Blunt aortic injury in a patient with prior coronary artery bypass surgery.

Traumatic aortic rupture is a significant challenge, further complicated by prior coronary artery bypass graft surgery with a left internal mammary artery anastomosis. We present a patient with prior coronary artery bypass graft and valve replacement who sustained multiple injuries, including an aortic rupture, after a motor vehicle crash. This report describes successful treatment of a patient with a thoracic endograft and carotid subclavian bypass to preserve the left internal mammary artery inflow.

Endovascular repair of traumatic aortic injuries.

Endograft repair has clearly revolutionized the treatment of traumatic aortic injury. Numerous studies, both retrospective and prospective, have documented the advantages with respect to lower mortality and lower paraplegia rates as compared with traditional open repair. Additionally, 2 recent meta-analyses of the published literature both reported significantly lower mortality and paraplegia rates with endovascular repair.

Traumatic arteriovenous fistula 52 years after injury.

Untreated traumatic arteriovenous fistulae (AVF) have been associated with aneurysmal dilatation of the involved artery and vein, congestive heart failure, and limb ischemia. Open surgical repair of these lesions can be challenging due to the elevated venous pressure and surrounding inflammation. This case report describes a hybrid open and endovascular approach to treatment of a traumatic AVF in the right groin, presenting with aneurysmal ileo-femoral arteries and veins and pulmonary hypertension.

Vascular injuries after blunt chest trauma: diagnosis and management.

Background: Although relatively rare, blunt injury to thoracic great vessels is the second most common cause of trauma related death after head injury. Over the last twenty years, the paradigm for management of these devastating injuries has changed drastically. The goal of this review is to update the reader on current concepts of diagnosis and management of blunt thoracic vascular trauma.

Endograft repair of traumatic aortic injury-a technique in evolution: a single institution's experience.

Objective: We evaluated a large single center experience of endograft repair of blunt traumatic injury of the thoracic aorta.

Summary Background Data: Traumatic aortic transection is a devastating injury with high morbidity and mortality. Endograft repair of these injuries has reduced the rates of death and paraplegia seen with open surgical treatment in the past.

Endovascular stenting for traumatic aortic injury: an emerging new standard of care.

Background: Thoracic aortic injury remains a leading cause of death after blunt trauma. Thoracic aortic stents have the potential to treat aortic tears using a less invasive approach. We have accumulated the largest series of patients treated with blunt thoracic aortic injury over a 2-year period.

Endovascular embolization of a giant renal artery aneurysm with preservation of renal parenchyma.

Renal artery aneurysm is a rare condition that has an unclear etiology. Although some patients present with symptoms of hypertension, pain, hematuria, or rupture, the majority are asymptomatic. Traditional surgical repair of renal artery aneurysms is often complex and may require ex vivo repair and reimplantation of the kidney if branch vessels are involved.

Intraoperative coil embolization reduces transplant nephrectomy transfusion requirement.

Transplant nephrectomy for failed renal transplants can be challenging. Patients often have numerous comorbidities, and the procedure may be associated with considerable blood loss. This study was performed to determine if intraoperative coil embolization of the transplant renal artery reduces blood loss associated with transplant nephrectomy.

Twenty consecutive cases of endograft repair of traumatic aortic disruption: lessons learned.

Objectives: Endograft repair holds considerable promise in the treatment of traumatic disruption of the thoracic aorta because patients often have multiple coexisting injuries further complicating traditional open repair. In addition, patients are often young, with an aortic anatomy dissimilar to those with atherosclerotic aneurysms. As a result, techniques for endograft repair have to be refined accordingly.

Lemierre's syndrome: a potentially fatal complication that may require vascular surgical intervention.

Septic phlebitis of the internal jugular vein, Lemierre's syndrome, is extremely rare. However, Lemierre's syndrome may cause septic pulmonary emboli or result in fatal systemic sepsis, or both, if a timely diagnosis and appropriate treatment are not provided. We present a case of Lemierre's syndrome that occurred in an otherwise healthy young man.

Exteriorization and control of a retained embolization coil in the carotid artery--a case report.

Advances in endovascular technology have enabled the development of complex techniques for the treatment of vascular conditions. Not surprisingly, the modern vascular surgeon will likely encounter unusual complications and will need to formulate plans for their management. In the current case report, the vascular surgery service was consulted to assist in the management of a retained embolization coil in the carotid artery.

Combined endovascular and surgical repair of a large traumatic pseudoaneurysm of the thigh-a case report.

Thigh pseudoaneurysms are rare compared to pseudoaneurysms of the groin, and usually result from direct injury to an arterial branch. Direct open repair can be associated with a large volume blood loss. The authors describe a combined endovascular and surgical approach to a large, traumatic, pseudoaneurysm of the thigh.

Surgical thrombectomy and transluminal balloon angioplasty for failed above-knee femoropopliteal polytetrafluoroethylene bypass grafts.

Endovascular therapy offers an alternative to redo bypass or surgical graft revision for failed above-knee femoropopliteal PTFE bypass grafts. We evaluated the outcome of surgical thrombectomy and balloon angioplasty for the treatment of thrombosed bypass grafts. Thirty selected patients with thrombosed above-knee femoropopliteal PTFE bypass grafts were treated.

Magnetic resonance imaging for planning aortic endograft procedures.

Patients with aortic aneurysms and renal insufficiency are at an increased risk when conventional imaging modalities (contrast enhancing computed tomography and arteriography) are used for aortic endograft design. Magnetic resonance imaging (MRI) provides a nonionizing, noninvasive alternative to standard measurement techniques. Reliable diameter and length measurements can be obtained with MRI at a computer workstation without the use of iodinated radiologic contrast agents.

Endovascular repair of a penetrating thoracic aortic ulcer by way of the carotid artery.

Introduction: Endovascular repair of thoracic aortic lesions offers an attractive alternative to traditional open repair. Access to the thoracic aorta can occasionally be challenging because of large device size and vessel tortuosity. Traditional access by way of the femoroiliac vessels might not be possible in the setting of synchronous iliac occlusive disease.

Coagulopathy as a result of factor V inhibitor after exposure to bovine topical thrombin.

We describe a case of severe coagulopathy after mesenteric revascularization. Laboratory investigation results revealed the presence of plasma inhibitors of factor V believed to result from exposure to bovine thrombin used for intraoperative hemostasis. Vascular and cardiothoracic surgeons commonly use topical thrombin for surgical hemostasis, and many patients undergo multiple exposure.

Platelets inhibit the lysis of pulmonary microemboli.

Using tracings of (125)I-labeled fibrin(ogen) in rodents, we examined the hypothesis that platelets impede the lysis of pulmonary emboli. (125)I-Microemboli (ME, 3-10 micron diameter) lodged homogeneously throughout the lungs after intravenous injection in both rats and mice (60% of injected dose), caused no lethality, and underwent spontaneous dissolution (50 and 100% within 1 and 5 h, respectively). Although lung homogenates displayed the most intense fibrinolytic activity of all the major organs, dissolution of ME was much slower in isolated perfused lungs (IPL) than was observed in vivo.