Can we rely on mediastinal widening on chest radiography to identify subjects with aortic injury?

Widening of the mediastinum on chest radiography is widely promoted as a useful criterion for detecting aortic injury. We sought to determine the reliability, sensitivity, and specificity of this sign. The initial chest radiographs from 30 subjects with aortic injury and 47 controls were independently reviewed by six radiologists, who were blinded to diagnosis.

An evaluation of commonly employed central venous catheter kits and their potential risk for complications of excess guidewire introduction.

Study Objective: To evaluate the components of commonly used central venous catheter kits with respect to the potential for guidewire-mediated complications during catheter placement.Prospective, nonrandomized, observational study.

Setting: Six academic hospitals across the United States.

Percutaneous arterial closure devices.

Advances in interventional angiography such as covered stent technology and adjunctive anticoagulation and antiplatelet therapy for arterial recanalization have reached the margins of percutaneous application. In these circumstances, compression methods of arterial closure require prolonged compression or long arterial sheath dwell times that increase procedural time, complication rates, and patient discomfort. Percutaneous arterial closure devices offer the potential of rapid hemostasis and shorter times to ambulation and discharge.

Management of traumatic rupture of the thoracic aorta in pediatric patients.

Background: Traumatic rupture of the thoracic aorta (TRA) in the pediatric population is uncommon. Management of TRA in general has evolved to include selective nonoperative and endovascular stent graft approaches, although operative repair remains the standard.

Methods: We conducted a retrospective chart review of patients younger than 16 years of age admitted to a single institution between March 1985 and February 2002.

Treatment of acute thoracic aortic injury with commercially available abdominal aortic stent-grafts.

Traumatic rupture of the thoracic aorta is a common cause of death after vehicle collisions. Associated injuries are common, and patients with lung injury, cardiac contusion, abdominal bleeding, and head injury comprise a group at high risk for conventional surgical or medical therapy. In this particular population, existing commercially available stent-grafts may provide a life-saving repair option.

Angiographic description of blunt traumatic injuries to the thoracic aorta with specific relevance to endograft repair.

Purpose: To describe the precise anatomical location and extent of injury (based on angiography) in a series of patients with blunt thoracic aortic injury (BTAI) and evaluate the findings relative to the potential for endograft repair.

Methods: Thoracic aortograms from 50 trauma patients (37 men; mean age 37 years, range 13-87) with BTAI were retrospectively reviewed. Parameters important for endograft repair were recorded, including the length of the pseudoaneurysm, the distance between the origin of the most distal arch vessel and the pseudoaneurysm, the diameter of the aorta both above and below the pseudoaneurysm, and finally, the curvature of the aorta in the vicinity of the pseudoaneurysm.

Natural history of traumatic rupture of the thoracic aorta managed nonoperatively: a longitudinal analysis.

Background: Although traumatic rupture of the thoracic aorta (TRA) has traditionally been considered a surgical emergency, there exists a small patient population for whom nonoperative management may be appropriate. The short- and long-term consequences of patients managed in a nonoperative fashion remain unclear.

Methods: A review of patients admitted with TRA over a period of 16 years was performed.

Intermittent opacification of an injured artery: a potential aid to superselective transcatheter embolization.

Purpose: To evaluate the prevalence of intermittent opacification, a finding previously described as diagnostic of active bleeding that allows identification of an injured vessel at initial aortography or first-order selective angiography.

Materials And Methods: Retrospective review was performed of 35 consecutive cases that were positive for true or false aneurysm, arteriovenous fistula or malformation, or hemorrhage when a lesion was located beyond a first-order branch of the aorta. An artery that potentially supplied the lesion was considered positive if it filled with contrast material, emptied, and filled again while adjacent vessels demonstrated progressive opacification.