scholarly journals Long-term intra-arterial shunt

2020 ◽  
Vol 5 (1) ◽  
pp. e000486 ◽  
Author(s):  
David V Feliciano
Keyword(s):  
Operating Room ◽  
Upper Extremity ◽  
Thoracic Aorta ◽  
Axillary Artery ◽  
Damage Control ◽  
Uneventful Recovery ◽  
Axillary Vein ◽  
Descending Thoracic Aorta ◽  
Resuscitative Thoracotomy ◽  
The Right

This is a case report of a patient who sustained a stab wound to the right axilla with injuries to the right axillary artery and vein. The patient had near-exsanguination in the field and no recordable blood pressure upon admission to the trauma center. Resuscitation was performed with endotracheal intubation, a left anterolateral resuscitative thoracotomy with cross-clamping of the descending thoracic aorta, and the rapid infusion of crystalloid solutions and packed red cells. In the operating room, the third portion of the right axillary artery and the adjacent right axillary vein were found to be transected. As part of a ‘damage control’ procedure, the ends of the right axillary vein were ligated. A 14 French intra-arterial shunt was inserted into the transected ends of the right axillary artery to restore the flow to the right upper extremity. The patient’s postoperative course was complicated by a coagulopathy, adult respiratory distress syndrome (ARDS), and anuria. The coagulopathy and anuria resolved within the first 48 hours, but the patient’s ARDS was slow to resolve. On the 10th postinjury day, the patient was returned to the operating room for a definitive repair of the right axillary artery. After the intra-arterial shunt was removed, a reversed greater saphenous vein graft was inserted between the ends of the right axillary artery in a medial intermuscular (extra-anatomic) tunnel. The patient made an uneventful recovery and was discharged home on the 16th postinjury day.The following principles of advanced trauma care were part of the management of this patient: (1) occasional need for resuscitative thoracotomy with cross-clamping of the descending thoracic aorta in a patient without a thoracic injury; (2) ‘damage control’ operation with ligation of the right axillary vein and placement of a temporary intra-arterial shunt to restore the flow to the right upper extremity; and (3) vascular reconstruction with an extra-anatomic bypass in a previously contaminated field.

Thoracic Endovascular Aortic Repair for Iatrogenic Injury of the Thoracic Aorta

2021 ◽  
pp. 152660282110659
Author(s):  
Peyton Tharp ◽  
Ryan W. King ◽  
Bruce M. Frankel ◽  
Mathew D. Wooster
Keyword(s):  
Thoracic Aorta ◽  
Pedicle Screws ◽  
Aortic Injury ◽  
Iatrogenic Injury ◽  
Descending Thoracic Aorta ◽  
Thoracic Pain ◽  
Spinal Reconstruction ◽  
Novel Approach ◽  
The Right ◽  
Scoliosis Deformity

Purpose: Address iatrogenic injury to the descending thoracic aorta by breached spinal screws through a novel approach of concomitant spinal screw removal and thoracic endovascular repair (TEVAR) placement. Case Report: A 36-year-old female with idiopathic scoliosis underwent T4 to L3 bilateral pedicle instrumentation with spinal fusion and correction of scoliosis deformity. Ten months post-operative, she continued to complain of mid-thoracic pain; computed tomography (CT) angiography revealed protrusion of the left T5 and T6 transpedicular screws into her descending thoracic aorta by 3 and 5 mm, respectively. She was taken to the odds ratio (OR) in a combination case with vascular and neurosurgery. Positioned in the right lateral decubitus position, TEVAR was successfully deployed while neurosurgery concurrently removed the invading spinal screws via posterior spinal exposure. Neurosurgery then completely revised the spinal hardware during the same operation. The patient progressed well throughout the remainder of her hospital stay and was discharged on postoperative day 4. Two-year angiography demonstrated a well-placed TEVAR with no extravasation or aortic abnormality. Conclusions: In the setting of iatrogenic aortic injury due to pedicle screws, concomitant TEVAR and spinal screw removal is a safe and feasible treatment option that allows for spinal reconstruction to occur without multiple trips to the operating room.

A congenital fistula between the descending aorta and the right pulmonary vein in a neonate presenting with heart failure

2007 ◽  
Vol 17 (5) ◽  
pp. 563-564 ◽  
Author(s):  
Suhair O. Shebani ◽  
Mohammad D. Khan ◽  
Magdi A. Tofeig
Keyword(s):  
Heart Failure ◽  
Pulmonary Vein ◽  
Thoracic Aorta ◽  
Cardiac Failure ◽  
Cardiac Catheterisation ◽  
Newborn Baby ◽  
Descending Thoracic Aorta ◽  
Descending Aorta ◽  
The Right ◽  
Congenital Fistula

AbstractWe report a large congenital fistula connecting the descending thoracic aorta to the right upper pulmonary vein in a newborn baby presenting on the seventh day of life with cardiac failure and a continuous murmur heard posteriorly. The fistula was detected echocardiographically, and shown at cardiac catheterisation not to be suitable for percutaneous occlusion. The anatomy of the fistula was confirmed at surgery, when it was ligated successfully.

Surgical Management of a Ballistic Trauma of the Right Ventricle and Descending Thoracic Aorta

2014 ◽  
Vol 28 (5) ◽  
pp. 1315.e1-1315.e4
Author(s):  
Caroline Carrières ◽  
Yannick Georg ◽  
Ismail Khelifa ◽  
Fabien Koskas
Keyword(s):  
Right Ventricle ◽  
Thoracic Aorta ◽  
Surgical Management ◽  
Descending Thoracic Aorta ◽  
The Right ◽  
Ballistic Trauma

scholarly journals 639 Emergency Surgical Approach to A Bleeding Pseudoaneurysm Of the Posterior Inferior Pancreaticoduodenal Artery After Failed Embolisation

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Manku ◽  
N Gupta ◽  
J Ahmad ◽  
E McLaughlin
Keyword(s):  
Damage Control ◽  
Uneventful Recovery ◽  
Visceral Artery ◽  
Emergency Laparotomy ◽  
Pancreaticoduodenal Artery ◽  
Surgical Access ◽  
Post Surgery ◽  
Four Quadrant ◽  
The Right ◽  
Abdominal Packing

Abstract Background Pseudoaneurysms of visceral arteries are uncommon, with a prevalence of 0.01% to 0.2%1. Initial treatment is radiological embolisation (RE)2. If this fails, surgical access to the pseudoaneurysm is extremely difficult. They are associated with major complications such as rupture, ischaemia and shock2, with a 20-70% mortality rate3. We report the case of a patient admitted with a life-threatening bleed from an aberrant inferior pancreaticoduodenal artery (IPDA) with failed RE. Case Summary A 44-year-old patient presented with right upper quadrant pain, shock and low haemoglobin. His computerised tomography (CT) scan showed a large retroperitoneal haematoma with active bleeding from a 5x6mm IPDA pseudoaneurysm. After resuscitation, access to the IPDA during RE via the coeliac axis and superior mesenteric artery was unsuccessful and he deteriorated. He underwent an emergency laparotomy, which showed the retro-peritoneal haematoma had ruptured into the peritoneal cavity through the transverse mesocolon. Four-quadrant abdominal packing and supra-coeliac manual compression of the aorta was utilised. The right colon was mobilised with full kocherisation of the duodenum. The gastrocolic omentum was divided to enter the lesser sac. The haematoma was evacuated and bleeding branches from the IPDA were suture ligated. He required 26 units of blood throughout admission and underwent 24-hour damage control laparostomy on intensive care. CT mesenteric angiogram post-surgery and re-look laparotomy showed no further active bleeds. He had an uneventful recovery and discharged safely. Conclusions RE of visceral artery pseudoaneurysms is challenging. Surgery remains the last resort and should be performed by appropriately trained specialist surgeons.

A Case of Takaysu Arteritis Associated with Complete Obstruction of Descending Thoracic Aorta and Stenosis of the Right Coronary Artery

1997 ◽  
Vol 27 (2) ◽  
pp. 213
Author(s):  
Hong Seung Kim ◽  
Ju Yong Lee ◽  
Byoung Soo Yoo ◽  
Seung Chan Ahn ◽  
Jung Han Yoon ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Thoracic Aorta ◽  
Right Coronary Artery ◽  
Descending Thoracic Aorta ◽  
Complete Obstruction ◽  
The Right

Arteriosclerotic Aneurysm of the Descending Thoracic Aorta Presenting to the Right of the Spine

Radiology ◽  
1949 ◽  
Vol 53 (1) ◽  
pp. 93-96 ◽  
Author(s):  
Bernard S. Epstein ◽  
Robert L. Friedman
Keyword(s):  
Thoracic Aorta ◽  
Descending Thoracic Aorta ◽  
The Right

Changes in Coronary Flow Reserve following Stent Implantation in the Swine Descending Thoracic Aorta

2007 ◽  
Vol 14 (4) ◽  
pp. 544-550 ◽  
Author(s):  
Achilles A. Zacharoulis ◽  
Sophia M. Arapi ◽  
George A. Lazaros ◽  
Apostolos I. Karavidas ◽  
Apostolos A. Zacharoulis
Keyword(s):  
Thoracic Aorta ◽  
Coronary Flow Reserve ◽  
Stent Implantation ◽  
Coronary Flow ◽  
Aortic Diameter ◽  
Descending Thoracic Aorta ◽  
Stent Deployment ◽  
Flow Reserve ◽  
The Mean ◽  
The Right

Purpose: To evaluate coronary flow reserve (CFR) changes following stent implantation in the descending thoracic aorta (DTA) of a porcine model. Methods: Six pigs (3 males; 40 to 44 kg) were anesthetized and kept on mechanical ventilation. A 6-F guiding right Judkins catheter was advanced under fluoroscopy to the right coronary artery, and a pressure wire with a temperature sensor was placed within the vessel lumen at a distance of 4 cm from the ostium. CFR was estimated by the thermodilution method before and after maximal coronary vasodilation with 20 mg of intracoronary papaverine. Aortography was also performed to measure aortic diameter. Subsequently, a self-expanding vascular stent was deployed into the DTA just below the left subclavian artery (LSA), and CFR was measured again. All animals were maintained for 3 weeks; at the end of this period, a further CFR was calculated using the same procedure. Results: The mean aortic diameter below the LSA was 12.15±0.15 mm. Following stent deployment, the mean aortic diameter measured at the stented segment was 12.58±0.11 (p=0.001 versus baseline). The mean CFR value was 4.7062.00 before stent implantation, 2.6860.86 immediately after, and 4.0561.15 at 3 weeks after stenting. Accordingly, CFR values were significantly depressed immediately after stent placement compared with baseline (p=0.027). However, CFR values obtained 3 weeks following stent deployment were similar to the initial values (p=0.59). Conclusion: Stent deployment in the normal swine DTA produces a significant immediate decrease in CFR, which is attenuated 3 weeks later. The clinical impact of CFR changes following DTA endografting remain to be elucidated.

scholarly journals Endovascular treatment of the rupture of thoracic aortic aneurysm, manifested by a neurological «mask»

2021 ◽  
Vol 179 (6) ◽  
pp. 66-71
Author(s):  
A. N. Ryazanov ◽  
V. V. Soroka ◽  
S. P. Nokhrin ◽  
D. V. Kandyba ◽  
S. A. Platonov ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Pleural Cavity ◽  
Descending Thoracic Aorta ◽  
Suspected Pulmonary Embolism ◽  
Spiral Computed ◽  
Satisfactory Condition ◽  
Endovascular Methods ◽  
The Right

The article describes a case of successful treatment of the rupture of aortic aneurysm by the endovascular method. Patient P., 71 years old, was hospitalized in a multidisciplinary hospital with a diagnosis of acute cerebral circulation disorder. The patient was examined in the intensive care unit. Signs of neurological symptoms regressed. Spiral computed tomography of the chest organs was performed with suspected pulmonary embolism, the results of which revealed an aneurysm of the descending thoracic aorta, complicated by a rupture with the formation of a right-sided hemothorax. The patient underwent endoprosthesis of the thoracic aorta with stent graft. After 2 days, thoracoscopic sanitation, drainage of the right pleural cavity was performed. The postoperative period proceeded without peculiarities. The patient was discharged on the 12th day in satisfactory condition. At control examination in 1, 6, 12 months, the long-term steady positive result was noted. Endovascular methods minimize the risk of postoperative complications, contributing to a favorable outcome of the disease.

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