Improving Surveillance of Traumatic Thoracic Aortic Injuries Repaired with Thoracic Endovascular Graft Placement

2018 ◽  
Vol 84 (7) ◽  
pp. 1129-1132
Author(s):  
Nathan A. Ludwig ◽  
Neal Bhutiani ◽  
Paul L. Linsky ◽  
Amit J. Dwivedi ◽  
Matthew C. Bozeman
Keyword(s):  
Injury Severity ◽  
Vascular Complications ◽  
Aortic Injury ◽  
Late Complications ◽  
Thoracic Aortic Injury ◽  
University Of Louisville ◽  
Long Term Follow Up ◽  
Aortic Injuries

The optimal follow-up protocol for patients undergoing thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury remains unclear. The objective of this study was to assess follow-up patterns in such patients and present an approach to improve long-term follow-up in this cohort. The University of Louisville Trauma Registry was queried for patients who underwent TEVAR for traumatic thoracic aortic injuries between 2006 and 2016. Demographic, injury-specific, perioperative, and outcome measures were recorded for each patient. Follow-up evaluation and duration of follow-up were captured. Follow-up imaging was reviewed for any evidence of vascular complications. A total of 56 patients underwent TEVAR for traumatic thoracic aortic injury. Median age was 48 (range 18–86). Injury mechanism was largely blunt trauma (55 (98%)). Median injury severity score was 34 (range 17–43). Median length of stay was 12.5 days (range 1–40 days), and 51 patients (91%) survived to discharge. Of these, 30 (54%) made at least one follow-up appointment, and 21 of those 30 (70%) received a follow-up CT scan. Median time to last follow-up was one month (range 0–48 months), with 12 patients (21%) having follow-up beyond two months. No patients demonstrated any evidence of vascular complications on imaging at last follow-up. Despite the increased use of TEVAR to treat traumatic aortic injuries, limited follow-up data exist to predict the long-term outcomes of such interventions. Development of statewide or regional databases may help better track outcomes and identify late complications.

The effect of TEVAR for blunt traumatic thoracic aortic injury on maximal aortic diameter: Mid- and long-term outcome

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 411-416
Author(s):  
Hozan Mufty ◽  
Geert Maleux ◽  
Sabrina Houthoofd ◽  
Sandra A Cornelissen ◽  
Kim Daenens ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Aortic Injury ◽  
Aortic Diameter ◽  
Preoperative Imaging ◽  
Long Term Outcome ◽  
Thoracic Aortic Injury ◽  
Long Term Follow Up

Objective Thoracic endovascular aortic repair (TEVAR) has become the standard of care for blunt thoracic aortic injury (BTAI). Long-term effects of TEVAR on the aortic diameter are not well studied. This study evaluates the effect of TEVAR for BTAI on the aortic diameter in mid- and long-term follow-up. Methods All patients treated with TEVAR for BTAI between August 2000 and May 2016 were included. Maximum aortic diameter was measured at four predetermined thoracic aortic levels in the preoperative and first postoperative CT angiography (CTa) and in the last control CTa or MR angiography: 1 cm proximal (D1) and 1 cm distal to the left subclavian artery (D2), 3 cm distal to the left subclavian artery (D3) and 3 cm proximal to the celiac trunk (D4). Results A total of 27 patients (20 men, mean age 40 years (±17.55) were included. Mean follow-up time was 90 months (±48.36)). No re-interventions were needed. Mean growth of aortic diameter at level D1, D2, D3 and D4 was 0.22 mm ± 3.66, 1.79 mm ± 3.82, 0.73 mm ± 4.18 and –1.06 mm ± 2.82, respectively, when comparing last follow-up to the preoperative imaging without any statistical significant differences. When comparing the preoperative diameter with the first postoperative CT, only a statistical significant growth of 2.81 mm ± 2.69 was seen at level of D2 ( p < 0.05) Conclusion During mid- to long-term follow-up, a temporary significant increase of the maximum aortic diameter was seen at level D2 in the direct postoperative phase This increase was not associated with clinical events and suggests long-term efficacy of TEVAR after BTAI.

Early- and long-term results of thoracic endovascular aortic repair for blunt traumatic thoracic aortic injury: a single-centre experience†

2019 ◽  
Vol 56 (2) ◽  
pp. 307-312
Author(s):  
Daisuke Kaneyuki ◽  
Toshihisa Asakura ◽  
Atsushi Iguchi ◽  
Akihiro Yoshitake ◽  
Chiho Tokunaga ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Injury ◽  
Long Term Results ◽  
Technical Success Rate ◽  
Thoracic Aortic Injury ◽  
Cord Injury ◽  
Long Term Follow Up

Abstract OBJECTIVES Endovascular repair has been proposed as an alternative to classical surgical repair for the management of blunt traumatic thoracic aortic injury. However, the long-term outcomes of endovascular repair and the risks of left subclavian coverage remain unclear. METHODS From April 2001 to August 2018, 33 patients with blunt traumatic thoracic aortic injury underwent endovascular repair in our institution. A follow-up computed tomography and a clinical examination were performed before discharge and at 1 month, and yearly or every 2 years thereafter. RESULTS The mean age was 45 ± 19 years. The technical success rate was 100%. Complete coverage of the left subclavian artery (LSCA) was performed in 20 patients (60.6%). Among 20 patients with coverage of the LSCA, revascularization was performed in 1 patient. No in-hospital deaths occurred. The clinical follow-up rate was 97%, with a mean period of 7 years and a maximum of 18 years. The survival rates were 100% at 1 year, 95% at 5 years and 88.7% at 10 years after the event. Among the 5 patients (20%) who developed neurological complications, 1 who had undergone implantation of a 200-mm long stent graft and LSCA coverage without revascularization developed paraplegia during the long-term follow-up. CONCLUSIONS This study demonstrates that the endovascular treatment of blunt traumatic thoracic aortic injury is a safe and effective therapeutic method over a long-term follow-up period. LSCA coverage and long stent graft placement might be indications for revascularization to prevent spinal cord injury.

Abstract 165: Pial Synangiosis in Patients with Moyamoya less than 2 Years of Age

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Eric M Jackson ◽  
Ning Lin ◽  
Lissa Baird ◽  
R. Michael Scott ◽  
Edward R Smith
Keyword(s):  
Late Complications ◽  
High Risk Population ◽  
Consecutive Series ◽  
Ischemic Change ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Progression Of Disease ◽  
Long Term Prognosis

Introduction: Moyamoya patients under two years of age represent a therapeutic challenge because of their frequent neurologic instability and concomitant anesthetic risks. We report our experience with pial synangiosis revascularization in this population. Methods: We reviewed the clinical and radiographic records of all patients with moyamoya syndrome in a consecutive series of patients under 2 years of age, who underwent cerebral revascularization surgery using pial synangiosis at a single institution. Results: During a 12-year period (1994-2005), thirty-four procedures (15 bilateral, 4 unilateral) were performed in 19 patients under two years of age (out of a total of 456 procedures in 240 patients). Eighteen of these patients presented with either stroke or TIA. Average age at first surgery was 1.4 years (range 6 months to 1.9 years). Unanticipated staged operations occurred in three patients, two due to persistent EEG changes during the initial surgery and one due to brain swelling during the procedure requiring ventriculostomy. There were two perioperative strokes; both patients had post-operative seizures but made clinical recoveries. The average follow-up was 7 years (range 1-14). In long term follow-up, 13 patients (68%) were clinically independent for their age, with 8 (42%) having no significant deficit. Late complications included subdural hygroma evacuation (1), additional revascularization procedures years later for frontal lobe ischemia (2), late infarction (1) and asymptomatic ischemic change on routine follow-up MRI studies (1). All patients who had both pre and post-operative angiography demonstrated progression of disease. Conclusions: Despite the challenges inherent to this population, the majority of children with moyamoya under 2 years of age have a good long-term prognosis. Our data support the use of pial synangiosis as a safe, effective and durable method for treatment of moyamoya for most children in this potentially high-risk population.

The Evaluation of Aortic Diameter Changes During Long-Term Follow-Up After Endovascular Treatment of Acute Blunt Traumatic Thoracic Aortic Injuries

2018 ◽  
Vol 52 (5) ◽  
pp. 335-343 ◽  
Author(s):  
Federico Fontana ◽  
Edoardo Macchi ◽  
Filippo Piacentino ◽  
Larissa Nocchi Cardim ◽  
Giuseppe De Marchi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Mean Value ◽  
Aortic Diameter ◽  
Long Term Results ◽  
Technical Success ◽  
Long Term Follow Up ◽  
Aortic Injuries

Purpose: To evaluate the variations in aortic diameters and long-term results in patients who underwent thoracic endovascular aortic repair (TEVAR) for acute blunt traumatic thoracic aortic injuries (BTTAIs). Materials and Methods: We retrospectively evaluated 23 patients with a mean age of 39 years (range: 17-74 years) who underwent TEVAR for BTTAI between October 2000 and November 2014. All of the patients underwent computed tomography angiography (CTA) before hospital discharge as a baseline imaging for the subsequent follow-up examinations. The technical success, overall survival, and complications were evaluated. Furthermore, the aortic diameters outside of the stent-graft (1 cm proximal and 1 cm distal to the stent-graft) and the aortic diameters within the stent-graft (2 cm distal to the proximal end and 2 cm proximal to the distal end) were assessed. The diameters at baseline on CTA were compared with those of the latest available follow-up examination. Results: Technical success was 100% with a mean follow-up of 65.4 months (range: 12-171 months). No death was registered, and 2 (8.7%) of 23 endograft-related complications (1 stent-graft distal infolding and 1 endoleak 2 and 4 months after the procedure, respectively) were observed. An increase in aortic diameter either proximal or distal to the stent-graft (mean value 0.7 and 0.5 mm, respectively) or within the stent-graft (mean value of 0.5 mm for both proximal and distal diameters) was registered (mean follow-up at 65.4 months, range: 12-171 months). Conclusion: Aortic dilatation following TEVAR for BTTAI is minimal during long-term follow-up. Endovascular treatment represents a durable and safe option in acute BTTAIs.

Neurological long-term follow-up in left atrial myxoma: Are late complications frequent or rare?

1992 ◽  
Vol 239 (3) ◽  
pp. 170-174 ◽  
Author(s):  
H. Reichmann ◽  
R. Romberg-Hahnloser ◽  
E. Hofmann ◽  
T. Becker ◽  
H. G. Mertens
Keyword(s):  
Left Atrial ◽  
Late Complications ◽  
Atrial Myxoma ◽  
Left Atrial Myxoma ◽  
Long Term Follow Up

Trend of management of traumatic thoracic aortic injuries in a single center

Vascular ◽  
2013 ◽  
Vol 22 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Bibombe P Mwipatayi ◽  
Arwen Boyle ◽  
Michael Collin ◽  
Jean-Louis Papineau ◽  
Vikram Vijayan
Keyword(s):  
Endovascular Repair ◽  
Paradigm Shift ◽  
Injury Severity ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Aortic Injuries ◽  
The Mean ◽  
Aortic Trauma

The purpose of this study was to review the shift in the trend of management and mid-term outcomes of all patients who sustain thoracic aortic injury. A Retrospective analysis was performed of all patients sustaining blunt thoracic aortic trauma admitted to our unit. Forty-seven patients were presented with injury to the thoracic aorta following blunt chest injury. Ten patients underwent open surgical repair of their thoracic aortic injury. The mean age ± SD (range) was 29.4 ± 7.9 years (18–41) with a mean Injury Severity Score (ISS) of 41 ± 14.7 (25–75). Fifteen patients underwent thoracic endovascular repair for blunt aortic transections with a mean age of 35.1 ± 14.5 years (17–65), mean ISS of 40.8 ± 13.9 (20–75) and an average length of hospital stay of 25.6 ± 14.5 days (3–77). The mean aortic diameter proximal to the aortic injury was 23.46 ± 3.02 mm (19–28) with a mean aortic angulation of 58.46° ± 17.73 (44–80°). The mean oversizing was 24.4 ± 5.4% (17–32%). At our institution, there has been a paradigm shift in the emergent repair of blunt thoracic aortic injury from open surgery to endovascular repair. Oversizing of the stent-graft did not translate to a poorer outcome.

Immediate Gore-Tex Sling Suspension for Management of Facial Paralysis in Head and Neck Extirpative Surgery

2007 ◽  
Vol 137 (2) ◽  
pp. 228-232 ◽  
Author(s):  
Mia E. Skourtis ◽  
Stephen M. Weber ◽  
J. David Kriet ◽  
Douglas A. Girod ◽  
Terance T. Tsue ◽  
...  
Keyword(s):  
Head And Neck ◽  
Late Complications ◽  
Facial Reconstruction ◽  
High Rate ◽  
Wound Complications ◽  
Early Results ◽  
Aesthetic Results ◽  
Long Term Follow Up

OBJECTIVE: We sought to evaluate the functional and aesthetic outcomes of immediate facial reconstruction with a Gore-Tex (expanded polytetrofluoroethylene) sling in irradiated patients undergoing large head and neck tumor extirpation with facial nerve resection. STUDY DESIGN AND SETTING: We conducted a retrospective study of 17 patients at two academic institutions who underwent extirpative surgery with immediate Gore-Tex sling reconstruction and completed radiotherapy. Functional and aesthetic results were evaluated at three intervals. RESULTS: All patients had excellent immediate results and good or excellent intermediate-term results. At long-term follow-up, results were good to excellent in 47% and unacceptable in 35% of patients. CONCLUSION: In irradiated patients undergoing total parotidectomy with immediate facial reconstruction using Gore-Tex slings, early results are excellent, but there is a high incidence of major wound complications and unacceptable results in long-term follow-up. SIGNIFICANCE: There is a high rate of late complications associated with immediate facial reconstruction with Gore-Tex slings in irradiated patients.

scholarly journals Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Larry E. Miller
Keyword(s):  
Standard Of Care ◽  
Aortic Injury ◽  
Convincing Evidence ◽  
Mortality And Morbidity ◽  
Stent Grafting ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Rapid Deceleration

Blunt thoracic aortic injury (BTAI) is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR) has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology) VOMIT.

scholarly journals Μεσοπρόθεσμα και μακροπρόθεσμα αποτελέσματα της τοποθέτησης ενδαγγειακών προθέσεων στη θωρακική αορτή

2014 ◽  
Author(s):  
Κωνσταντίνος Σπηλιωτόπουλος
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Injury Severity Score ◽  
Injury Severity ◽  
Aortic Injury ◽  
Technical Success ◽  
Stent Grafts ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury

Objective: Surveillance for patients undergoing Thoracic Endovascular AorticRepair (TEVAR) for Blunt Thoracic Aortic Injury (BTAI) varies. Empiricalrecommendation of annual chest CTA is often suggested. Concerns over risks andcosts have emerged. Evaluation of optimal follow-up frequency is attempted,based on 11-years outcomes and surveillance experience.Methods: 76 patients with BTAI received TEVAR from May 2002 to July 2013.Demographics, cardiovascular risk factors and Injury Severity Score (ISS), types,sizes, timing and outcomes of stent-grafts were retrospectively collected.Results: Mean age: 39.7 years (17-85), 8 (11%) females. Mean ISS: 46.2+/-18.5(deceased: 61.0+/-19.2, surviving: 44.2+/-17.6, p=0.023). Technical success: 71(93.4%). Mortality, all-cause: 7 (9.2%), of which, one (1.3%) was procedurerelated.Lost in follow-up: 6 (8%). To examine the effect of surveillance frequencyon outcomes, after excluding the 2 most recent (<1 year) surviving patients, wearbitrarily divided the remaining 61, with stable repairs, on the basis of theirfollow-up timing; 36: timely (+/- 6 months annual due visit) follow-up (clinical,CTA/MRA/echocardiogram). 25: delayed (>6 months annual due visit). Nosignificant differences found on survival, graft-related complications, need for reintervention,except from persistent hypertension, higher in 1st group. Allsurviving patients: excellent outcomes, no CVAs, paraplegia/paraparesis, medianfollow-up, both groups: 3 years (IQR 2.0-3.5, 1.5-5.4 years).Conclusions: Mid-term outcomes of TEVAR for BTAI patients with stable repairare excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-upintervals at a median surveillance of 3 years. A larger prospective randomizedstudy could lead to a more relaxed, but equally safe surveillance schedule forthese patients, lowering both risks and costs.

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