Asunto(s)
Aneurisma Falso/cirugía , Angioplastia , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Tronco Braquiocefálico , Heridas no Penetrantes/complicaciones , Adulto , Disección Aórtica/etiología , Disección Aórtica/patología , Aneurisma Falso/etiología , Aneurisma Falso/patología , Angiografía , Aneurisma de la Aorta Torácica/etiología , Aneurisma de la Aorta Torácica/patología , Femenino , Humanos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Posttraumatic aortic rupture is a potentially lethal injury. Endovascular procedure has recently proved to be a valid option. Timing of the treatment, however, is still a debated issue. We evaluated the feasibility and safety of immediate stent-graft repair of acute posttraumatic aortic injury. METHODS: From 1998 to 2005, 15 patients (11 men and 4 women, mean age 42.3 years) with blunt aortic injury were treated with immediate stent-graft positioning. In patients with clinical and radiologic signs of impending rupture, endovascular treatment was performed in an emergency setting (11 cases). In the 4 remaining patients the aortic lesion was treated after clinical management. When present, immediate life-threatening nonaortic lesions were treated before endovascular stenting (6 cases). In 1 case emergency laparotomy and endovascular procedure were performed simultaneously. Stent positioning was monitored by intraoperative transesophageal echocardiography in all cases. RESULTS: Endovascular procedure was successful in 100% of the patients. Two patients died perioperatively as a consequence of a multiorgan failure. Both patients were in American Society of Anesthetists class V and were in severe intractable hemorrhagic shock before the procedure. Computed tomography scan performed before discharge showed correct positioning of the stent graft and absence of endoleaks in all cases. At a mean follow-up of 29 months (range 1-79) all patients were alive but 1, who died of unrelated cause, and no intervention-related complication had occurred. CONCLUSIONS: Immediate stent-graft repair of posttraumatic aortic injury is a feasible and safe procedure. It allows us to minimize the surgical risks and to treat stable and unstable lesions even when associated lesions would contraindicate traditional surgical intervention.
Asunto(s)
Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular , Heridas no Penetrantes/cirugía , Accidentes por Caídas , Accidentes de Tránsito , Adulto , Anciano , Prótesis Vascular , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Stents , Factores de Tiempo , Resultado del TratamientoRESUMEN
We report two cases of type A acute aortic dissection in which the traditional ascending aorta replacement was completed by aortic arch stenting to achieve a complete treatment and to avoid the risks that are connected to aortic arch replacement. Correct deployment of the stent was evaluated through an endoscope inserted in the transverse arch, which avoided fluoroangiography and the involvement of a radiologic team.
Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Enfermedad Aguda , Adulto , Anciano , Disección Aórtica/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Ecocardiografía Transesofágica , Humanos , Masculino , Stents , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Patients with prosthetic heart valves have a higher risk of developing valve thrombosis and arterial thromboembolism. Antithrombotic therapy in the early postoperative period after biological aortic valve replacement (BAVR) is controversial. The American College of Cardiology/American Heart Association and European Society of Cardiology guidelines recommend the use of warfarin for the first 3 months after BAVR, although the American College Chest Physician guidelines suggest that the recommendations are very weak and that the risk/benefit is unclear. This prospective study investigated the efficacy of postoperative warfarin compared with aspirin in patients after aortic valve replacement. METHODS AND RESULTS: Patients undergoing BAVR between 2001 and 2002 received 2 antithrombotic therapies: 141 patients received warfarin for the first 3 months, and 108 patients received only aspirin. The major end points evaluated were the rate of cerebral ischemic events, bleeding, and survival. There were 3 and 5 postoperative cerebral ischemic events between 24 hours and 3 months for patients treated with aspirin and warfarin, respectively. After 3 months, the incidence of cerebral ischemic events did not differ between the 2 groups. The rate of major bleeding events, the stroke-free survival, and the overall survival rates were not statistically significant between the warfarin and aspirin groups. CONCLUSIONS: There seem to be no advantages in performing early anticoagulation therapy compared with a low-antiplatelet regimen with regard to early cerebral ischemic events, bleeding, and survival. Currently there is no evidence to support the fact that warfarin is more effective than aspirin.