Thoracic aortic injuries caused by high impact trauma are life-threatening and require emergent diagnosis and management. With improvement in the acute care services, an increasing number of such injuries are being managed such that patients survive to undergo definitive therapies. A high index of clinical suspicion is required to order appropriate imaging. Computed tomography angiography is used to classify the injuries and guide treatment strategy. While low-grade injuries might be managed conservatively, high-grade injuries require urgent surgical or endovascular intervention. Over the past decade, endovascular repair of the thoracic aorta with or without a surgical bypass has become the preferred treatment with reduced mortality and morbidity. Rapid advancements in the stent graft technology have reduced the anatomic barriers to endovascular therapy and increased the confidence of the operators. Detailed planning prior to the procedure, understanding of the anatomy, correct choice of hardware, and adherence to technical protocol are essential for a successful endovascular procedure. These patients are often young and the limited data on the long-term outcome of aortic stent grafts make a case for a robust follow-up protocol.
Background The COVID-19 pandemic has brought unprecedented challenges to health care services including interventional radiology (IR). Treating COVID-19 infected patients became a priority; furthermore, government policies of differing elective procedures and the public’s fear of contacting COVID-19 have impacted IR workload worldwide. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the workflow in six vascular IR centers located across India.
Methods The data were collected retrospectively from April 1 to June 30, 2020. All the six centers were staffed by the alumni of a single parent center located in India. Data was also collected from the same time period in 2019 for comparison.
Results A total of 893 patients were treated from April 1 to June 30, 2019, and 419 were treated during the same period in 2020 during the pandemic, a 53% case volume reduction (95% CI:28. 56–129.44; p < 0.001). The month of April had the largest case volume reduction (66%, 95% CI: 13.57–50.43; p < 0.001). Elective procedures showed an 85% reduction (95% CI: 9.62–91.71; p < 0.001). Venous interventions showed the highest reduction of 76% (95% CI: 0.75–67.75; p < 0.001). Neurological emergencies, dialysis-related interventions, and nonvascular procedures did not show a significant change. No patient tested positive for COVID-19 prior to the procedure; however, one patient who was treated emergently was found to be positive later.
Conclusion COVID-19 pandemic has severely impacted IR practice across India. Workload reduction was more profound at the beginning of the COVID-19 pandemic with a gradual improvement over time.
Purpose: Pelvic angiography and embolization has been shown to be the definitive treatment for arterial hemorrhage in pelvic trauma. The Eastern association for the Surgery of Trauma (EAST) states that arterial extravasation on CT angiogram is an indication for pelvic angiography and embolization. The purpose of this study is to evaluate the efficacy of CTA in detecting arterial hemorrhage in pelvic trauma. Materials and Methods: Institutional review board approved retrospective study of 106 pelvic trauma patients who underwent CT angiograms (CTA) who subsequently underwent pelvic angiography between January 2011 and December 2016. Pelvic fractures were graded based on the Young-Burgess Classification. Both groups were combined for analysis of differences using T tests. Significance level was defined at P < 0.05 Results: Twenty-three of 106 patients (21.7%) had negative CTAs. Of those, 8 had arterial extravasation on subsequent pelvic angiography. The overall specificity, sensitivity, positive, and negative predictive values for CTA in this study were 57.7%, 85.9%, 50%, and 65.2%. Based on hemodynamic factors four (50%) of the patients with false negative CTA were in class III/IV shock. The average transfusion requirement for these 8 patients was 3 units of PRBS (SD 2.82). Five (33%)patients in this group had high-grade pelvic fractures. CT findings showed a pelvic hematoma in 6/8 (75%) of the positive group and 9/15 (60%) in the CTA negative group. Angiographic findings showed that 4(50%) had extravasation in the iliolumbar, sacral, or sacral branches of the superior gluteal arteries. The other 4 (50%) had extravasation in the internal pudendal, superior gluteal, and obturator arteries. Conclusions: The negative predictive value of CTA in pelvic trauma is 65.2% and therefore if there are signs of continued bleeding or hemodynamic instability in patients with negative CTA, definitive procedure such as angiography should be considered.
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