Transcarotid balloon occlusion of the brachiocephalic artery to control bleeding due to sharp injuries of the right subclavian artery

We present a new manoeuvre of transcarotid balloon occlusion of the brachiocephalic artery to control bleeding due to sharp injuries of the right subclavian artery.To control the bleeding, we employed a temporary balloon occlusion of the brachiocephalic artery with a 6.0 Fogarty balloon catheter, which was introduced through ECA retrogradely into the aorta, inflated and pulled back.Described manoeuvre is simple, rapid performed, relatively safe and it is capable of decreasing the morbidity and mortality rates of patients with sharp injuries to the right subclavian artery. Keywords: Sharp subclavian artery injury, Transcarotid balloon occlusion, Balloon bleeding control, Balloon occlusion of the brachiocephalic arter

The outcome of acute occlusion of the abdominal aorta with bilateral limb ischaemia

Background: The purpose of this study was to investigate if the duration of bilateral acute limb ischaemia (BALI) caused by acute aortic occlusion (AAO) affected amputation-free survival. Materials and methods: A retrospective analysis of patients treated between 1 January 2010 and 1 January 2019 for primary occlusion of the infrarenal aorta and BALI was performed. Univariate analysis was used to determine the risk factors for adverse outcomes and compare the duration of BALI between the amputation-free survival and non-amputation-free survival groups. Results: The data from 16 patients with a mean age of 70 ± 11 years were analysed. Predominantly females (56.3%, 9/16) were included in the study. Out of 16 patients, nine had Rutherford grade IIb, and seven had Rutherford grade III at admission. Seven patients underwent revascularisation attempts, two underwent primary major amputation, and seven underwent primary palliation. The mean ischaemia time was significantly shorter in the amputation-free survival group than in the non-amputation-free survival group (7.4 ± 3.5 h vs 22.4 ± 16.3 h, p = .01). The time frame for successful bilateral lower limb revascularisation was <11 h (p = .03). Conclusions: The duration of BALI due to AAO of <11 h was shown to be associated with improved amputation-free survival

Prevalence of the Computed Tomographic Morphological DISSECT Predictors in Uncomplicated Stanford Type B Aortic Dissection

Objective/Background: The aim was to analyse the prevalence of computed tomographic (CT) morphological predictors and their influence on early chronic phase aortic diameter expansion in patients with uncomplicated acute Stanford type B aortic dissection (ATBAD). Methods: This retrospective analysis reviewed the CT imaging of 140 patients admitted with uncomplicated ATBAD to two tertiary centres between March 2003 and April 2016. The prevalence of the following CT-morphological predictors was determined at baseline: primary entry tear (PET) diameter >= 10 mm, its location at the concavity of the aortic arch; maximum descending aortic diameter >= 40 mm; false lumen (FL) diameter >= 22 mm; partial FL thrombosis and a fusiform index (FI) of >= 0.64. Thoracic aortic diameter expansion (ADE) was evaluated in 65 patients treated by best medical therapy (BMT) (median CT follow up 11.6 months). Study end points were predictor prevalence and ADE. Results: A mean +/- SD of 2.45 +/- 1.35 predictors were registered among all 140 patients; 75.0% of patients showed at least two predictors. In 7.9% of patients, no predictor was found. The prevalence of PET at the arch concavity was 18.6%, PET diameter >= 10 mm in 60.0%, maximal descending aortic diameter >= 40 mm in 51.4%, FL diameter >= 22 mm in 47.9%, partial FL thrombosis in 47.9%, and FI >= 0.64 in 20.7%. An ADE >= 5 mm was observed in 38 of 65 patients. Median observed ADE was 5.1 mm (median follow up (FU) 11.6 months, range -3.2-27.4 mm). Regression analysis for multiple predictors showed a basic ADE of 2.5 mm plus 1.9 mm per predictor at the median FU of 11.6 months (2.5 mm +/- 1.9; 95% confidence interval CI = 0.2-5.2 mm +/- 0.7-3.0 mm; p=.003). Conclusion: In the majority of patients, at least one of the investigated morphological predictors of disease progression in uncomplicated ATBAD was detected. An ADE >= 5 mm affected 38 of 65 BMT patients. CT based predictors help to define TBAD patients at risk of progression. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved

Thoracic Endovascular Aortic Repair (TEVAR) First in Patients with Lower Limb Ischemia in Complicated Type B Aortic Dissection: Clinical Outcome and Morphology

Acute Type B aortic dissection (TBAD) can cause organ malperfusion, e.g., lower limb ischemia (LLI). Thoracic endovascular aortic repair (TEVAR) represents the standard treatment for complicated TBAD; however, with respect to LLI, data is scant. The aim of this study was to investigate clinical and morphological outcomes in patients with complicated TBAD and LLI managed with a &ldquo;TEVAR-first&rdquo; policy. Between March 1997 and December 2021, 731 TEVAR-procedures were performed, including 106 TBAD-cases. Cases with TBAD + LLI were included in this retrospective analysis. Study endpoints were morphological/clinical success of TEVAR, regarding aortic and extremity-related outcome, including extremity-related adjunct procedures (erAP) during a median FU of 28.68 months. A total of 20/106 TBAD-cases (18.8%, 32&ndash;82 years, 7 women) presented with acute LLI (12/20 Rutherford class IIb/III). In 15/20 cases, true lumen-collapse (TLC) was present below the aortic bifurcation. In 16/20 cases, TEVAR alone resolved LLI. In the remaining four cases, erAP was necessary. A morphological analysis showed a relation between lower starting point and lesser extent of TLC and TEVAR success. No extremity-related reinterventions and only one major amputation was needed. The data strongly suggest that aTEVAR-first-strategy for treating TBAD with LLI is reasonable. Morphological parameters might be of importance to anticipate the failure of TEVAR alone

Dynamic Morphology of the Ascending Aorta and Its Implications for Proximal Landing in Thoracic Endovascular Aortic Repair

In this study, we assessed the dynamic segmental anatomy of the entire ascending aorta (AA), enabling the determination of a favorable proximal landing zone and appropriate aortic sizing for the most proximal thoracic endovascular aortic repair (TEVAR). Methods: Patients with a non-operated AA (diameter Results: A total of 100 patients were enrolled (53% male; median age 82.1 years; age range 76.8–85.1). Analysis of the dynamic plane dimensions of the AA during the cardiac cycle showed significantly higher systolic values than diastolic values (p p p Conclusions: The entire AA showed greater systolic than diastolic aortic dimensions throughout the cardiac cycle. The mid-ascending and distal-ascending segments showed favorable forms for TEVAR using a regular cylindrical endograft design. The most proximal segment of the AA showed a pronounced conical form; therefore, a specific endograft design should be considered