The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
M Girotti - One of the best experts on this subject based on the ideXlab platform.
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blunt abdominal Aortic Trauma in association with thoracolumbar spine fractures
Injury-international Journal of The Care of The Injured, 2001Co-Authors: K Inaba, Andrew W Kirkpatrick, J Finkelstein, J Murphy, Frederick D Brenneman, Bernard R Boulanger, M GirottiAbstract:All patients with blunt abdominal Aortic disruption (BAAD) in the Trauma registries at the three Regional Trauma Centres were retrospectively reviewed over the last decade. From the 11465 Trauma admissions ISS>16,194 sustained Aortic injuries. Eight cases of BAAD were identified, six with concurrent thoracolumbar spine (TLS) fractures (mean ISS 42). Patients with BAAD and TLS were subject to a detailed analysis. Clinically, three injury types were seen, hemodynamically unstable (uncontained full thickness laceration), stable symptomatic (intimal dissection with occlusion), and stable asymptomatic (contained full thickness laceration or intimal dissection without occlusion). All spinal column fractures involved a distractive mechanism, one with both distractive and translational fracture components. We propose that a distractive force, applied to the aorta lying anterior to the anterior longitudinal ligament, results in an Aortic injury spectrum ranging from an intimal tear to a full thickness laceration, as a related injury. Computed tomography (CT) was an important imaging modality in the stable asymptomatic patients. All intimal dissections without occlusion were managed non-operatively. With distractive TLS fractures, BAAD needs to be considered.
Branko Ermenc - One of the best experts on this subject based on the ideXlab platform.
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Classification of blunt Aortic injuries a new systematic overview of Aortic Trauma
Forensic Science International, 2009Co-Authors: Ticijana Prijon, Branko ErmencAbstract:Abstract Blunt (non-penetrating) Aortic injuries, in which the arterial wall is damaged in the direction from the intima towards the adventitia, are most commonly the result of a traffic accident. The various forms of blunt Aortic injuries, from limited laceration of the intima to complete transection of the aorta, depend on the morphological structure of the arterial wall and the strength of forces causing the Trauma. An overview of the literature and medical documentation reveals that different terms, including tear, laceration, disruption, transection, rupture and pseudoaneurysm, are used to describe certain forms of Traumatic Aortic injuries, which can lead to misinterpretation of findings or diagnoses. We therefore, propose a classification that would enable uniform systematic screening of all forms of blunt Aortic injuries. In a retrospective examination of autopsy reports from 1999 to 2006, all those who had died in traffic accidents and who had blunt Aortic injuries were selected from the archive at the Institute of Forensic Medicine of the Medical Faculty of the Universtiy of Ljubljana, Slovenia. Blunt Aortic injuries (ruptures) were classified into three basic types and corresponding subtypes: type I (intramural), type II (transmural) and type III (multiple) Aortic ruptures. The study included 230 deceased persons with 355 Aortic ruptures. According to our classification, type I ruptures were observed in 25 (11%), type II ruptures in 131 (57%) and type III ruptures in 74 (32%) cases. The new classification we propose allows simple and systematic screening of all types of blunt Aortic injuries. It prevents misinterpretation of various types of Aortic injury in medical practice.
Eric K. Hoffer - One of the best experts on this subject based on the ideXlab platform.
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Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review
Journal of vascular and interventional radiology : JVIR, 2008Co-Authors: Eric K. Hoffer, Andrew R. Forauer, Anne M. Silas, John M. GemeryAbstract:Purpose To evaluate the available data on stent-graft repair of acute blunt Traumatic thoracic Aortic injury with regard to safety and efficacy compared with conventional open surgical repair. Materials and Methods The literature on endovascular repair of acute Traumatic Aortic injury since 1990 was systematically reviewed. Metaanalysis of publications with open and stent-graft repair cohorts was performed to evaluate whether there was a difference in treatment effect with regard to mortality and paraplegia. Case series were included to obtain an adequate population to assess the incidence of stent-graft procedure–related complications. Results There were no prospective randomized studies. Nineteen publications that compared the outcomes of 262 endograft repairs and 376 open surgical repairs were identified. The odds ratio for mortality after endovascular versus open repair was 0.43 (95% CI, 0.26–0.70; P = .001). The odds ratio for paraplegia after endovascular versus open repair was 0.30 (95% CI, 0.12–0.76; P = .01). In the pooled group of 667 endovascular repair survivors from 50 reports, the incidence of early endoleak was 4.2%, and late endoleak occurred in 0.9%. Stroke or transient ischemic attack was reported in 1.2%. Access site complications that required intervention occurred in 4.1%. Conclusions The available cohort and case series data support stent-graft repair as a highly successful technique that may reduce mortality and paraplegia rates by half compared with open surgery. These data support endograft repair as first-line therapy for blunt thoracic Aortic Trauma.
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Endovascular stent-graft as a bridge to definitive repair of Aortic Trauma
Emergency Radiology, 2001Co-Authors: Eric K. Hoffer, Riyad Karmy-jones, K. Gibson, John J. BorsaAbstract:We report a case of Traumatic rupture of the thoracic aorta immediately treated with endovascular covered stent placement. Follow-up demonstrated a small endoleak, and because of the improved overall condition of the young patient a conventional repair was performed. The stent-graft provided an acute, minimally invasive therapeutic option.
Robert J. Siegel - One of the best experts on this subject based on the ideXlab platform.
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Giant floating Aortic thrombus: a rare finding on transesophageal echocardiography.
The American journal of cardiology, 2007Co-Authors: Gregory Cogert, Robert J. SiegelAbstract:Transesophageal echocardiography is highly sensitive for diagnosing Aortic injury. We report the case of a woman presenting after a motor vehicle accident in whom large Aortic thrombi were identified at the Aortic isthmus by transesophageal echocardiography. Aortic injury is a known cause of morbidity and mortality following chest Trauma. Aortic thrombosus is a rare and life-threatening consequence of Aortic Trauma. In conlcusion, transesophageal echocardiography should be considered in patients who have sustained blunt Aortic Trauma.
Michael D. Dake - One of the best experts on this subject based on the ideXlab platform.
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Midterm survival after thoracic endovascular Aortic repair in more than 10,000 Medicare patients
The Journal of thoracic and cardiovascular surgery, 2014Co-Authors: Justin M. Schaffer, Bharathi Lingala, D. Craig Miller, Y. Joseph Woo, R. Scott Mitchell, Michael D. DakeAbstract:Objective Aneurysms and dissections of the descending thoracic aorta represent a complex substrate with a variety of therapeutic options. The introduction of thoracic endovascular Aortic repair (TEVAR) has revolutionized the treatment of thoracic Aortic disease. However, longitudinal analyses of post-TEVAR outcomes appropriately stratified by Aortic disease remain limited. Methods A total of 11,996 patients undergoing TEVAR from 2005-2010 were identified from the Medicare/Centers for Medicare and Medicaid Services database. Patients were stratified by underlying Aortic disease and the presence of Current Procedural Terminology (CPT) codes. Survival was assessed using Kaplan-Meier analysis. Cox proportional hazards analysis determined predictors of survival from TEVAR. Results After TEVAR, patients had a median survival of 57.6 months (95% confidence interval, 54.9-61.3 months). Although patients without CPT codes had significantly fewer recorded comorbidities, TEVAR survival was comparable between patients with and without CPT codes (56.3 vs 59.5 months, P = .54). The early and late incidence of death varied significantly by Aortic disease. Patients with Aortic rupture, acute Aortic dissection, and Aortic Trauma had the highest early incidence of death, whereas late survival was highest in patients with acute Aortic dissection, Aortic Trauma, and isolated thoracic Aortic aneurysm. Although hospital TEVAR volume was not associated with survival, an independent hospital effect (determined by using a mixed-effect Cox model) associated certain hospitals with a hazard for death 50% of what it was at other hospitals. Conclusions TEVAR has been applied to a multitude of Aortic diseases in the Medicare population; early and late post-TEVAR survival varies by Aortic disease. The late incidence of death remains high in TEVAR recipients, although certain Aortic diagnoses such as acute Aortic dissection, Aortic Trauma, and isolated thoracic Aortic aneurysm were associated with improved late survival. An independent hospital effect, but not hospital volume, is correlated with post-TEVAR survival. Future analyses of TEVAR outcomes using the Medicare database should adjust for underlying Aortic diagnoses and the presence of CPT codes.