RESUMO
OBJECTIVES: To present a single centers' 7-year experience in the endovascular treatment of acute traumatic lesions of the descending thoracic aorta (ATL of the DTA). MATERIALS & METHODS: Between March 1999 and December 2006, 34 consecutive acute traumatic lesions of the descending aorta (23 men, mean age 44 years) were treated endovascularly. Stentgrafts used were TAG Excluder, Zenith TX2 and Talent. In 23 patients the Left Subclavian Artery (LSA) was covered. Mean procedural duration was 20 to 75 minutes. RESULTS: Exclusion of the rupture site was achieved in all cases with no conversion to open surgery. Overall 30-day mortality was 8.8%. Two patients died on post operative day (pod) 1 and one on pod 22 from cranial injuries. No death or neurological deficit related to the endovascular treatment was reported. Four type I endoleaks required treatment either by balloon reexpansion (n=2) or by additional stentgraft implantation (n=2). In two patients the stentgraft collapsed totally several days postoperatively. Two patients required secondary surgical procedures (iliac access complication and revascularisation of the left subclavian artery n=1). The average follow-up was 43.8 months (1-93 months). No stentgraft related abnormality has been subsequently documented. CONCLUSIONS: The endovascular treatment of ATL of the DTA may offer the best means of therapy in a polytrauma patient.
Assuntos
Angioplastia , Aorta Torácica/lesões , Ruptura Aórtica/cirurgia , Prótese Vascular , Stents , Adolescente , Adulto , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Aortografia , Causas de Morte , Criança , Desenho de Equipamento , Falha de Equipamento , Feminino , Fluoroscopia , Mortalidade Hospitalar , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Reoperação , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada EspiralRESUMO
Saving vital space in less invasive cardiac surgery is of great importance, especially in mitral valve surgery which is sometimes difficult, even with the full sternotomy approach. We present a modification of the venous cannulation protocol we use in less invasive, direct-vision mitral valve surgery through a half-lower partial sternotomy. The superior vena cava is drained with a right jugular vein cannula. For inferior vena cava drainage we use an oval venous cannula which is exteriorized through another small skin incision. These modifications, together with the use of a smaller diameter aortic cannula, provide vital space for surgical maneuvers through a small (810 cm) skin incision.