Thoracic Endovascular Aortic Repair Versus Open Repair: Analysis of the National Trauma Data Bank

Elkbuli, Adel; Dowd, Brianna; Spano, Paul J.; Smith, Zachary; Flores, Rudy; McKenney, Mark; Boneva, Dessy

doi:10.1016/j.jss.2019.07.076

Cited by 19 publications

(7 citation statements)

References 12 publications

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“…Prophylactic consultation and involvement of the endovascular and/or interventional radiology team is recommended in cases of complex and sever mandibular fractures, particularly those with proximity to a vascular structure that could be potentially injured due to excessive dissection/manipulation. Over the last decade, minimally invasive procedures, including ultrasound guided compression and thrombin injection, coil and glue embolization, and endovascular repairs of vascular injuries have been augmenting or even replacing open procedures due to its improved outcomes and prognoses [ [15] , [16] , [17] ].…”

Section: Discussionmentioning

confidence: 99%

A rare case of large left internal maxillary artery pseudoaneurysm secondary to mandibular fracture: A case report and review of the literature

Cogollo

Elkbuli

McKenney

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Pseudoaneurysms secondary to traumatic vessel wall disruption are a rare but potentially fatal complication after traumatic injury. The majority of the cases are found incidentally. Case presentation An 80-year-old woman was brought into our Level 1 Trauma Center after sustaining a ground-level fall with significant facial swelling. Her imaging revealed an acute traumatic comminuted fracture of the right mandibular condyle and left mandibular ramus. The patient underwent closed maxillomandibular fixation (MMF) to stabilize fractures, and allow the swelling to decrease for definitive fixation. During the definitive procedure, profuse bleeding was encountered. CT angiography evaluation was immediately performed and determined the presence of a left internal maxillary artery pseudoaneurysm which was successfully treated by coil and glue embolization. Clinical discussion This case highlights an unusual presentation of a vascular injury following major traumatic mandibular fracture and its management. Mandibular fractures have been reported in a series of cases to be a risk factor for vascular injuries. When a vascular injury is suspected, or the evaluation is unclear, surgeons should carefully determine the necessity to perform additional studies like CT angiogram. Vascular injuries secondary to mandibular fractures can be fatal if left unrecognized and untreated. Hence adequate recognition and treatment are warranted to avoid prolonged length of stay with bad outcomes. Conclusion Optimal management of pseudoaneurysms is achieved by endovascular approach with prior resuscitation and adequate hemodynamic stabilization. Open surgical management is deferred only for those cases where endovascular treatment is not available, or disruption is found intraoperatively.

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Section: Discussionmentioning

confidence: 99%

A rare case of large left internal maxillary artery pseudoaneurysm secondary to mandibular fracture: A case report and review of the literature

Cogollo

Elkbuli

McKenney

et al. 2021

International Journal of Surgery Case Reports

Self Cite

View full text Add to dashboard Cite

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“…11) has gained popularity over open surgical repair, and is now the first line of treatment if it is technically feasible. 24,33 The morbidity associated with a thoracotomy, aortic cross-clamping, and cardiopulmonary bypasses can be avoided with endovascular repair. 8,34 Endovascular repair prevents further progression of ATAI by excluding the aorta from systemic blood pressure.…”

Section: Endovascular Versus Open Repairmentioning

confidence: 99%

“…Endovascular repair ( Fig. 11 ) has gained popularity over open surgical repair, and is now the first line of treatment if it is technically feasible [ 24 , 33 ]. The morbidity associated with a thoracotomy, aortic cross-clamping, and cardiopulmonary bypasses can be avoided with endovascular repair [ 8 , 34 ].…”

Section: Managementmentioning

confidence: 99%

Current updates in acute traumatic aortic injury: radiologic diagnosis and management

et al. 2022

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Acute traumatic aortic injuries, which have substantial lethal outcomes at the time of admission, are fatal in 80% to 90% of cases. These injuries are relatively rare and have nonspecific clinical presentations. Radiologists and emergency physicians need to identify the radiological signs of acute traumatic aortic injury and differentiate them from common imaging errors to ensure accurate diagnosis and determine appropriate management protocols. In combination with image-guided interventions, advances in cross-sectional imaging have enabled nonsurgical management of acute traumatic aortic injuries. Timely and precise diagnoses of these injuries following prompt treatment are essential as up to 90% of patients presenting at the hospital can undergo early repair.

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“…Conventional surgical repair has been utilized in BTAI previously until the emergence of a minimally invasive procedure via thoracic endovascular aortic repair (TEVAR). With improved outcomes demonstrated by several reports, TEVAR rapidly replaced open repair as the standard of care for these injuries [2][3][4]. A grading system adopted by the Society for Vascular Surgery (SVS) divided BTAI into four grades determined by the severity of injuries to guide clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Delayed endovascular repair for traumatic aortic pseudoaneurysms: experience from an Asian single center

Liu

Sun

Wang

et al. 2023

J Cardiothorac Surg

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Background Traumatic aortic pseudoaneurysms (PSAs) classified as grade III aortic injuries are conventionally repaired as procedural emergencies, generally within 24 h of arrival. These patients typically require adequate resuscitation and treatment of multiple traumatic injuries, which complicate optimal management strategies of aortic PSAs. This study reviews the experience of an Asian single center to evaluate the efficacy and safety of delayed (> 24 h) endovascular repair for PSAs. Methods Twenty-seven patients with blunt aortic injury (BTAI) were brought to our institution between February 2014 and May 2020. Patients with other grades of aortic injuries (grade I, II, or IV) were excluded from the study, and the remaining patients with grade III aortic injuries were placed into the early (< 24 h) and delayed (> 24 h) groups according to the timing of repair. Medical records and follow-up computed tomography (CT) scans were reviewed to document the outcomes of the procedures. Primary outcomes included mortality and complications. Results During this period, there were 14 patients (13 males and 1 females) with aortic PSAs, and each patient received thoracic endovascular aortic repair (TEVAR). Of these 14 patients, 1 underwent emergent TEVAR, and 13 underwent delayed repair (median 7 days, range, 3–14 days). Over a period of 8 years, the overall survival of our series was 100%. No paraplegia, stroke, ischemia of limb or other serious procedural complications were observed during the duration of follow-up. Conclusion The experience of our center indicates that delayed repair for selected PSAs could be permissible, which enables a repair in more controlled circumstances.

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Thoracic Endovascular Aortic Repair Versus Open Repair: Analysis of the National Trauma Data Bank

Cited by 19 publications

References 12 publications

A rare case of large left internal maxillary artery pseudoaneurysm secondary to mandibular fracture: A case report and review of the literature

A rare case of large left internal maxillary artery pseudoaneurysm secondary to mandibular fracture: A case report and review of the literature

Current updates in acute traumatic aortic injury: radiologic diagnosis and management

Delayed endovascular repair for traumatic aortic pseudoaneurysms: experience from an Asian single center

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