Resuscitative Endovascular Balloon Occlusion of the Aorta: A Review for Emergency Clinicians

BackgroundNon-compressible torso hemorrhage (NCTH) is difficult to control and associated with significant mortality. Resuscitative endovascular balloon occlusion of the aorta (REBOA) utilizes an infra-diaphragmatic approach to control NCTH and is less invasive than resuscitative thoracotomy (RT). This article highlights the evidence for REBOA and provides an overview of the indications, procedural steps, and complications in adults for emergency clinicians.DiscussionTraumatic hemorrhage can be life threatening. Patients in extremis, whether from NCTH or exsanguination from other sites, may require RT with aortic cross-clamping. REBOA offers another avenue for proximal hemorrhage control and can be completed by emergency clinicians. The American College of Surgeons Committee on Trauma and the American College of Emergency Physicians recently released a joint statement detailing the indications for REBOA in adults. The evidence behind its use remains controversial, with significant heterogeneity among studies. Most studies demonstrate improved blood pressure without a significant improvement in mortality. Procedural steps include arterial access (most commonly the common femoral artery), positioning the initial sheath, balloon preparation and positioning, balloon inflation, securing the balloon/sheath, subsequent hemorrhage control, balloon deflation, and balloon/sheath removal. Several major complications can occur with REBOA placement. Future studies should evaluate training protocols, the role of simulation, and which target populations would benefit most from REBOA.ConclusionsREBOA can provide proximal hemorrhage control and can be performed by emergency clinicians. This article evaluates the evidence, indications, procedure, and complications for emergency clinicians.     

Dissected Aorta Repair Through Stent Implantation trial: Canadian results

Objectives

We describe the Canadian results of the Ascyrus Medical Dissection Stent (AMDS), a novel partially uncovered aortic arch hybrid graft implanted antegrade during hypothermic circulatory arrest to promote true lumen expansion and enhance aortic remodeling.

Three-Dimensional CT Evaluation for Endovascular Abdominal Aortic Aneurysm Repair. Quantitative Assessment of the Infrarenal Aortic Neck

Endovascular grafting of abdominal aortic aneurysms should be offered only to those patients with suitable anatomy. This is especially true at the level of the proximal aortic neck in order to secure long-term proximal fixation. Aortoiliac anatomy is easy to understand conceptually, however, it is difficult to define and measure quantitatively. In this article, we discuss the use of three dimensional computed tomographic angiography to determine aneurysm morphology and select patients for endovascular repair. Specifically, we apply our methods to define and measure angulation of the aorta and iliac arteries. The anatomic definition of the angulation of the proximal aortic neck is emphasized.     

I125 irradiation stent for treatment of hepatocellular carcinoma with portal vein thrombosis: A meta-analysis

PurposeA meta-analysis aimed to systematically evaluate the safety and efficiency of I¹²⁵ irradiation stent placement for patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT).Materials and methodsThe Cochrane library, PubMed/Medline, EMBASE, CNKI, Wanfang Data and CQVIP were systematically screened out from the earliest to December 2019. The qualities of all included studies were assessed. The primary endpoints were the 6-month, 12-month stent cumulative patency rate and 6-month, 12-month, 24-month overall survival rate while the secondary endpoints were the objective response rate of PVTT, main portal venous pressure changes and treatment-related adverse events. Our meta-analysis was conducted using Stata 12.0 software.ResultsTotally seven studies with 1018 patients were included in the final analysis, in which 602 patients received TACE and I¹²⁵ irradiation stent placement, and 416 patients in control group underwent TACE and stent placement without endovascular brachytherapy (EVBT). Meta-analysis showed that the I¹²⁵ irradiation stent improved the cumulative stent patency rates in 6 months [OR = 1.65, 95% CI (1.32–2.05), P < 0.001] and 12 months [OR = 2.55, 95% CI (1.90–3.42), P < 0.001] and the survival rates in 6 months [OR = 1.77, 95% CI (1.41–2.22), P < 0.001], 12 months [OR = 3.14, 95% CI (2.24–4.40), P < 0.001] and 24 months [OR = 7.39, 95% CI (3.55–15.41), P < 0.001]. However, there was no difference in the objective response rate of PVTT [OR = 1.13, 95% CI (0.87–1.48), P = 0.365], main portal venous pressure and the occurrence adverse event [OR = 0.88, CI = 0.72–1.08, P = 0.212] between two groups.ConclusionI¹²⁵ irradiation stent seems to be more effective in treating hepatocellular carcinoma with portal vein tumor thrombosis. The usage of portal vein stent combined endovascular brachytherapy has the potential to act as an alternative therapy for HCC with PVTT. On account of the limitation of studies included, more studies with high-level evidence, such as RCTs, are requisite to support the above promising results.     

Modern Composite Materials and Technical Strategies in Posttraumatic Augmentation Rhinoplasty

The selection of ideal posttraumatic augmentation rhinoplasty materials and technical strategies has always been a pressing challenge.Owing to the complexity of the traumatic nasal anatomical structure,such procedures are more complicated than ordinary cosmetic rhinoplasty.The choice of reconstruction material should emphasize its inherent characteristics,such as biocompatibility,anti-infective ability,strength,and plasticity.With the development of rhinoplasty,the choice of material is less limited and composite materials have become mainstream.This review outlines current composite materials and techniques in posttraumatic augmentation rhinoplasty.     

Neuro-Pathology

Behçet's disease (BD) is a type of vasculitis with a chronic relapsing course that affects arteries and veins of all sizes. Intracranial aneurysms are rare manifestations. We report a patient with the diagnosis of BD, who had a fusiform aneurysm of the internal carotid artery at the level of the sinus cavernosus. He presented with sinus cavernosus syndrome findings. The aneurysm was treated endovascularly.