List Archives

Thu Mar 22 00:09:00 GMT 2007

Oy.

I have to agree with Ken; not with the tired,
misguided, incorrect, invalid, disproved, and worn-out
arguments he always seems to make about CTA versus
aortography whenever we discuss this issue (I won't
engage you in this debate Ken, the data speaks for
itself), but because it sounds like this guy SHOULD
HAVE gotten a definitive repair if there was no other
interceding situation.

In my experience, endografts are most useful in:
1.  Unstable or significantly morbid patients in whom
adequate beta blockade cannot be safely achieved to
bridge until definitive repair.
2.  Elderly patients in whom open repair carries a
prohibitively high mortality.
3.  Anybody else who cannot safely get their aorta
repaired by a conventional open technique for whatever
reason.

Endografts are not the perfect solution in young
people and require long term maintenance and follow up
to ensure they don't develop an endoleak or
aortoesophageal fistula.  Many are considering them to
be "bridging" procedures until definitive repair can
be performed (which involves explanting the
endograft).  But the facts are that we don't know what
the long term data on thoracic endografts for trauma
will be yet, but if early experience is any marker my
bias is that it won't be as good as traditional
thoracotomy in the stable patient.

Ben Reynolds, PA-C
Pittsburgh, PA

--- Roy Danks <roydanks at hotmail.com> wrote:

> 1.8 cm to be exact.  An AneuRx iliac-extension stent
> was placed.
> 
> > From: KMATTOX at aol.com> Date: Tue, 20 Mar 2007
> 18:16:57 -0400> To: trauma-list at trauma.org> Subject:
> Re: Thoracic Ao Transection> > 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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