The measurement of pressure and volume during angioplasty enabled the construction of pressure/volume curves that showed deviations from the curves obtained in air. The balloon volume results, and significant deviation of the curve shape from the control curve shape, predicted vessel damage, which was confirmed by the IVUS appearance of the vessel after angioplasty. When pressure was used as the endpoint of balloon inflation the balloons were significantly underdilated compared with the manufacturer's nominal sizes. These data indicate that monitoring of pressure and volume during angioplasty may provide an alternative method of predicting vessel damage.
A mobile thrombus of the thoracic aorta is a rare entity, which might have serious clinical manifestations, including arterial emboli. Due to its low incidence, there is no consensus regarding the most adequate management of mobile thoracic aorta thrombus. The current case describes a patient with Polycythemia Vera and myeloproliferative neoplasm, who presented with mobile thrombus of the thoracic aorta, manifested by blue toe syndrome and asymptomatic splenic infarct. She was treated conservatively with anti-coagulation and Iloprost alongside the patient’s permanent treatment of Aspirin, Hydrea and Atorvastatin. Under this treatment, the thrombus resolved completely, and the blue toes improved, except for one.
Background
Uncontrolled hemorrhage is a significant cause of death worldwide. Rapid bleeding control is a major life saving goal.
Resuscitative endovascular balloon of the aorta (REBOA) is a minimally invasive technique which temporarily occludes the aorta and achieves hemorrhage control.
Methods
We present a case series of patients that underwent emergent laparotomy due hemorrhagic shock and were stabilized intraoperatively using REBOA
Results
Between December 2018- September 2021, intra operative REBOA was inserted in six patients. Etiologies included two postpartum hemorrhages, two gastrointestinal bleeds and two trauma cases.
REBOA was positioned and inflated in descending aorta [n = 3] and infra abdominal aorta [n =3].
In all cases, REBOA resulted in immediate stabilization of blood pressure enabling definitive treatment. Partial inflation was performed in all cases after initial stabilization.
There was one minor access related complication, treated successfully. No mortality at six months follow up.
Conclusions
REBOA is another important resuscitative tool to be considered, also in the open abdomen. It allows for hemodynamic stabilization and enables definitive surgical repair of other major injuries.
with an endovascular approach was significantly higher than open surgery e 10/47 vs 0/17 (p¼ 0.03). There was no statistical difference in re-intervention ratese 5/37 vs 3/17 (p¼ 0.28). Conclusion -An endovascular approach provides a viable first line appraoch to occlusive iliac disease with acceptable patency rates. Use of endovascular techniques allow for a low risk alternative to an open surgery albeit at the cost of a lower technical success rate.
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