irace
TEVAR is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year old male was admitted to the Emergency Department following a high-impact road traffic collision. Whole body CT scan documented multiple injuries, including rupture of descending thoracic aorta just below the isthmus. There was no evidence of paraplegia or stroke. We decided to treat him in an endovascular fashion with a Zenith Cook (Cook Incorporated, Bloomington, IN) endograft...
September 8, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28733569/a-case-of-missed-blunt-traumatic-aortic-injury-btai
#2
N M Nik Azlan, H Rossman
We are reporting a case of missed blunt traumatic aortic injury (BTAI). A 28 year male presented with chest pain following a motor vehicle accident. He was discharged following normal clinical signs and chest radiograph. The following day he complained of lower limb weakness. Traumatic aortic dissection was revealed via computer tomography (CT) of the thorax. BTAI cannot be ruled out with normal clinical signs and chest radiograph alone. CT thorax is mandatory to rule out BTAI in high impact chest injury.
June 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28640779/nonoperative-management-rather-than-endovascular-repair-may-be-safe-for-grade-ii-blunt-traumatic-aortic-injuries-an-eleven-year-retrospective-analysis
#3
Stephen M Spencer, Karen Safcsak, Chadwick P Smith, Michael L Cheatham, Indermeet S Bhullar
BACKGROUND: The Society of Vascular Surgery (SVS) guidelines currently suggest thoracic endovascular aortic repair (TEVAR) for grade II-IV and non-operative management (NOM) for grade I blunt traumatic aortic injury (BTAI). However, there is increasing evidence that grade II may also be observed safely. The purpose of this study was to compare the outcome of TEVAR and NOM for grade I-IV BTAI and determine if grade II can be safely observed with NOM. METHODS: The records of patients with BTAI from 2004 to 2015 at a Level I trauma center were retrospectively reviewed...
June 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28538630/the-evolution-of-care-improves-outcome-in-blunt-thoracic-aortic-injury-a-western-trauma-association-multicenter-study
#4
Steven R Shackford, Casey E Dunne, Riyad Karmy-Jones, William Long, Desarom Teso, Martin A Schreiber, Justin Watson, Cheri Watson, Robert C McIntyre, Lisa Ferrigno, Mark L Shapiro, Kevin Southerland, Julie A Dunn, Paul Reckard, Thomas M Scalea, Megan Brenner, William A Teeter
BACKGROUND: The management of blunt thoracic aortic injury (BTAI) has evolved radically in the last decade with changes in the processes of care and the introduction of thoracic endovascular repair (TEVAR). These changes have wrought improved outcome, but the direct effect of TEVAR on outcome remains in question as previous studies have lacked vigorous risk adjustment and long-term follow-up. To address these knowledge gaps, we compared the outcomes of TEVAR, open surgical repair, and nonoperative management for BTAI...
May 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28390914/thoracic-endovascular-repair-of-blunt-thoracic-aortic-injury-in-the-setting-of-an-aberrant-right-subclavian-artery
#5
Donald G Harris, Michael E Huffner, Luqman Croal-Abrahams, Laura DiChiacchio, Behzad S Farivar, Joseph D Ayers, Shahab Toursavadkohi, Joseph Rabin, Robert S Crawford
Blunt thoracic aortic injury (BTAI) in a patient with an aberrant right subclavian artery (ARSA) presents unique challenges for patient management and aortic repair. Specific considerations include the need to treat coincidental ARSA, subclavian revascularization, and ARSA exclusion. Despite the rise of endovascular repair as the primary modality for aortic repair for BTAI, reports of this technique in the setting of ARSA are limited. Here we describe 3 patients with ARSA who underwent TEVAR for BTAI, and discuss critical management and technical issues in these patients...
April 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28389290/symptomatic-intragraft-thrombus-following-endovascular-repair-of-blunt-thoracic-aortic-injury
#6
Sherwin Abdoli, Sung Wan Ham, Alison G Wilcox, Fernando Fleischman, Lydia Lam
Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis...
April 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28346475/treatment-of-blunt-thoracic-aortic-injury-in-germany-assessment-of-the-traumaregister-dgu%C3%A2
#7
Alexander Gombert, Mohammad E Barbati, Martin Storck, Drosos Kotelis, Paula Keschenau, Hans-Christoph Pape, Hagen Andruszkow, Rolf Lefering, Frank Hildebrand, Andreas Greiner, Michael J Jacobs, Jochen Grommes
PURPOSE: Using the data delivered by the German Trauma Register DGU® from 2002 till 2013, the value of different therapies of blunt thoracic aortic injury (BTAI) in Germany was analyzed. METHODS: Prospectively collected data of patients suffering from BTAI were retrospectively analyzed with focus on the different treatment modalities for grade I-IV injuries. RESULTS: 821 patients suffering from BTAI were identified: 51.6% (424) grade I injury, 35...
2017: PloS One
https://www.readbyqxmd.com/read/27903474/functional-assessment-and-evaluation-of-outcome-after-endovascular-therapy-with-coverage-of-the-left-subclavian-artery-in-case-of-blunt-thoracic-aortic-injury
#8
Alexander Gombert, Drosos Kotelis, Ulrike M Griepenkerl, Gustav Fraedrich, Josef Klocker, Bernhard Glodny, Michael J Jacobs, Andreas Greiner, Jochen Grommes
BACKGROUND: Patients suffering blunt thoracic aortic injury (BTAI) can be treated by use of thoracic endovascular aortic repair (TEVAR). In this setting, the coverage of the left subclavian artery (LSA) is frequently necessary. Nevertheless, the functionality of the upper left extremity after TEVAR had been rarely analyzed. Thus, this study intends to underline the safety of TEVAR as well as to determine the functionality of the left arm after coverage of the LSA. METHODS: All patients suffering from BTAI treated by endovascular means in 3 centers (Aachen [Germany], Maastricht [Netherlands], and Innsbruck [Austria]) between 1996 and 2009 were retrospectively analyzed...
November 27, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27890837/association-between-prehospital-time-and-mortality-following-blunt-thoracic-aortic-injuries
#9
Biniam Kidane, Vaibhav Gupta, Mostafa El-Beheiry, Kelly Vogt, Neil G Parry, Richard Malthaner, Thomas L Forbes
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) can be lethal, but advances in trauma systems and surgical care have helped reduce mortality. The purpose of this study is to investigate whether time from injury to presentation is associated with mortality following BTAI. METHODS: Using the Ontario Trauma Registry, all patients were identified who were hospitalized with BTAI between 1999 and 2009. Variables including age, sex, Injury Severity Score, Charlson comorbidity index, systolic blood pressure on admission, operative intervention, and time from injury to presentation were analyzed using multivariate logistic regression to determine independent predictors of mortality...
May 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27572614/when-and-how-should-we-manage-thoracic-aortic-injuries-in-the-modern-era
#10
REVIEW
Benjamin Bottet, François Bouchard, Christophe Peillon, Jean-Marc Baste
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was what are the optimum treatment modality and timing of intervention for blunt thoracic aortic injury (BTAI) in the modern era? Of the 697 papers found using the reported search, 14 (5 meta-analyses, 2 prospective and 7 retrospective studies) represented the best evidence to answer the clinical question. The author, journal, country, date of publication, patient group studied, study type, relevant outcomes, results and weakness of these papers are tabulated...
December 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27461999/nonoperative-management-of-grade-iii-blunt-thoracic-aortic-injuries
#11
COMPARATIVE STUDY
Sagar S Gandhi, Joseph V Blas, Stewart Lee, John F Eidt, Christopher G Carsten
OBJECTIVE: Blunt thoracic aortic injuries (BTAIs) have historically been treated with open surgery; thoracic endovascular aortic repair (TEVAR), however, is rapidly becoming the standard of care for all grades of injury. Previous studies have shown successful, conservative management of low-grade (I and II) BTAI, but limited literature exists regarding nonoperative management (NOM) for high-grade BTAI. The purpose of this study was to evaluate NOM for grade III BTAI compared with TEVAR...
December 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27263820/nonoperative-management-of-traumatic-aortic-pseudoaneurysms
#12
REVIEW
Donald G Harris, Joseph Rabin, Abhishek Bhardwaj, Angelina S June, Connor P Oates, Danon Garrido, Shahab Toursavadkohi, Ali Khoynezhad, Robert S Crawford
BACKGROUND: Current blunt thoracic aortic injury (BTAI) guidelines recommend early repair of traumatic pseudoaneurysms (PSAs) due to risk for subsequent aortic rupture. Recent analyses indicate that early repair is required only in the setting of high-risk features, while delayed repair is safe and associated with lower morbidity and mortality in appropriately selected patients. To evaluate the appropriate indications for nonoperative management (NOM) of traumatic PSAs, we performed a systematic review of studies reporting outcomes for this management strategy...
August 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27241160/aortic-intimal-separation-resulting-from-manual-cardiopulmonary-resuscitation-completing-the-spectrum-of-blunt-thoracic-aortic-injury-complicating-cpr
#13
Andrew S Williams, Mathieu Castonguay, Shawn K Murray
Blunt thoracic aortic injury (BTAI) resulting from cardiopulmonary resuscitation (CPR) is rarely reported and most reports are of aortic rupture. Clinical reports have also documented aortic dissection and intramural hematomas with sequential imaging showing the development of these aortic injuries after the administration of CPR, suggesting that non-transmural aortic injury may also result from CPR. We report partial separation of an aortic intimal atheromatous plaque as a component injury in a case with multiple complications of manual CPR...
November 2016: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/27221382/evolution-of-lesion-specific-management-of-blunt-thoracic-aortic-injury
#14
REVIEW
Donald G Harris, Joseph Rabin, Benjamin W Starnes, Ali Khoynezhad, R Gregory Conway, Bradley S Taylor, Shahab Toursavadkohi, Robert S Crawford
Developments in diagnosis and treatment have transformed the management of blunt thoracic aortic injuries (BTAIs). For patients in stable condition, treatment practice has shifted from early open repair to nonoperative management for low-grade lesions and routine delayed endovascular repair for more significant injuries. However, effective therapy depends on accurate staging of injury grade and stability to select patients for appropriate management. Recent developments in BTAI risk stratification enable lesion-specific management tailored to the patient and aortic lesion...
August 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/26965820/blunt-thoracic-aortic-injury-in-case-of-a-15-year-old-boy-difficulties-and-possibilities-of-the-endovascular-approach
#15
Alexander Gombert, Mohammad Esmaeil Barbati, Jochen Grommes, Houman Jalaie, Karina Schleimer, Michael J Jacobs, Johannes Kalder
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) are rare but life threatening. Most BTAI are caused by high-energy trauma. Among children with blunt trauma, the incidence of BTAI is below 1 percent. The present case deals with covered thoracic aortic rupture of a 15-year-old boy. Emphasizing the value and the difficulties of endovascular surgery in children is the motivation for this case report. CASE REPORT: We are presenting the case of a 15-year-old boy, who suffered multiple traumata after accident...
May 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/26926941/injury-grade-is-a-predictor-of-aortic-related-death-among-patients-with-blunt-thoracic-aortic-injury
#16
Gerald R Fortuna, Alexa Perlick, Joseph J DuBose, Samuel S Leake, Kristofer M Charlton-Ouw, Charles C Miller, Anthony L Estrera, Ali Azizzadeh
OBJECTIVE: The current Society for Vascular Surgery Clinical Practice Guidelines suggest urgent (<24 hours) thoracic endovascular aortic repair for grade (G) II to G IV blunt thoracic aortic injuries (BTAIs). The purpose of this study was to determine whether some patients may require more emergency treatment. METHODS: We reviewed imaging variables of prospectively collected BTAI patients between 1999 and 2014. We used computed tomographic angiography to classify BTAIs into four categories: G I, intimal tear; G II, intramural hematoma; G III, aortic pseudoaneurysm; and G IV, free rupture...
May 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/26506935/blunt-thoracic-aortic-injury-with-small-pseudoaneurysm-may-be-managed-by-nonoperative-treatment
#17
Shinsuke Tanizaki, Shigenobu Maeda, Hideyuki Matano, Makoto Sera, Hideya Nagai, Taizo Nakanishi, Hiroshi Ishida
OBJECTIVE: The efficacy of nonoperative management of blunt thoracic aortic injury (BTAI) was evaluated in patients with pseudoaneurysm. METHODS: A retrospective review was done for patients with BTAI at Fukui Prefectural Hospital during a 9-year period. Charts were reviewed for age, gender, Injury Severity Score, Abbreviated Injury Scale for each body area, initial type of aortic injury, site of aortic injury, type of definitive management, complications, and outcomes...
February 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/26489109/lessons-learned-from-the-endovascular-management-of-blunt-thoracic-aortic-injuries-a-single-centre-experience
#18
J Pillai, C Yazicioglu, T Monareng, T B Rangaka, R Jayakrishnan, M G Veller
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) remain a leading cause of death after blunt trauma. In severe injuries, thoracic endovascular aortic repair (TEVAR) has provided a less invasive alternative to conventional open repair. OBJECTIVE: To report the TEVAR-related complications and uncertainties in patients who presented with traumatic pseudoaneurysms (grade III BTAI). METHODS: From April 2004 to February 2012, 55 patients (42 male, mean age 34...
March 2015: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/26449602/aorto-internal-iliac-artery-endovascular-reconstruction-for-critical-limb-ischaemia-a-case-report
#19
Jayandiran Pillai, Taalib Monareng, Thomas B Rangaka, Ceyhan Yazicioglu, Raj Jayakrishnan, Martin G Veller
The internal iliac artery and cruciate anastomosis are important collateral vessels in severe aortoiliac occlusive disease. This report describes a patient with left leg rest pain due to occlusion of the left common and external iliac arteries. In addition, there was a high-grade stenosis of the right common iliac artery. Direct catheter canulation of the left internal iliac artery revealed that it was patent. Endovascular stent placement was successful in re-establishing blood flow into the left internal iliac artery...
March 2015: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/26407315/thoracic-endovascular-repair-tevar-versus-open-surgery-for-blunt-traumatic-thoracic-aortic-injury
#20
REVIEW
Dominic Pang, Diane Hildebrand, Paul Bachoo
BACKGROUND: Blunt traumatic thoracic aortic injury (BTAI) is a life-threatening surgical emergency associated with mortality up to 8000 per year, most commonly caused by rapid acceleration/deceleration injury sustained through motor vehicle accident and/or blunt thoracic trauma. BTAI has high pre-hospital mortality following the primary injury, with only 10% to 15% of patients surviving long enough to reach the hospital. Open surgical repair had remained the standard treatment option for BTAI since successfully introduced in 1959...
September 25, 2015: Cochrane Database of Systematic Reviews
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