List Archives

Tue Mar 20 22:16:57 GMT 2007

1.    First, in all due respect the CTA is a SCREENING  tool, and STILL IS 
WITH THE FASTER SCANNERS.    I continue to see  far too many VOMITS from CT and 
CTA in the thoracic aorta.    

2.    Your hospital and your surgeons are in a better  position at your 
trauma center to approach this patients management and timing  of treatment than is 
the "Heart" Hospital.  For a long list of  reasons.  

3.    This patient is YOUNG.   It is probable  that his aorta is less than 22 
mm in diameter.  If so, the ONLY approved  endograft is far too big and you 
risk enfolding, etc. With our current  knowledge, unless this patient is really 
high risk, I would NOT recommend or  support an endograft.    

4.    Because this patient is young and his aorta will  dilate with age, I 
WOULD NOT put in an endograft for the long term unknowns of  endografting.      

5.    Delay in surgery is appropriate in some patients,  but do not delay too 
long if you are going to do him early.    If  you delay more than 3 days, you 
might wish to delay for 6 weeks or  more.    The delay in surgery categories 
and decisions were made  during the days when decision trees were made from 
aortography, NOT  CTA.   DO NOT MAKE A DECESION TO WAIT FOR DELAYED REPAIR BASED 
ON THE  CTA.   Far too little supporting literature to defend you in  court.  

6.    Just bite the bullet and do what is  SAFEST.   Do an aortogram.   Make 
a decision about early or  delayed treatment.   Do the treatment in YOUR  
hospital.    

k

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