Endovascular stenting of blunt thoracic aortic injury in an 11-year-old

Blunt traumatic thoracic aortic injury in children is very rare. Open surgical repair is the definitive treatment. Thoracic endovascular aortic repair (TEVAR) for trauma has been performed in adults with good outcomes. Its use has been adopted in pediatric population, and its role is evolving. We report a successful TEVAR in a critically injured 11-year-old boy. To our knowledge, this is the youngest patient to be successfully treated with TEVAR.     

Pulsatile dysesthesia and an axillary artery pseudoaneurysm associated with a penetrating axillary artery injury

A patient is presented in whom an uncommon subjective complaint of pulsatile dysesthesia (periodic dysesthesias following a radicular pattern and occurring simultaneously with the transmitted pulse) occurred following a gunshot wound to the axilla. The patient's symptoms were relieved by the surgical obliteration of a pseudoaneurysm of the axillary artery.     

Emergent antegrade endovascular stent placement in a patient with perforated Stanford B dissection via right axillary artery

We present a case of a ruptured chronic Stanford B dissection of the aorta which was successfully treated with a tapered endoprosthesis using the right axillary artery for access. Challenges to endovascular strategies for thoracic aortic pathology include relatively restricted endoprosthesis configurations and problems associated with endovascular access. Especially in younger patients the right axillary artery should be considered as a possible and safe access for antegrade stent placement.     

Endovascular treatment of penetrating injury of axillary vein with Viabahn endoprosthesis

Penetrating injuries of the axillary or subclavian venous system are associated with extensive blood loss and are fatal in more than 50% of cases. Patients are usually unstable and are treated with surgical exploration. We present a case of axillary venous injury that was treated in the operating room with intravenous placement of a self-expanding Viabahn endoprosthesis (W.L. Gore). The device was delivered to the injured site percutaneously via a basilica vein, with immediate control of hemorrhage.     

股动脉长段病变腔内治疗325例体会

目的探讨腔内治疗股动脉长段闭塞的技术问题。方法 2005年3月～2011年2月采用腔内介入治疗股动脉长段闭塞(闭塞长度均≥10.0cm)患者325例(381条肢体);将其治疗前后踝肱指数(ABI)进行比较,并对治疗后临床疗效及动脉通畅率进行统计分析。结果本组技术成功297例,技术成功率91.4%,15例(4.6%)单纯球扩,282例同时置入支架,术前、术后ABI比较,差异有统计学意义(0.31±0.10vs0.72±0.15,P<0.01)。出院时症状明显缓解者276例。随访206例,随访时间30天至50个月,症状复发55例,复发率26.7%,6例膝上截肢,5例膝下截肢,15例足趾截趾,保肢率88.9%;1、3年累积通畅率分别为62.3%、37.2%。结论腔内治疗股动脉长段闭塞微创、安全,近期疗效确切,注意介入技巧可以提高腔内治疗的成功率。     

Endovascular repair of traumatic injuries of the subclavian and axillary arteries

INTRODUCTION: Injury to the subclavian and axillary arteries is uncommon. Standard surgical techniques require wide exposure and dissection in traumatised areas which is often challenging and associated with significant morbidity, and mortality ranges from 5 to 30%. We report our experience with the endovascular treatment of these injuries. METHODS: We retrospectively studied patients with blunt or penetrating (including iatrogenic) injuries to the subclavian or axillary artery between January 2000 and September 2004. Demographic data, mechanism of injury, concomitant injuries, angiographic findings, and treatment method and outcome were recorded. Nine patients with injury to the subclavian or axillary artery were seen at our institution during the study. Two patients underwent interventions, seven patients had lesions amenable to endovascular repair. RESULTS: Immediate success was obtained in all procedures (100%). All patients continue to have patent grafts with a follow-up ranging from 3 to 48 months (mean 22.6 months). The procedure-related complication was the need for a brachial artery pseudoaneurismectomy at the site of device insertion in one patient (14.7%). None of the patient developed a device fracture. CONCLUSION: Endovascular stent-grafts offer an effective, less invasive alternative to standard techniques in treating traumatic arterial lesions, resulting in shorter procedure time and less blood loss than previously reported.     

高危颈动脉狭窄患者的血管腔内治疗

目的探讨高危颈动脉狭窄患者血管腔内治疗的短期疗效和并发症预防。方法对41例高危颈动脉狭窄患者行颈动脉支架植入术,术前狭窄程度为75.0%～98.0%,狭窄长度1.3～3.6 cm,患者均合并一种或多种内科疾病。结果本组均采用脑保护伞及自膨式支架,操作均获得成功,术中颈动脉造影残余狭窄率≤30%。12例患者于术中出现一过性不同程度心率下降,1例患者支架释放后近端出现动脉夹层,1例患者在支架置入后出现失语及右侧肢体偏瘫,无脑出血,经保守治疗14天后症状缓解。随访33例患者,随访时间3～18个月。随访期间,1例死于恶性肿瘤,1例死于心肌梗死,2例出现支架内再狭窄,但无临床症状,其余患者支架无移位,支架内血流通畅,无脑缺血症状。结论对于高危患者,血管腔内治疗近期疗效较好,规范操作可减少并发症的发生。     

Computed tomographic angiography in pediatric blunt traumatic vascular injury

Pediatric vascular injuries are rare but can be difficult to diagnose and challenging to manage. We present our experience with computed tomographic angiography in 3 pediatric patients with vascular injuries secondary to blunt trauma. Computed tomographic angiography is noninvasive, fast, rapidly available in most centers, and can evaluate for other injuries. We present a review of the literature and recommend computed tomographic angiography as the diagnostic tool of choice in the evaluation of pediatric blunt vascular trauma.     

血管内治疗外伤性颈内动脉损伤

目的探讨血管内治疗对外伤性颈内动脉损伤的临床价值。方法16例外伤性颈内动脉损伤患者,经DSA造影证实为假性动脉瘤3例、岩部巨大蛇性动脉瘤及颈内动脉起始部动脉瘤各1例以及颈内动脉海绵窦瘘11例,分别采用可脱落球囊、电解可脱式弹簧圈（GDC）或带膜内支架对损伤部位进行动脉内栓塞治疗。结果对3例假性动脉瘤及1例岩部巨大蛇性动脉瘤患者以可脱落球囊闭塞患侧颈内动脉成功。9例颈内动脉海绵窦瘘（CCF）在保持颈内动脉通畅的情况下采用球囊成功栓塞瘘口,1例CCF予以GDC填塞海绵窦;其余1例CCF两次球囊栓塞均失败,但术后24h患侧凸眼明显回缩,间断按压患侧颈内动脉1周后患者临床症状和体征消失。1例颈内动脉起始部动脉瘤行带膜内支架成功植入,动脉瘤被旷置,颈内动脉保持通畅。结论血管内治疗是外伤性颈内动脉损伤安全有效的治疗方法。     

Endovascular treatment of abdominal aortic aneurysms

BACKGROUND: Endovascular treatment of abdominal aortic aneurysms is a rapidly evolving technique that has gained broad acceptance in the treatment of patients with abdominal aortic aneurysms. METHODS: A review of the English literature was done to determine the short- and long-term outcomes of endovascular repair of abdominal aortic aneurysms. Reports of complications such as endoleak, graft migration, graft limb occlusion, aneurysm rupture, and aneurysm enlargement were evaluated. RESULTS: Short-term results of endovascular repair of abdominal aortic aneurysms are excellent. The necessity for open conversions is less than 5%. The cumulative risk of aneurysm rupture is approximately 1% per year. The coverall incidence of graft limb occlusion was 2.8% in the follow-up period. The cumulative risk for a secondary procedure was 12% at 1 year, 24% at 2 years, and 35% at 3 years. Moderate and severe neck angulation was associated with an increased incidence of adverse events in the follow-up period. Endografts have the potential to become infected and develop aortoduodenal fistula. The treatment of ruptured aneurysms with endovascular grafts has been successful and a technique that is increasingly used. CONCLUSION: Endovascular treatment of abdominal aortic aneurysm is an effective technique with excellent short-term results. The long-term results remain to be determined. Ongoing surveillance is necessary to avoid late complications of aneurysm rupture.     

Use of a silicone T-tube for management of a tracheal injury in a patient with cervical blunt trauma

A 71-year-old woman fell forward hitting the anterior part of her neck against a table. Bronchoscopy revealed deformation of the cartilage crescent in the cervical trachea (suggestive of cartilage contusion) and a longitudinal tear in the membranous region. Because subcutaneous emphysema and dyspnea developed and progressed, we made a tracheostomy and inserted a silicone T-tube through the stoma to relieve intraluminal pressure. This then served as a stent for the airway after the patient had progressed through the acute stage. The subcutaneous emphysema and pneumomediastinum abated gradually during the 7 days after insertion of the T-tube, which remained in the cervical trachea as a tracheal stent for 2 months thereafter. The T-tube is easy to manage and can be inserted through the stoma without major surgery. As an alternative to tracheotomy, the T-tube is nonirritating, allows speech, aspiration of sputum, and respiration through the nasopharynx, and in general requires little if any special maintenance or cleaning. Furthermore, a relatively long T-tube can be used, and so the stent can occupy a longer section of the trachea than can a tracheostomy tube. We recommend the placement of a T-tube to provide a useful stent for cervical tracheal injury.     

Anaphylaxis due to suxamethonium in a 7-year-old child: a 14-year follow-up with allergy testing

In 1973 a 7-year-old girl had anaphylactic reactions after two general anaesthetics. In-vitro testing with the leucocyte challenge histamine release test showed a strong response to suxamethonium, and other tests indirectly suggested an allergic mechanism. The conclusion was that this was an allergy to suxamethonium. Further blood was sent for testing against a range of neuromuscular blockers, but the patient was 'lost' until she re-appeared 14 years later as an antenatal patient. In-vitro testing was repeated against suxamethonium and all the available neuromuscular blockers after delivery. The radio-allergosorbent test for allergen-specific IgE antibodies was performed on newly collected serum and that which had been stored for 13-14 years. Skin testing was also performed. The results remain positive and suggest a degree of allergy to all the neuromuscular blockers with the possible exception of vecuronium. The radio-allergosorbent test was negative in the patient's baby.     

孤立性髂动脉瘤36例的临床诊断和治疗

目的提高对孤立性髂动脉瘤（isolated iliae artery aneurysm,IIAA）的认识,总结临床诊断和治疗经验。方法回顾性分析1983年1月至2006年3月期间收治的36例IIAA的临床资料。无症状患者17例,有症状患者19例。择期手术治疗33例,急诊手术3例。治疗措施主要包括动脉瘤切除和动脉重建术。辅助手术包括输尿管松解术和输尿管切断再缝合。结果择期手术术后发生切口延期愈合1例,臀肌跛行2例,下肢运动和排尿障碍1例,均经药物保守治疗,症状减轻和消失,其余患者均康复良好出院。急诊手术3例于术后死亡。结论IIAA临床罕见,破裂出血死亡率高,早期诊断和手术治疗是降低死亡率的关键。微创血管腔内治疗术是值得推荐应用的方法。     

腔内修复主动脉弓动脉瘤或夹层动脉瘤14例

目的探讨腔内修复主动脉弓动脉瘤或夹层动脉瘤的疗效。方法回顾性分析2003年6月至2004年8月腔内修复主动脉弓动脉瘤或夹层动脉瘤14例的临床资料。其中,DebakeyⅢ型主动脉夹层动脉瘤(aorticdissectionaneurysm, ADA)12例,动脉瘤2例。8例ADA直接行腔内修复,覆盖左锁骨下动脉开口;另4例ADA和2例动脉瘤接受辅助性右左颈总动脉、左颈总左锁骨下动脉旁路联合腔内修复。结果14例均取得技术成功。1例动脉瘤患者腔内修复术后并发缺血性脑卒中死亡。生存的13例围手术期和随访期间(1 ~14个月,平均11个月)无神经系统或肢体缺血性并发症。3个月CT证实所有ADA患者原发破口封闭。存活动脉瘤患者术后1个月CT显示瘤腔内血栓形成。结论腔内修复主动脉弓动脉瘤或夹层动脉瘤是安全、有效的。     

Aortoenteric Fistula After Endovascular Stent Grafting for an Abdominal Aortic Aneurysm: Report of a Case

We report a case of an aortoenteric fistula (AEF) developing after endovascular stent grafting (EVSG) for an abdominal aortic aneurysm (AAA). A 69-year-old male patient with a history of panperitonitis caused by rectal perforation underwent EVSG for an AAA. A follow-up contrast-enhanced computed tomography (CT) scan, done 12 months after the EVSG, confirmed shrinkage of the AAA with no endoleak. However, 19 months postoperatively, an AEF developed between the AAA and the jejunum. Although there was no endoleak on a subsequent CT scan, we noted enlargement of the AAA and inflammatory changes in the surrounding tissue. The patient was treated surgically and discharged in good health 74 days postoperatively. Thus, one should consider the possibility of this devastating complication, even in patients without an endoleak, after EVSG for AAA.