RESUMEN
Traumatic aortic injuries in children and adolescents are rare, and even more rare are blunt traumatic injury to the abdominal aorta in this population. Therefore, there are few reports discussing the presentation and repair of such injuries, especially within the pediatric population. We report the successful repair of traumatic abdominal aortic transection in a 10-year-old female after a high speed MVC. She arrived in extremis with a seatbelt sign and was taken emergently for damage control laparotomy with subsequent postoperative CT findings of aortic transection/dissection at L3 with active extravasation. She immediately underwent open thrombectomy of the bilateral iliac arteries, and repair of her aortic injury with a 12 × 7 mm Hemashield interposition graft extending just distal to the IMA and 1 cm proximal to the aortic bifurcation. There are little data regarding long-term outcomes of pediatric patients undergoing different aortic repair techniques, and further research is needed.
Asunto(s)
Enfermedades de la Aorta , Disección Aórtica , Lesiones del Sistema Vascular , Heridas no Penetrantes , Humanos , Niño , Femenino , Adolescente , Desaceleración , Cinturones de Seguridad/efectos adversos , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aorta Abdominal/lesiones , Enfermedades de la Aorta/cirugía , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/etiología , Heridas no Penetrantes/cirugíaRESUMEN
In those patients requiring urgent hemodialysis, the use of early-access grafts may reduce the need for temporary hemodialysis catheters and their resultant complications such as infection and central venous stenosis. We review a consecutive group of patients undergoing placement of a traditional polytetrafluoroethylene (PTFE) graft as compared with a cohort of patients who underwent insertion of a trilaminate PTFE vascular graft (TPVG). During the period from January 2008 to December 2009, 65 sequential patients received a traditional PTFE graft with 78 subsequent patients having a TPVG inserted. Factors examined included use of temporary hemodialysis catheters during the period of graft maturation, incidence of infection, and primary and secondary graft patency. For all patients, incidence was reported as observed during the first year after graft insertion. With the use of the TPVG, need for temporary hemodialysis catheters was reduced from 91 to 32 per cent, and 1-year overall graft patency was improved from 36 to 77 per cent (P < 0.01). We report that the use of a trilaminate PTFE graft allowed early access, reduced the need for temporary hemodialysis catheters, decreased overall graft complication rates, and significantly improved 1-year patency.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/métodos , Cateterismo Venoso Central/métodos , Fallo Renal Crónico/terapia , Diálisis Renal/métodos , Adulto , Anciano , Derivación Arteriovenosa Quirúrgica/efectos adversos , Cateterismo Venoso Central/efectos adversos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Estimación de Kaplan-Meier , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Dispositivos de Acceso Vascular , Grado de Desobstrucción Vascular/fisiología , Adulto JovenRESUMEN
Boerhaave syndrome is a rare entity which classically presents with perforation and mediastinal sepsis. The patients' outcome is directly related to the length of time required to diagnose and surgically address the syndrome. Atypical presentations can contribute to a delay in recognizing the phenomenon, which portends poorly. The case of a man with postemetic esophageal perforation presenting with a massive left hemothorax is presented. To the authors' knowledge, this is the only case of this type to be described in the literature.