List Archives

Wed Oct 17 17:02:14 BST 2007

Let me be clear.   I did not say that I would not consider an  endograft in 
this case.   I stated that I would NOT put an endograft  into this case with 
the information provided in this CT scan.     I have and will continue to make a 
case that CT scanning often does not give  sufficient information to appropr
iately treat the patient.   I have  seen a number of cases, including some in 
print where the CT showed a TRIVIAL  injury, and at the time of the insertion 
of the stent graft, the aortic  injection demonstrated NO INJURY !!!!!   And 
endografts were inserted  anyway.   

In this case, I am not really sure that this really represents an aortic  
tear.   I could offer at least 3 other possibilities for this shadow  on the CT.  
 I also cannot clear the ascending aorta, aortic arch,  branch vessels and 
distal thoracic aorta.      

For Dr. Gross' case, we need better imaging and in my view this is still  the 
aortogram.     We also need to know additional  information regarding the 
patient.  

I also feel very strongly that there are still too many abiding questions  
and issues.   Although I do believe that we will eventually use  endografting in 
the majority of thoracic aortic tears, for a long list of  reasons, we are 
not yet there for this to be a standard.    Such  cases must be on a rigidly 
controlled local and FDA controlled protocol, much  like the carotid endografts 
for ASOD.     

Finally, we will never totally abandon the need for OPEN cases.   NEVER.   In 
every multicenter study, there are cases which had to be  converted to open.  
  AND we have not at this point defined  internationally or in the US, just 
which cases should be open.   

I do know that in many of the cases I have seen in the literature and in  
journals, endografts have been inserted in thoracic aortas (and at great cost)  
in patients that in the pre-endograft days, would NEVER have had an open  
procedure for such a trivial intimal tear.     We must not  let technology drive 
judgement.  

k

************************************** See what's new at http://www.aol.com

List Archives

For your convenience, find the Trauma List Archive Below

Traumatic aortic transections and stents