Primary fibrinolysis during supraceliac aortic clamping

Illig, Karl A.; Green, R.M.; Ouriel, Kenneth; Riggs, Patrick; Bartos, Susan; Whorf, R.; DeWeese, James A.; Chhibber, Ashwani K.; Marder, Victor J.; Francis, Charles W.

doi:10.1016/s0741-5214(97)70346-x

Cited by 74 publications

(41 citation statements)

References 23 publications

(3 reference statements)

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“…In addition, an earlier suggestion about elevation of fibrinolytic factors in rAAAs could be related to the application of supraceliac cross clamp that in turn reduces the hepatic blood flow and results in elevation of fibrinolytic factors. [19][20][21] In the study by Adam et al, 21 even nonruptured AAAs exhibited significant coagulation status difference to that of rAAAs. The markers of thrombin generation thrombin-antithrombin complex and prothrombin fragment 1 þ 2 concentration were statistically higher in rAAAs in comparison to the nonruptured cases (135.5 mg/L vs 61 mg/L, P .02).…”

Section: Discussionmentioning

confidence: 88%

The Clinical Implication of Blood Product Transfusion on Morbidity and Mortality of Ruptured Abdominal Aortic Aneurysm

Kordzadeh

Askari

Parsa

et al. 2015

Clin Appl Thromb Hemost

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Section: Discussionmentioning

confidence: 88%

The Clinical Implication of Blood Product Transfusion on Morbidity and Mortality of Ruptured Abdominal Aortic Aneurysm

Kordzadeh

Askari

Parsa

et al. 2015

Clin Appl Thromb Hemost

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“…Time of inflow control should be noted and kept as short as possible. Prolonged aortic clamping is associated with an induced fibrinolysis and more profound reperfusion injury [25,26]. After obtaining proximal and distal control, the first option for repair is a lateral aortorrhaphy with 3-0 or 4-0 prolene suture.…”

Section: Supramesocolic Zone Imentioning

confidence: 99%

Management of Penetrating Trauma to the Major Abdominal Vessels

2016

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Penetrating abdominal vascular injuries result in significant mortality. In the pre-hospital phase of care, Bscoop and run^is the optimal strategy while on-scene interventions are restricted only to basic airway maneuvers. Early in-hospital diagnosis and operative interventions are prerequisites for survival in vascular trauma. Hypotension and peritonitis following penetrating abdominal trauma mandate immediate access to the operating room with vascular surgery capabilities. Patients presenting in extremis should be managed with a resuscitative thoracotomy in the emergency department. The majority of abdominal vascular injuries surviving to the operating room are subjected to damage control intervention. In hemodynamically stable patients, diagnostic modality of choice is computed tomography angiography and endovascular interventions are evolving.

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“…At the same time, arterial cross-clamping results in stagnant blood and presents a significant risk of intra-arterial thrombus formation. The fibrinolytic state induced by supraceliac crossclamping appears to occur secondary to increased release of tissue-type plasminogen activator from ischemic vascular tissues [1]. In cardiac cases antifibrinolytics have been found to reduce the need for blood transfusions with occasional inconsistent concerns regarding worsened renal, neurological, and cardiac outcomes [2][3][4][5][6][7][8][9][10].…”

Section: Coagulopathymentioning

confidence: 99%

Optimizing Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair

2015

JACCOA

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Open thoracoabdominal aortic aneurysm (TAAA) repair is a high-risk surgery associated with significant morbidity and mortality. It can be difficult to accumulate experience managing open TAAA repairs due to the low volume of cases and the increasing popularity of endovascular approaches. It is important to review management strategies for these challenging cases as clinical situations remain for which an open repair is preferred. Recent advances now allow for distal aortic perfusion during an off-pump open thoracoabdominal aortic aneurysm repair. This approach is not without risks and a clear, team based, plan is essential for successful management. Key considerations include managing co-morbidities, spinal cord protection, prevention of ischemia (coronary, cerebral, visceral, and peripheral), renal protection, massive transfusion, rapid hemodynamic changes, acidosis, coagulopathy, one lung ventilation, and postoperative pain control. In this case report, we detail an off-pump perioperative approach involving retrograde aortic perfusion, transesophageal echocardiography, and multiple spinal cord protective strategies which resulted in a favorable patient outcome.

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Primary fibrinolysis during supraceliac aortic clamping

Cited by 74 publications

References 23 publications

The Clinical Implication of Blood Product Transfusion on Morbidity and Mortality of Ruptured Abdominal Aortic Aneurysm

The Clinical Implication of Blood Product Transfusion on Morbidity and Mortality of Ruptured Abdominal Aortic Aneurysm

Management of Penetrating Trauma to the Major Abdominal Vessels

Optimizing Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair

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