Outcome of endovascular treatment of traumatic aortic transection

Steuer, Johnny; Wanhainen, Anders; Thelin, Stefan; Nyman, Rickard; Eriksson, Mats-Ola; Björck, Martin

doi:10.1016/j.jvs.2012.03.259

Cited by 23 publications

(19 citation statements)

References 24 publications

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“…13,15,17 This poses several technical and logistical challenges as young patients tend to have a more acute curvature of the aortic arch with the risk of poor apposition of the stentgraft, thereby a tendency to develop a bird beak configuration with an increased risk of subsequent endoleak and stent graft collapse. 1,11 In the present cohort, five of the 13 patients who underwent reintervention had infolding and partial stent graft collapse; in three of them it occurred within 3 weeks of the acute TEVAR. Plausibly, some of the re-interventions related to oversizing could have been avoided if more suitably sized stent grafts had been obtainable.…”

Section: Discussionmentioning

confidence: 71%

“…All four centers followed the same patient management principles and had 24/7 on call systems with readiness to perform TEVAR around the clock. The Uppsala protocol for trauma patients with blunt aortic injury has been reported previously, 11 and so has an early Zurich series of patients. 12 The patients were monitored by CT angiography before discharge and at 1 month, after 3e6 months, and at 12 months, and annually thereafter.…”

Section: Methodsmentioning

confidence: 99%

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Editor's Choice – Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral Centers

Steuer

Björck

Sonesson

et al. 2015

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 71%

Section: Methodsmentioning

confidence: 99%

Editor's Choice – Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral Centers

Steuer

Björck

Sonesson

et al. 2015

European Journal of Vascular and Endovascular Surgery

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“…20 Comparisons between age, ISS score, GCS score, and outcome in patients who did and did not receive heparin at the time of endovascular stenting did not reveal any significant differences, but our sample size is too small for definitive conclusions on this subject. Of the 7 patients who received heparin, 6 did not experience progression of their intracranial lesions, and 1 died of hemodynamic instability prior to repeat imaging.…”

Section: Anticoagulation Therapy In Aortic Injury/tbimentioning

confidence: 66%

“…3 However, open thoracic aortic surgery often requires a thoracotomy with single-lung ventilation and aortic cross-clamping, which can have severe, negative consequences in polytrauma patients, including a surge in mean arterial blood pressure and cerebral circulation. 6,20 The on ly case series we found that specifically addresses treatment of aortic injury with TBI suggested that only endovascular procedures and conservative management should be used if TBI is present. 13 However, Mosquera et al found that with conservative, nonoperative treatment, 38% of patients experienced a complication that resulted in death or required a delayed operative intervention after discharge from the hospital.…”

Section: Hospital Managementmentioning

confidence: 99%

Management of simultaneous traumatic brain injury and aortic injury

Kitagawa

Haren

Yokobori

et al. 2013

JNS

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Object. Simultaneous traumatic brain injury (TBI) and aortic injury has been considered unsurvivable for many years because treatments such as sedation and blood pressure goals conflict for these 2 conditions. Additionally, surgical interventions for aortic injury often require full anticoagulation, which is contraindicated in patients with TBI. For these reasons, and due to the relative rarity of aortic injury/TBI, little data are available to guide treating physicians.Methods. A retrospective review was performed on all simultaneous TBI and aortic injury cases from 2000 to 2012 at a university-affiliated, Level I trauma center. Patient demographics, imaging studies, interventions, and outcomes were analyzed. Traumatic brain injury/aortic injury cases treated with endovascular stenting were specifically studied to determine trends in procedure timing, use of anticoagulation, and neurological outcome.Results. Thirty-three patients with concurrent TBI and aortic injury were identified over a 12-year period. The median patient age was 44 years (range 16-86 years) and the overall mortality rate after imaging diagnosis was 46%. All surviving patients were awake and neurologically functional at discharge, and 83% were discharged home or to rehabilitation facilities. Patients who died had a higher Injury Severity Scale score (p = 0.006). Severe TBI (p = 0.045) or hemodynamic instability (p = 0.015) upon arrival to the hospital was also correlated with increased mortality rates. Thirty-three percent of aortic injury/TBI patients (n = 11) underwent endovascular stenting, and 7 of these patients received intravenous anticoagulation therapy at the time of surgery. Six of these 7 anticoagulation-treated patients experienced no significant progression on postoperative brain CT, whereas 1 patient died of hemodynamic instability prior to undergoing further imaging.Conclusions. Simultaneous TBI and aortic injury is a rare condition with a historically poor prognosis. However, these results suggest that many patients can survive with a good quality of life. Technological advances such as endovascular aortic stenting may improve patient outcome, and anticoagulation is not absolutely contraindicated after TBI. Key woRDS • aortic injury • traumatic brain injury • aortic stentAbbreviations used in this paper: GCS = Glasgow Coma Scale; ISS = Injury Severity Scale; SAH = subarachnoid hemorrhage; SDH = subdural hematoma; TBI = traumatic brain injury.

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“…Endovascular aortic repair (EVAR) improves clinical outcomes, as evidenced by reduced operative morbidity and mortality and shorter hospital stays. Thus, this procedure has become the preferred option for treatment of several aortic pathologies, such as aortic dissection, aneurysms and ruptured aneurysms, and traumatic injury, during the past decade [ 1 – 6 ]. The common femoral artery must be exposed during conventional endovascular repair, and this surgical cutdown (SC) technique increases the incidence of complications associated with the incision [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Femoral Artery Closure Versus Surgical Cutdown for Endovascular Aortic Repair: A Single-Center Experience

Yang

Liu

2018

Med Sci Monit

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BackgroundTo compare the outcome and complication rates of femoral artery closure and surgical cutdown for endovascular aortic repair procedures (EVAR).Material/MethodsPatients underwent either percutaneous femoral artery closure (PA group) or surgical cutdown (SC group) for EVAR between July 2011 and June 2016 and EVAR procedures were used for all cases. Data on outcomes and complications were collected and compared.ResultsThe SC group contained 55 patients and the PA group contained 60 patients and the technical success rates were 100.0% and 98.0%, respectively. The mean operation time, time to ambulation, and postoperative hospital stay were significantly shorter in the PA group (P<0.01). The estimated intraoperative blood loss and wound pain scores were significantly higher in the SC group (P<0.01). However, the PA procedure was more expensive (P<0.01). The overall incidence rate of complications was higher in the SC group (P=0.026).ConclusionsThe PA technique had a high success rate, shorter operation time and hospital stay, and fewer wound complications compared to SC. Thus, PA might be the preferred choice for selected EVAR procedures.

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Outcome of endovascular treatment of traumatic aortic transection

Abstract: Endovascular repair allows rapid and minimally invasive therapy in patients with traumatic aortic injury with good technical results. The outcome is highly dependent on the severity of other concurrent injuries.

Cited by 23 publications

References 24 publications

Editor's Choice – Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral Centers

Editor's Choice – Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral Centers

Management of simultaneous traumatic brain injury and aortic injury

Femoral Artery Closure Versus Surgical Cutdown for Endovascular Aortic Repair: A Single-Center Experience

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