Successful Revascularization of Aortic Arch in a 39-Year-Old Blunt Trauma Patient with Acute Diffuse Axonal Injury without the Use of Systemic Anticoagulation
| Autor: | Xiaoyi Li, Priscilla Sanchez, Keith M. Jones, Jordan Sasson, Andrew M. Abi-Chaker, Jorge Rey |
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| Rok vydání: | 2016 |
| Předmět: |
Aortic arch
Adult Male medicine.medical_specialty Computed Tomography Angiography medicine.medical_treatment Aorta Thoracic 030204 cardiovascular system & hematology Revascularization Wounds Nonpenetrating Aortography law.invention 03 medical and health sciences Pseudoaneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine law medicine.artery Internal medicine Ascending aorta medicine Cardiopulmonary bypass Brain Injuries Diffuse Humans business.industry Trauma center Accidents Traffic Contraindications Drug Anticoagulants 030208 emergency & critical care medicine General Medicine Vascular System Injuries medicine.disease Surgery Blood Vessel Prosthesis medicine.anatomical_structure Treatment Outcome Blunt trauma cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Annals of vascular surgery. 44 |
| ISSN: | 1615-5947 |
| Popis: | Blunt traumatic aortic injury is the second leading cause of death in trauma patients aged 4–34 years. Of the patients who are able to receive treatment, mortality rates as high as 40% have been reported. Endovascular repair options have allowed for more expeditious repairs with reduced iatrogenic trauma; however, when the injury involves the ascending aorta or arch, current endografts lack fenestrations needed for cerebral blood flow. Traditionally, on pump, cardiopulmonary bypass with systemic anticoagulation has been used to repair these injuries. In this paper, we describe a unique case of repairing a large traumatic aortic arch pseudoaneurysm in the setting of which systemic anticoagulation is contraindicated. The patient is a 39-year-old otherwise healthy Hispanic male who presented to Ryder Trauma Center in Miami, Florida, following a motor vehicle collision and found to have multiple intracranial hemorrhages and a large aortic pseudoaneurysm of the distal ascending aorta. In lieu of standard cardiopulmonary bypass, a hybrid approach was utilized. Cranial blood flow was maintained using a temporary extra-anatomical left femoral to bilateral carotid bypass during endovascular coverage of the aortic arch. Aortic arch revascularization was then achieved by means of in situ laser fenestration of the innominate artery followed by a right-to-left carotid–carotid–subclavian bypass. This case demonstrates the viability of a hybrid vascular repair of a complex aortic disruption without the use of systemic anticoagulation in the setting of contraindicated or unknown risk of systemic anticoagulation. Further research is warranted on whether emergent traumatic cases with contraindications to anticoagulation can be performed in a similar fashion to safely reduce the morbidity and mortality associated with aortic disruptions. |
| Databáze: | OpenAIRE |
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