RESUMEN
Although the management of traumatic injuries to the thoracic aorta has shifted toward endovascular management, the historical standard of care is open reconstruction. Choosing to reoperate when faced with a complication from a prior open repair can be challenging; endovascular management can be a reasonable option in this situation. This report describes a 54-year-old man with a remote history of open surgery for a traumatic injury to the descending thoracic aorta who underwent endovascular aortic stent graft placement for coverage of extrathoracic graft extension with pseudoaneurysm formation and distal embolization. He returned a year later with a type IIIb endoleak with rupture into the posterolateral chest wall. A sec ond endovascular approach was used to successfully reline the graft and exclude the rupture.
Asunto(s)
Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Heridas por Arma de Fuego , Masculino , Humanos , Persona de Mediana Edad , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Implantación de Prótesis Vascular/efectos adversos , Stents/efectos adversos , Procedimientos Endovasculares/efectos adversos , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Prótesis Vascular/efectos adversos , Resultado del Tratamiento , Complicaciones PosoperatoriasRESUMEN
BACKGROUND: Coronary artery disease is the primary cause of death in the United States, with obesity as a leading preventable risk factor. Previous studies have established the beneficial effect of Roux-en-Y gastric bypass on both weight and cardiac risk factors. Further assessment of cardiac function may be accomplished using B-type natriuretic peptide (BNP), which has demonstrated clinical utility in diagnosing congestive heart failure. This study aimed to assess changes in BNP after intentional weight loss through gastric bypass surgery. METHODS: Plasma volume, weight, and BNP were measured preoperatively and at 3, 6, and 12 months postoperatively for 101 consecutive patients undergoing laparoscopic gastric bypass surgery by a single surgeon in an academic medical setting. Outcomes were compared by matched t-test. Multivariable linear regression and Pearson's correlation were used to examine predictors of pro-B-type natriuretic peptide (NT-proBNP) concentration. RESULTS: The concentration of BNP increased significantly from a mean preoperative level of 50.5 ng/l to postoperative levels of 73.9 ng/l at 3 months (P=0.013), 74.3 ng/l at 6 months (P<0.001), and 156.3 ng/l at 12 months (P<0.001). In addition, excess weight loss was the only statistically significant predictor of increased BNP concentration (odds ratio, 1.483; P<0.05). CONCLUSION: Gastric bypass leads to significant excess weight loss and surprisingly increased BNP concentrations. Correlation of BNP increase with weight loss suggests an additional novel mechanism for surgically induced weight loss.