Ascending Aortic Arch Injury

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Professor,

Your reply leads me, along with some other thoughts I have, to question the
philosophy of the science behind the clinical management in these
situations. You state that you should never stent these lesions. Supposing
an appropriate device was developed, with clear theoretical advantages for
the patient. At what point does the use of such a device cease to be an
experiment, therefore part of a trial in accordance with the principles of
the Declaration of Helsinki, and become accepted clinical practice? In Las
Vegas in your excellent summing up you stated that such endovascular
technology was coming. How should it be introduced, and at what point does
clinical acumen take precedence over the conclusions of a properly conducted
scientific trial? A drug is required to prove that it is at least as good as
conventional therapy, why not a device?

The real question I am asking here is: When is an experiment not an
experiment?

Respectfully,

Guy Jackson
London, UK.


----- Original Message ----- 
From: <KMATTOX at aol.com>
To: <trauma-list at trauma.org>
Sent: Monday, January 08, 2007 10:54 PM
Subject: Re: Ascending Aortic Arch Injury


> In a message dated 1/8/2007 4:46:49 P.M. Central Standard Time,
> karim at trauma.org writes:
>
> Repeat  CT today shows dissection flap in ascending aorta.  Starts above
left
> coronary.  No extension into neck vasculature (yet).
> Not visible on initial CT.
>
> BP = 160 systolic -> controlled  with labetalol.
>
> Now what?
> Do NOT rely on the CT for a diagnosis.   Motion artifacts in this  area
are
> well recognized.    PLEASE do a FORMAL  aortogram.    And then we will
> reconsider.
>
> Conservative management? - NOT if it is a real injury   -   CPB and repair
of
> ascending aorta.  canulate via groin, not  ascending aorta.
>
>
> Stent?   NEVER NEVER NEVER to this location
>
> Open repair? Technique?   YES, if this is a real injury, but  CT does NOT
> make the diagnosis.     NO hypothermia,   Just regular CPB,  Clamp and fix
it,
> prob primary repair, it may  require a graft.    TOTAL CPB,with bicaval
> canulation, NOT a  single stage catheter in RA.
>
> k
>
>
>
>
> --
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