scholarly journals Pictorial review on the endovascular management of paediatric aortic injuries

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190017
Author(s):  
Neville W Nicholas ◽  
David R Shaw ◽  
Sapna Puppala
Keyword(s):  
Gold Standard ◽  
Surgical Repair ◽  
Vascular Anatomy ◽  
Aortic Injury ◽  
Pictorial Representation ◽  
Endovascular Management ◽  
Rare Injury ◽  
Pictorial Review ◽  
Aortic Injuries ◽  
Aortic Trauma

Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.

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.

scholarly journals Extra-anatomical ascending-thoraco-abdominal bypass for aortic fistula after thoracic endovascular aortic repair

2019 ◽  
Vol 56 (6) ◽  
pp. 1199-1201
Author(s):  
Zain Al Rstum ◽  
Akiko Tanaka ◽  
Hazim J Safi ◽  
Anthony L Estrera
Keyword(s):  
Abdominal Aorta ◽  
Surgical Repair ◽  
Aortic Injury ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Open Surgical Repair ◽  
Aortic Repair ◽  
Aortic Injuries ◽  
Fatal Complications

Abstract Aortobronchial and aorto-oesophageal fistulae after thoracic endovascular aortic repair (TEVAR) for traumatic aortic injuries are rare but serious. Potentially fatal complications may occur years after the stent graft deployment. Surgical management is challenging. We report on a 33-year-old male with aorto-oesophageal fistula and a 25-year-old male with aortobronchial fistula—both of whom received TEVAR for traumatic aortic injury. Each underwent successful staged open surgical repair with extra-anatomical bypass from the ascending aorta to the thoraco-abdominal aorta, along with arch vessel reconstructions and debridement of infected lesions. They remained alive after 18 months.

scholarly journals Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Konstantinos Lagios ◽  
Georgios Karaolanis ◽  
Theodossios Perdikides ◽  
Theodoros Bazinas ◽  
Nikolaos Kouris ◽  
...  
Keyword(s):  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Aortic Injury ◽  
Time Interval ◽  
Spinal Cord Blood Flow ◽  
Pseudoaneurysm Formation ◽  
Hematoma Formation ◽  
Thoracic Aortic Injury ◽  
Aortic Injuries ◽  
Aortic Trauma

Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved.

Endovascular Management Of Blunt Abdominal Aortic Injury

Vascular ◽  
2006 ◽  
Vol 14 (4) ◽  
pp. 223-226 ◽  
Author(s):  
Michael E. Halkos ◽  
Jeffrey Nicholas ◽  
Li Sheng Kong ◽  
J.Ryan Burke ◽  
Ross Milner
Keyword(s):  
Unusual Case ◽  
Bowel Resection ◽  
Left Subclavian Artery ◽  
Excellent Result ◽  
Aortic Injury ◽  
Endovascular Management ◽  
Abdominal Aortic ◽  
Thoracic Aortic Injury ◽  
Aortic Injuries ◽  
Abdominal Aortic Dissection

The endovascular management of blunt aortic injuries is being used more frequently in the trauma patient. Traumatic aortic injuries usually occur in the descending thoracic aorta near the origin of the left subclavian artery. Many reports in the literature demonstrate the efficacy of endovascular repair of blunt thoracic aortic injury. We report here an unusual case of abdominal aortic dissection secondary to blunt abdominal trauma following a fall. The patient also had associated intra-abdominal injuries requiring bowel resection and repair of small bowel mesenteric lacerations. He was treated with a bifurcated abdominal endograft with an excellent result after the initial operation was performed to treat the bowel injuries.

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Valentina Chiarini
Keyword(s):  
Trauma Center ◽  
Aortic Rupture ◽  
Damage Control ◽  
Aortic Injury ◽  
Balloon Occlusion ◽  
Traumatic Lesion ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
Accepted Practice ◽  
Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

scholarly journals External fixation to correct tarsal-metatarsal fracture in rock pigeon (Columba livia)

Revista CERES ◽  
2017 ◽  
Vol 64 (1) ◽  
pp. 25-30
Author(s):  
Leandro Almeida Rui ◽  
Diego Carvalho Viana ◽  
Adriano Barile Dora ◽  
Paula Fratini
Keyword(s):  
Gold Standard ◽  
Minimal Invasive Surgery ◽  
Surgical Repair ◽  
Bone Fractures ◽  
Columba Livia ◽  
Minimal Invasive ◽  
External Fixators ◽  
Post Surgery ◽  
Metatarsal Fracture ◽  
Rock Pigeon

ABSTRACT Orthopedic conditions, such as bone fractures, are very common in avian medicine. External fixators have been considered the gold standard for birds, since they allow early movement of the limbs and minimal invasive surgery. Fractures in several bones have been successfully treated in pigeons. However, to the best of our knowledge, this case represents the first report of successful surgical repair of tarsal-metatarsal fracture in rock pigeon. External fixator was made with four 24G catheters, being inserted manually proximal and distal to the fracture and connected with polymerizable acrylic. Radiographic consolidation of fracture was observed 60 days post-surgery and anti-inflammatory and antibiotic protocols were successful on avoiding pain and infection during surgery and bone healing.

Occult Aortic Injury after Penetrating Abdominal Trauma

2007 ◽  
Vol 73 (3) ◽  
pp. 239-242
Author(s):  
John Sonfield ◽  
Jacob Robison ◽  
Stuart M. Leon
Keyword(s):  
Unusual Case ◽  
Primary Repair ◽  
Aortic Injury ◽  
Initial Attempt ◽  
Penetrating Abdominal Trauma ◽  
Stent Grafting ◽  
Abdominal Aortic ◽  
Extremity Trauma ◽  
Early Imaging ◽  
Aortic Trauma

Although pseudoaneurysms after penetrating extremity trauma are well described, we describe an unusual case of residual occult aortic injury after an initial attempt at repair that was recognized on postoperative imaging. Reoperation with primary resection and end-to-end repair was accomplished successfully. Because this entity is so unusual, we review strategies to avoid and recognize its occurrence. Early imaging allows early identification of aortic pseudoaneurysms should they occur, and will preclude delayed manifestation of complications, including death. Our case illustrates the utility of such postoperative scanning. Other alternatives to primary repair or interposition grafting in management of penetrating abdominal aortic trauma, such as interventional stent grafting, are discussed.

scholarly journals Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas

2020 ◽  
Vol 9 (9) ◽  
pp. 2965
Author(s):  
Ronald Chang ◽  
Stacy A. Drake ◽  
John B. Holcomb ◽  
Garrett Phillips ◽  
Charles E. Wade ◽  
...  
Keyword(s):  
Penetrating Trauma ◽  
Aortic Injury ◽  
Definitive Treatment ◽  
Medical Examiner ◽  
Infrarenal Aorta ◽  
Harris County ◽  
Hemostatic Resuscitation ◽  
Aortic Injuries ◽  
Trauma Mortality ◽  
Trauma Deaths

Background: The National Academies of Science have issued a call for zero preventable trauma deaths. The mortality characteristics in all patients with aortic injury are not well described. Methods: All prehospital and hospital medical examiner records for deaths occurring in Harris County, Texas in 2014 were retrospectively reviewed, and patients with traumatic aortic injury were selected. The level of aortic injury was categorized by zone (0 through 9) and further grouped by aortic region (arch, zones 0 to 2; descending thoracic, zones 3 to 5; visceral abdominal, zones 6 to 8; infrarenal, zone 9). Multiple investigators used standardized criteria to categorize deaths as preventable, potentially preventable, or non-preventable. Results: Of 1848 trauma deaths, 192 (10%) had aortic injury. There were 59 (31%) aortic arch, 144 (75%) descending thoracic, 19 (10%) visceral abdominal, and 20 (10%) infrarenal aortic injuries. There were 178 (93%) non-preventable deaths and 14 (7%) potentially preventable deaths, and none were preventable. Non-preventable deaths were associated with blunt trauma (69%) and the arch or thoracic aorta (93%), whereas potentially preventable deaths were associated with penetrating trauma (93%) and the visceral abdominal or infrarenal aorta (79%) (all p < 0.05). Half of potentially preventable deaths (n = 7) occurred at the scene, and half occurred at a trauma center. Conclusion: Potentially preventable deaths after aortic injury were associated with penetrating mechanism and injury to the visceral abdominal and/or infrarenal aorta. Optimal prehospital and ED treatment include temporizing hemorrhage control, hemostatic resuscitation, and faster transport to definitive treatment.

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