List Archives

Thu Oct 18 14:47:36 BST 2007

Miranda

You rely on collaterals (not solely the vertebral).  In all our
thoracic stent grafts, traumatic or otherwise, we have only had to
revascularise the left subclavian once (via the left carotid) for left
arm 'claudication' symptoms.

I have a patient with a traumatic arch injury who had a debranching
and carotid-carotid cross-over where we covered the left carotid and L
subclavian who has mild claudication int he left arm but wisely does
not want anything done.  Most people have adequate collaterals or are
not manual laborers such that they would notice.

Regards

Karim

On 18/10/2007, Miranda Voss <mvossak at yahoo.co.uk> wrote:
> Karim,
>
> Pls excuse very basic question, but if you cover the
> subclavian do you need to revascularise the arm or
> would you rely on collateral from vertebral?
>
> Miranda
>
>
> Ken
>
> Of course you need a lot more information than a
> single bad reformat
> before proceeding.  However if it is as
> straight-forward as it looks
> (few centimetres distal to the L subclavian), then I
> think now
> stent-graft is the procedure of choice.  I would plan
> to cover the
> subclavian.  Probably choose a Medtronic or Gore
> device for
> conformability although this aorta does not look too
> kinked..
>
> Karim
>
> On 17/10/2007, KMATTOX at aol.com <KMATTOX at aol.com>
> wrote:
> > I had looked at the ppt on my blackberry, now I have
> looked at it on
>  my big
> > computer.    I definitely would NOT proceed with a
> stent at this
>   point, for I
> > could make a case that this is not an aortic
> transection.    This
>  particular
> > cut leaves a lot to be desired  and raises more
> questions than it
>  answers.
> > Need better cuts or  an aortogram.
> >
> > BE CAREFUL.
> >
> > k
> >
> >
> >
>
>
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