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1.
Updates Surg ; 72(2): 527-536, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32130669

RESUMO

EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.


Assuntos
Aorta , Arteriopatias Oclusivas/terapia , Oclusão com Balão/métodos , Pelve/lesões , Sistema de Registros , Choque Hemorrágico/terapia , Adolescente , Adulto , Arteriopatias Oclusivas/etiologia , Oclusão com Balão/efeitos adversos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Sístole , Índices de Gravidade do Trauma , Adulto Jovem
2.
Cardiovasc Intervent Radiol ; 40(1): 130-134, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27796532

RESUMO

Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.


Assuntos
Tronco Braquiocefálico/lesões , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia , Adulto , Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Humanos , Masculino , Traumatismos Torácicos/complicações , Resultado do Tratamento , Ferimentos não Penetrantes/complicações
3.
Innovations (Phila) ; 10(5): 370-2, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26536079

RESUMO

We present a short case of a total endovascular repair of a ruptured thoracic pseudoaneurysm after previous coarctation aortic conduit bypass surgery. A 67-year-old man with two previous coarctation repairs many years ago was admitted with chest pain, dyspnea, and hemoptysis. Computed tomography showed a rupture in the distal anastomosis of the thoracic extra-anatomic graft. Successful treatment was achieved by placement of an endovascular stent graft between the old graft and the native aorta and with a vascular plug occlusion of the native aorta.


Assuntos
Falso Aneurisma/cirurgia , Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Falso Aneurisma/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Humanos , Masculino , Tomografia Computadorizada por Raios X
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