Browsing by Subject "Endovascular repair"

Now showing 1 - 3 of 3
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    Contemporary Management of Axillo-subclavian Arterial Injuries Using Data from the AAST PROOVIT Registry
    (Division of Cardiothoracic and Vascular Surgery and General Surgery, Örebro University Hospital, Sweden, 2021) Guntur, Grahya; DuBose, Joseph J.; Bee, Tiffany K.; Fabian, Timothy; Morrison, Jonathan; Skarupa, David J.; Inaba, Kenji; Kundi, Rishi; Scalea, Thomas; Feliciano, David V.; AAST PROOVIT Study Group; Surgery, School of Medicine
    Background: Endovascular repair has emerged as a viable repair option for axillo-subclavian arterial injuries in select patients; however, further study of contemporary outcomes is warranted. Methods: The American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry was used to identify patients with axillo-subclavian arterial injuries from 2013 to 2019. Demographics and outcomes were compared between patients undergoing endovascular repair versus open repair. Results: 167 patients were identified, with intervention required in 107 (64.1%). Among these, 24 patients underwent open damage control surgery (primary amputation = 3, ligation = 17, temporary vascular shunt = 4). The remaining 83 patients (91.6% male; mean age 26.0 ± 16) underwent either endovascular repair (36, 43.4%) or open repair (47, 56.6%). Patients managed with definitive endovascular or open repair had similar demographics and presentation, with the only exception being that endovascular repair was more commonly employed for traumatic pseudoaneurysms (p = 0.004). Endovascular repair was associated with lower 24-hour transfusion requirements (p = 0.012), but otherwise the two groups were similar with regards to in-hospital outcomes. Conclusion: Endovascular repair is now employed in >40% of axillo-subclavian arterial injuries undergoing repair at initial operation and is associated with lower 24-hour transfusion requirements, but otherwise outcomes are comparable to open repair.
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    Endovascular approach to thrombosed limb of aortoiliac endoprosthetic stent graft following abdominal endovascular aneurysm repair
    (Elsevier, 2022-07-20) Willhite, Sydney R.; Warner, Adam C.; Hain, Julius S.; Nickerson, Margaret C.; Peterson, David A.; Cuddy, Duangnapa S.; Graduate Medical Education, School of Medicine
    The increasing use of endovascular aneurysm repair to treat abdominal aortic aneurysms has mandated solutions to the limitations of this operation, including the requirement for additional procedures. A 64-year-old man had presented with symptomatic thrombosis of the left iliac limb after endovascular aneurysm repair. We have reported the use of an innovative endovascular repair for our patient.
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    Revascularization Outcomes of Acute Limb Ischemia in Patients With COVID-19
    (Elsevier, 2022) Kabeil, Mahmood; Wohlauer, Max; Moore, Ethan; Harroun, Nikolai; Gillette, Riley; Boggs, Shelbi; Motaganahalli, Raghu L.; Judelson, Dejah R.; Sundaram, Varuna; Mouawad, Nicolas J.; Bonaca, Marc P.; Cuff, Robert; Surgery, School of Medicine
    Objective: Acute limb ischemia (ALI) is one of the most catastrophic thrombotic manifestations of COVID-19 resulting in limb loss if not promptly treated. Our goal is to evaluate revascularization outcomes of ALI in patients with COVID-19 who underwent either open or endovascular treatment. Methods: The Vascular Surgery COVID-19 Collaborative started in March 2020 to assess hematological changes of COVID-19. We performed an interim data analysis on 46 patients with COVID-19 associated ALI submitted to the ALI module of the Vascular Surgery COVID-19 Collaborative REDcap database from 10 institutions in the United States. Results: Among the 46 patients included in the analysis, the mean age was 62.2 (standard deviation [SD]: 9.51) years. The majority of patients were male (73.9%). A total of 67.4% were White, 13% were Hispanic, and 4.3% were Black. In total, 93.5% of patients met Rutherford’s criteria of ALI class 2 or 3. On average, patients developed ALI 12.2 (SD: 13.5) days after a positive COVID test. Revascularization was attempted using open thrombectomy in 50.0%, endovascular lysis or thrombectomy in 23.9%, and bypass in 2.2%, and revascularization was not attempted in 23.9% of the patients (Table). Revascularization was successful in 41.3% with symptom resolution and 15.2% with limb salvage but persistent symptoms; 2.2% had minor amputation, 4.3% ultimately had a major amputation, 4.3% required reoperation, and revascularization was unsuccessful in 10.9% of patients. The average length of hospital stay was 13.2 (SD: 13.3) days, the average intensive care unit (ICU) length of stay was 4.66 (SD: 6.85) days, and the average ventilation days was 12.3 (SD: 10.8) days. Overall, in-hospital mortality was 21.7%, 8.7% had major amputation, 8.7% had stroke, 6.5% required major limb intervention, and 2.2% had sepsis. Successful revascularization rate was 62.5% in the 24 patients who underwent open surgery vs 36.4% in the 11 patients who underwent endovascular repair. The average length of stay in the ICU was shorter in the open group (mean = 3.24 days) than in the endovascular group (mean = 8.60 days). Of the 11 patients who had no revascularization attempt, 36.4% died, 18.2% had a major amputation, 9.1% had a pulmonary embolism, and 9.1% had a stroke. Conclusions: COVID-19-associated ALI carries a high mortality. Patients with COVID-19 who develop ALI can be managed successfully with open surgery or endovascular intervention. In our cohort, open revascularization resulted in reduced ICU stay and reduced ventilation days with improved limb salvage than the endovascular group. Further data are needed to develop management algorithms for ALI in patients with COVID-19.