Blunt aortic injuries in the new era: radiologic findings and polytrauma risk assessment dictates management strategy.

Purpose: Blunt aortic injuries (BAI) have historically been considered an indication for emergent surgical intervention. Nevertheless, the observation that the outcome of the concomitant traumatic injuries has a major impact on prognosis and the rise of thoracic endovascular aortic repair (TEVAR) as an effective therapy for BAI have significantly changed in recent years the treatment algorithm of this condition. Our objective was to identify findings associated with the aortic injury which would be the best predictor of prognosis, with the objective of guiding the decision-making process for selecting the optimal timing of aortic repair.

Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy.

Venous tumor thrombus occurs in 5-10% of patients with renal cell carcinoma. Surgical excision offers the best chance for survival, but is technically difficult. Risk of pulmonary embolism from venous thrombus or tumor thrombus is high, especially with tumors located higher in the inferior vena cava.

Novel percutaneous transcatheter intervention for refractory active endocarditis as a bridge to surgery-angiovac aspiration system.

Guidelines for the treatment of active right-sided endocarditis are not well defined. We report the first novel use of an aspiration catheter system for transcatheter therapy of refractory active right sided endocarditis on a bioprosthetic valve in a high-risk surgical patient as a bridge to surgical intervention.

Use of axillary cannulation for simultaneous endo-occlusion and antegrade perfusion during minimally invasive surgery.

Objective: We aimed to develop an antegrade arterial perfusion method that would allow a single suture line on the heart.

Methods: Using an 8-mm Dacron graft sewn to the right axillary artery, we performed antegrade arterial flow and simultaneous endo-occlusion, as well as the delivery of antegrade cardioplegia.

Results: Five patients underwent right axillary antegrade flow, with intention to use axillary endo-occlusion.

Staged total exclusion of the aorta for chronic type B aortic dissection.

Hybrid techniques using extra-anatomic bypass of critical aortic branches to enable endovascular treatment of complex aortic pathology have been previously described. A staged endograft repair of a complex, chronic Stanford type B aortic dissection with aneurysmal degeneration is reported in a 50-year-old man. The aneurysmal portion of the dissection extended from the distal arch to both common iliac arteries and was covered with an endograft from the ascending aorta to both external iliac arteries.

Endovascular management of iliac rupture during endovascular aneurysm repair.

Background: Inadequate iliac artery diameter, calcification, and tortuosity are associated with increased incidence of iliac injury during abdominal (EVAR) and thoracic endovascular aneurysm repair (TEVAR). Despite careful preoperative assessment and use of iliac conduits, inadvertent iliac rupture is a source of morbidity and mortality. This report details our single-center, 10-year experience with intraoperative iliac artery rupture and describes a successful endovascular salvage technique.

Robot-assisted laparoscopic aortobifemoral bypass: initial experience developing a new program.

Despite improved technology for endovascular treatment of aorto iliac occlusive disease, aortobifemoral bypass (ABF) continues to offer superior long-term patency. In an effort to reduce the morbidity of surgical ABF, multiple minimally invasive techniques have been reported. The da Vinci robot may facilitate the construction of a minimally invasive aortic anastomosis using standard vascular suture techniques.

Endovascular thoracic aortic aneurysm repair: evaluating the utility of intravascular ultrasound measurements.

Purpose: To compare intravascular ultrasound (IVUS) and computed tomography (CT) measurements of aortic diameter for the determination of stent-graft sizes used in thoracic endovascular aneurysm repair (TEVAR).

Methods: A retrospective review was conducted of 71 IVUS measurements performed in 33 patients (17 men; mean age 69 years) undergoing endovascular repair for thoracic aortic aneurysm (TAA). For comparison, an inanimate model of the aortic arch and the great vessels was created; 5 independent operators took multiple blinded IVUS measurements.

Percutaneous endoscopic transgastric jejunostomy: a new approach.

A percutaneous transgastric jejunostomy allows long-term simultaneous gastric decompression and jejunal feedings. We have developed a safe and effective bedside technique for placement of a large-bore (22 French) feeding tube while providing gastric drainage with no mortalities and minimal morbidities. We have modified the push technique used for percutaneous gastrostomies and introduced a cut-away sheath that is placed using a modified Seldinger technique.