decreased mortality rate, decreased incidence of postoperative paralysis, and decreased need for systemic heparinization in patients with significant concomitant injuries compared with open repair. Because of the age of these patients, lifelong surveillance has been emphasized as the morphology of the aorta can change over time, and the aortic diameter changes with volume resuscitation. Unfortunately, relatively healthy patients are often lost to follow-up. Device-related complications include stent graft collapse, thrombosis, migration, and endoleak. We present the case of a 19-year-old patient who sustained a blunt traumatic aortic injury with subsequent urgent endovascular repair. He was lost to follow-up and presented 8 months later with heart failure and multiorgan malperfusion, the cause of which was initially unclear. Computed tomography angiography identified thrombosis of the distal thoracic endovascular aortic repair (TEVAR). Prior case reports describe only open repair as salvage for this rare complication. Endovascular salvage with branch vessel embolic protection and relining of the TEVAR was pursued and was successful. His organ malperfusion resolved with no embolic complications, although he sustained transient spinal cord reperfusion complications. At 6-month follow-up, TEVAR remains patent with no further thrombus lining.
In particular, there was wide variation across hospitals in payments for facility fees and professional services (Fig); 34% of patients had a hospital stay of >1 day. Each additional day of hospitalization after CEA represents an incremental cost of as much as $5461. Conclusions: There is tremendous variation in payments after both asymptomatic and symptomatic CEA. Much of this variation can be explained by differences in base facility payments and professional services (eg, intensive care unit care, nursing care, consultations), but more than one-third of patients have a prolonged length of stay attributable to an additional cost of as much as $5461 per day. As providers and payers target value, increased attention to pathways of care and prompt discharge will be imperative to optimize value.
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