Endovascular treatment of traumatic azygous vein injuries: a case report

Abstract Background Management of thoracic vascular injury predominantly focuses on the aorta and its tributaries while reports of venous injury are less frequent. Although rare, traumatic azygous vein injuries are associated with high mortality. Prompt treatment is required and has traditionally been open surgery. We present a case of an endovascular repair of an azygous vein injury. Case presentation A female patient presented to our trauma center following ejection after a motor vehicle collision (MVC). CT imaging workup revealed mediastinal and periaortic hematoma with active contrast extravasation adjacent to the azygos vein. She was referred to interventional radiology for vascular evaluation and potential endovascular intervention. The patient met criteria for class III hypovolemic shock upon arrival in the endovascular suite. Aortography demonstrated no arterial injury. Venography revealed a pseudoaneurysm on the superior aspect of the azygos arch and contrast extravasation from the inferior margin of the azygous arch. A stent-graft was deployed and post-deployment venogram showed no extravasation and successful exclusion of the injuries. The patient did not have further signs of bleeding. She left the interventional suite with improved vital signs, yet her condition remained guarded. Follow-up CT chest confirmed continued patency of the stent-graft at 8 days and 2 years post-procedure. Conclusion Historically, azygos vein injuries are a rare occurrence and managed with open surgery. Swift management is necessary to prevent the increased morbidity and mortality associated with azygous vein injury, particularly in polytrauma patients such as the one presented here. We believe endovascular stent-graft treatment offers an innovative alternative to the current standard of operative management of azygos vein injury.

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Endovascular Treatment of Traumatic Azygous Vein Injuries: A Case Report

10.21203/rs.3.rs-297291/v1 ◽

2021 ◽

Author(s):

Kristine DeMaio ◽

Shivam Kaushik ◽

Venu Vadlamudi

Keyword(s):

Stent Graft ◽

Open Surgery ◽

Motor Vehicle ◽

Azygos Vein ◽

Arterial Injury ◽

Azygous Vein ◽

Contrast Extravasation ◽

Inferior Margin ◽

Venous Injury ◽

Vein Injury

Abstract Background:Management of thoracic vascular injury predominantly focuses on the aorta and its tributaries while reports of venous injury are less frequent. Although rare, traumatic azygous vein injuries are associated with high mortality. Prompt treatment is required and has traditionally been open surgery. We present the first reported case of an endovascular repair of an azygous vein injury.Case Presentation:A female patient presented to our trauma center following ejection after a motor vehicle collision (MVC). CT imaging workup revealed mediastinal and periaortic hematoma with active contrast extravasation adjacent to the azygos vein. She was referred to interventional radiology for vascular evaluation and potential endovascular intervention. Aortography demonstrated no arterial injury. Venography revealed a pseudoaneurysm on the superior aspect of the azygos arch and contrast extravasation from the inferior margin of the azygous arch. A stent-graft was deployed and post-deployment venogram showed no extravasation and successful exclusion of the injuries. The patient did not have further signs of bleeding. Follow-up CT chest confirmed continued patency of the stent-graft.Conclusion:Historically, azygos vein injuries are a rare occurrence and managed with open surgery. Swift management is necessary to prevent the increased morbidity and mortality associated with azygous vein injury, particularly in polytrauma patients such as the one presented here. We believe endovascular stent-graft treatment offers an innovative alternative to the management of azygos vein injury.

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Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma

Medical & Clinical Research ◽

10.33140/mcr.02.01.09 ◽

2017 ◽

Vol 2 (1) ◽

Keyword(s):

Motor Vehicle ◽

Pelvic Fractures ◽

Motor Vehicle Crash ◽

Organ Injury ◽

Contrast Extravasation ◽

Body Fracture ◽

Mesenteric Hematoma ◽

Level I ◽

Hispanic Male ◽

Trauma Bay

A 25-year-old Hispanic male was transferred to our level I trauma center after being ejected 40 feet from a motor vehicle crash. Once stabilized in the trauma bay, a computed tomography (CT) scan of the abdomen/pelvis with IV contrast revealed two AAST Organ Injury Scale grade III liver lacerations without contrast extravasation, bilateral pulmonary contusions, right posterior non-displaced fourth rib fracture, non-displaced right scapular body fracture, and bilateral anterior and posterior pelvic fractures [Figures 1–2]. A non-operative approach to the hepatic lacerations was chosen and the patient underwent closed reduction and percutaneous pinning of his posterior pelvic fractures as well as anterior external fixation of his bilateral pubic rami fractures.

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Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

Author(s):

Tilo Kölbel ◽

Christian Detter ◽

Sebastian W. Carpenter ◽

Fiona Rohlffs ◽

Yskert von Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Open Surgery ◽

Type A ◽

Ascending Aorta ◽

Type I ◽

Acute Type ◽

Stent Grafts ◽

Type A Aortic Dissection ◽

Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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Endovascular strategies for post-dissection aortic aneurysm (PDAA)

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01331-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zhaoxiang Zeng ◽

Yuxi Zhao ◽

Mingwei Wu ◽

Xianhao Bao ◽

Tao Li ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Open Surgery ◽

Primary Repair ◽

False Lumen ◽

Term Survival ◽

Mortality And Morbidity ◽

First Choice ◽

Minimal Invasion

Abstract Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.

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Primary Endovascular Repair of the Ascending Aorta

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000561 ◽

2018 ◽

Vol 13 (6) ◽

pp. 448-450

Author(s):

Bruno Borrello ◽

Davide Carino ◽

Andrea Agostinelli ◽

Alessandro Maria Budillon ◽

Francesco Nicolini

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Open Surgery ◽

Case Series ◽

Ascending Aorta ◽

Off Label

Different case series have been published demonstrating the feasibility of endovascular repair of the ascending aorta in selected patients deemed unfit for open surgery. However, the use of commercially available stent graft in the ascending aorta remains off-label, and their excessive length often prevents their deployment in the ascending aorta. Here we report a case of successful primary endovascular repair of the ascending aorta using a physician modified off-the-shelf device.

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CT diagnosis of a post-embolization ischemic diverticulitis of Meckel

Acta Radiologica Short Reports ◽

10.1177/2047981614531954 ◽

2014 ◽

Vol 3 (9) ◽

pp. 204798161453195 ◽

Cited By ~ 1

Author(s):

Tom De Beule ◽

Katya Op de Beeck ◽

Gert De Hertogh ◽

Gregory Sergeant ◽

Geert Maleux

Keyword(s):

Small Bowel ◽

Bowel Resection ◽

Hypovolemic Shock ◽

Small Bowel Resection ◽

Ct Diagnosis ◽

Contrast Extravasation ◽

Diffuse Abdominal Pain ◽

Bleeding Point ◽

Pathologic Analysis ◽

Endoscopic Investigation

A 23-year-old man presented with hypovolemic shock due to a lower gastrointestinal bleeding. Radiological and endoscopic investigation did not reveal the bleeding site. Emergency visceral angiography showed contrast extravasation at a right-sided branch of the superior mesenteric artery (SMA). Embolization of the bleeding point was performed, resulting in bleeding cessation. One week later, the patient presented with a new episode of moderate anal blood loss associated with diffuse abdominal pain. Computed tomography (CT) revealed an ischemic small bowel diverticulum that was treated by a laparoscopically-assisted segmental small bowel resection. Intraoperative and pathologic analysis confirmed a post-embolization ischemic diverticulitis of Meckel.

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A Rare Case of Hemorrhagic Shock: Morel-Lavallée Lesion

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.9.43674 ◽

2019 ◽

Vol 3 (4) ◽

pp. 417-420 ◽

Cited By ~ 1

Author(s):

Lieke Claassen ◽

Myriam Franssen ◽

Erik Robert de Loos

Keyword(s):

Treatment Options ◽

Hypovolemic Shock ◽

Clinical Signs ◽

Hemodynamic Instability ◽

Trauma Patients ◽

Lumbar Region ◽

Bilateral Pneumothorax ◽

Contrast Extravasation ◽

Multiple Rib Fractures ◽

Degloving Injury

Hemorrhage is a major cause of death among trauma patients. Controlling the bleeding is essential but can be difficult when the source of bleeding remains unidentified. We present a 67-year-old healthy male with a hypovolemic shock after a suicide attempt by jumping from a height. Apart from a bilateral pneumothorax with multiple rib fractures, a femur fracture and spine fractures, computer tomography (CT) revealed a closed, degloving injury of the back, also known as a Morel-Lavallée lesion. Hemodynamic instability due to hemorrhage caused by a Morel-Lavallée lesion in the lumbar region is very rare and easily overlooked. This case demonstrates the importance of clinical signs of Morel-Lavallée, and illustrates the need for total body CTs to exclude other locations of bleeding and to detect contrast extravasation. This report also discusses the possible treatment options for Morel-Lavallée lesions.

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Development of an In Vitro Porcine Aorta Model to Study the Stability of Stent Grafts in Motor Vehicle Accidents

Journal of Biomechanical Engineering ◽

10.1115/1.2948398 ◽

2009 ◽

Vol 131 (4) ◽

Cited By ~ 4

Author(s):

Kurosh Darvish ◽

Mehdi Shafieian ◽

Vasily Romanov ◽

Vittorio Rotella ◽

Michael D. Salvatore ◽

...

Keyword(s):

Stent Graft ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Aortic Aneurysms ◽

Endovascular Stent ◽

Stent Grafts ◽

Vehicle Accidents ◽

Impact System ◽

The Stability

Endovascular stent grafts for the treatment of thoracic aortic aneurysms have become increasingly utilized and yet their locational stability in moderate chest trauma is unknown. A high speed impact system was developed to study the stability of aortic endovascular stent grafts in vitro. A straight segment of porcine descending aorta with stent graft was constrained in a custom-made transparent urethane casing. The specimen was tested in a novel impact system at an anterior inclination of 45deg and an average deceleration of 55G, which represented a frontal automobile crash. Due to the shock of the impact, which was shown to be below the threshold of aortic injury, the stent graft moved 0.6mm longitudinally. This result was repeatable. The presented experimental model may be helpful in developing future grafts to withstand moderate shocks experienced in motor vehicle accidents or other dynamic loadings of the chest.

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Seatbelt: A Double-Edged Sword

Case Reports in Pediatrics ◽

10.1155/2012/326936 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3

Author(s):

P. Raychaudhuri ◽

N. K. Cheung ◽

C. Bendinelli ◽

M. Puvaneswary ◽

R. Ferch ◽

...

Keyword(s):

Blunt Trauma ◽

Vascular Injury ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Rapid Identification ◽

Mesenteric Vein ◽

Correct Placement ◽

Vehicle Accident ◽

Vein Injury ◽

High Degree

Intra-abdominal vascular injury due to blunt trauma is unusual in children. Due to its rarity, detailed reports dealing with its management are scarce in paediatric literature. Diagnosis of these injuries is challenging, and a high degree of awareness is necessary for rapid identification and treatment of these injuries. We report the case of a child with seatbelt sign and mesenteric vein injury due to blunt trauma to the abdomen during a motor vehicle accident where the seatbelt was incorrectly placed. She also sustained cervical vertebral injury. The pattern of injuries in children in these situations may differ from that found in adults. While seatbelts have undoubtedly saved many lives, awareness about correct placement of these restraints is extremely necessary.

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