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Biomedical subjects

L A Sanchez

Publications and source records attributed to L A Sanchez.

At least 55 records · Page 3Linked to original sources
PubMed1996

c-MYC oncoprotein production in experimental vein graft intimal hyperplasia.

PURPOSE: The expression of c-MYC oncoprotein in proliferating smooth muscle cells (SMCs) was analyzed in an experimental model of vein graft intimal thickening. METHODS: Superficial epigastric vein grafts were inserted into the femoral arteries of male Sprague-Dawley rats. The vein grafts were harvested at 6 hr, 2 days, 1 week, 2 weeks, and 4 weeks after grafting and were rapidly frozen in liquid nitrogen. Immunohistochemical labeling and morphologic analysis of vein graft sections with a double staining technique were used to identify c-MYC/alpha SMC actin and proliferating cell nuclear antigen (PC10)/alpha SMC actin within intimal cells. c-MYC/alpha SMC actin and PC10/alpha SMC actin positive cells were quantitated in the perianastomotic area (R-1) and the body of the graft (R-2) for each time period. Total wall and intimal thickness of perfusion fixed vein grafts were measured with a computer digitized system. RESULTS: Intimal and total wall thickening in the R-1 region peaked at 1 week (27.4 and 579.4 microns respectively) and were significantly thicker (P < 0.01) than the same region at 6 hr after graft implantation (6.0 and 113.5 microns respectively). Staining for c-MYC and PC10 in R-1 was also significantly higher (P < 0.05) at 1 week (5.75 and 7.00 positive cells/10 cells, respectively) compared with that at 6 hr (1.5 and 1.33, respectively). The R-1 region stabilized and remodeled over the following 3 weeks, while c-MYC and PC10 staining progressively decreased. In the R-2 region, intimal thickness significantly increased (P < 0.05) from 6 hr (4.0 micrometers) to 1 week (12.0 micrometers) and stabilized, while total wall thickness increased throughout the first week and the difference became significant at 2 weeks (P < 0.05). Staining for c-MYC and PC10 paralleled the staining in R-1 with a significant peak at 1 week (P < 0.05). CONCLUSIONS: c-MYC oncoprotein is expressed early after experimental vein grafting, with peak expression at 1 week. This occurs during a period of maximal intimal thickening, SMC proliferation, and increased expression of PC10. Expression of c-myc protooncogene may contribute to the induction and regulation of SMC proliferation, producing intimal hyperplasia.

Actins↗
PubMed1996

Fluoroscopically assisted thromboembolectomy: an improved method for treating acute arterial occlusions.

We performed bilateral femoral artery dissections in a single 50 kg mongrel dog. Digital fluoroscopic arteriograms documented the luminal diameter of the left iliac and right superficial femoral arteries. Balloon thrombectomy catheter passage was performed through hemostatic sheaths by 12 surgeons. Embolectomy balloons were filled with radiographic contrast material and the balloon catheter diameter was compared with the underlying vessel diameter. The percentage of overdistention of the embolectomy balloon relative to the arterial wall was 23% +/- 5% in the iliac artery and 40% +/- 13% in the femoral artery. Over a 25-month period, we used fluoroscopically assisted thromboembolectomy to treat 21 patients with acute arterial or graft occlusions. As the balloon was gently withdrawn to extract intravascular thrombus, deformities of the compliant balloon profile caused by underlying arterial lesions were identified fluoroscopically and their locations recorded to facilitate further treatment. After initial clot removal in these 21 patients, 15 residual lesions were documented. Repeat thrombectomy (n = 8), balloon angioplasty (n = 3), and placement of intravascular stents (n = 4) eliminated all 15 lesions. Luminal continuity was successfully restored in all 21 of these patients, 10 of whom required distal open vascular reconstruction to correct existing outflow artery disease. Fluoroscopically assisted thromboembolectomy is a simple and safe method for treating acute arterial or graft occlusions in patients with diffuse arteriosclerosis. It minimizes arterial damage and blood loss during balloon thrombectomy and reduces the need for intravascular contrast agents. It also has the potential to facilitate accurate identification, localization, and treatment of significant underlying arterial lesions.

Adult↗
PubMed1996

Comparison of endovascular and conventional vascular prostheses in an experimental infection model.

INTRODUCTION: The causes and management of prosthetic graft infections have been extensively studied for conventional bypass grafts; however, the infectivity and therapy for endovascular graft infections are completely unknown. The aim of this study was to compare the biologic properties of infected aortic grafts when inserted by endoluminal or standard transabdominal techniques. METHODS: Eighteen dogs underwent placement of polytetrafluoroethylene grafts in their infrarenal aortas either by an endovascular technique (8) or a standard interposition technique (10). Endovascular grafts were constructed from polytetrafluoroethylene (3 cm) and two balloon-expandable stents coaxially mounted onto a balloon catheter delivery system. The grafts were inserted through a left carotid arteriotomy under fluoroscopic control. Initially, seven grafts were infected with decreasing inocula of Staphylococcus aureus, starting at 10(7) organisms per ml for 30 minutes and then rinsed briefly (10 seconds) in normal saline solution, until a 50% infective dose for the standard grafts was determined to be 10(2) organisms per ml. After this initial experiment, a second group of 11 dogs were compared at a concentration of 10(2) S. aureus per ml. Five dogs underwent endovascular repair, and six dogs had standard graft interpositions after an identical period of bacterial exposure. All grafts were removed at 2 weeks under sterile conditions and were submitted for quantitative culture analysis. RESULTS: Three of the six dogs (50%) with standard grafts appeared to clear their infections, whereas only one of the five dogs (20%) with an endovascular graft was free of organisms at 14 days. This results was further manifested by statistically significant lower postmortem colony counts in the standard grafts (p < 0.01). CONCLUSIONS: The endoluminal position of the graft and its proximity to the arterial wall do not appear to provide protection against infection. These data suggest that if endovascular grafts become infected, they may be in a disadvantaged position for host defense mechanisms to be effective.

Animals↗
PubMed1996

Endovascular aortounifemoral grafts and femorofemoral bypass for bilateral limb-threatening ischemia.

PURPOSE: Although axillobifemoral bypass procedures have a lower mortality rate than aortobifemoral bypass procedures, they are limited by decreased patency, moderate hemodynamic improvement, and the need for general anesthesia. This report describes an alternative approach to bilateral aortoiliac occlusive disease using unilateral endovascular aortofemoral bypass procedures in combination with standard femorofemoral reconstructions. METHODS: Seven patients who had bilateral critical ischemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascular grafts, which were inserted into predilated, recanalized iliac arteries. The proximal end of the endovascular graft was fixed to the distal aorta or common iliac artery with a Palmaz stent. The distal end of the graft was suture-anastomosed to the ipsilateral patent outflow vessel, and a femorofemoral bypass procedure was then performed. RESULTS: All endovascular grafts were successfully inserted through five occluded and two diffusely stenotic iliac arteries under either local (1), epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9 +/- 3 mm to 30 +/- 7 mm and from 6 +/- 2 mm to 26 +/- 4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely resolved. Procedural complications were limited to one local wound hematoma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months). CONCLUSIONS: Endovascular iliac grafts in combination with standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aortoiliac occlusive disease, particularly when bilateral axillary-subclavian disease is present.

Aged↗
PubMed1996

Immunolocalization and temporal distribution of cytokine expression during the development of vein graft intimal hyperplasia in an experimental model.

PURPOSE: Vein graft stenosis caused by intimal hyperplasia (IH) accounts for 30% to 50% of late bypass graft failures; however, the biochemical mediators of vein graft IH have been poorly defined. We attempted to evaluate the spatial and temporal distribution of five principal cytokines (interleukin-1 beta [IL-1 beta], platelet-derived growth factor-AA [PDGF-AA], basic fibroblast growth factor [bFGF], interferon gamma [INF gamma], and tumor necrosis factor alpha [TNF-alpha]) during the development of IH in a rat vein graft model. METHODS: Rat epigastric vein interposition grafts in the femoral artery were harvested at 6 hours, 2 days, 1 week, 2 weeks, and 4 weeks after the grafting procedure and studied with immunohistochemical and standard histologic techniques. The cytokine expression in the endothelium and media/neointima was quantified as the percentage of immunopositive cells per high-power field. RESULTS: Maximal hyperplasia occurred 2 weeks after the grafting procedure. Peak expression of IL-1 beta and bFGF occurred by 2 days. PDGF-AA expression paralleled the development of IH, peaking at 2 weeks and then declining. TNF-alpha expression increased at 1 week and remained elevated. INF gamma was seen only in control grafts. CONCLUSIONS: The coordinated early release of IL-1 beta and bFGF and the down-regulation of INF gamma seem to trigger an inflammatory response, thereby initiating IH. The process then is propagated by the release of PDGF-AA and TNF-alpha, with concomitant smooth muscle cell proliferation and production of extracellular matrix. It is likely that this complex milieu of local paracrine signaling is required to generate the hyperplastic response seen in failing vein grafts.

Actins↗
PubMed1996

The merit of polytetrafluoroethylene extensions and interposition grafts to salvage failing infrainguinal vein bypasses.

PURPOSE: The purpose of this study was to evaluate the merit of polytetrafluoroethylene (PTFE) extensions and interpositions for the management of failing infrainguinal vein bypass grafts. METHODS: The treatment of 133 failing vein grafts in 125 patients over a 10-year period was retrospectively reviewed. Twenty-two graft-threatening lesions were detected in patients who did not have a usable autogenous vein conduit as determined by preoperative and intraoperative evaluations. A PTFE extension or interposition graft was used for the necessary reconstruction in all cases. RESULTS: Ten lesions were within the vein graft, 11 were proximal to the graft in the femoral or popliteal artery segments, and one was distal to the graft in the popliteal artery. The treatment of these lesions included 19 extensions and three mid graft interpositions. The vein graft lesions developed significantly sooner (mean 10.6+/-2.5 months) after the bypass (p<0.05) than the arterial lesions (mean 28.0+/-6.1 months). The 3-year cumulative secondary patency rate for these vein grafts treated with PTFE extensions or interpositions was 84%+/-8%. This was not significantly different from the 3-year cumulative secondary patency rate for vein grafts treated with vein extensions or interpositions at our institution over the same time period (82%+/-10%). The 3-year limb salvage rates were 95% and 89%, respectively. CONCLUSIONS: These results indicate that PTFE extensions and interpositions can be used successfully to maintain the patency of failing vein grafts and may serve to prolong limb salvage in patients without any usable autogenous vein. Early reintervention with a PTFE conduit in this difficult group of patients is appropriate to salvage a failing vein graft.

Aged↗
PubMed1996

Polytetrafluoroethylene bypasses to infrapopliteal arteries without cuffs or patches: a better option than amputation in patients without autologous vein.

PURPOSE: This study was undertaken to evaluate our results of polytetrafluoroethylene (PTFE) tibial and peroneal artery bypasses done for limb salvage. METHODS: Within a group of patients undergoing infrainguinal limb salvage bypasses at our institution between January 1986 and May 1995, 63 patients faced an immediate amputation, had no autologous vein on duplex examination and operative exploration, and had only a tibial or peroneal artery as an outflow vessel for bypass. Most of these patients (82%) had two or more prior ipsilateral infrainguinal bypasses. These 63 patients underwent 66 PTFE bypasses to a tibial or peroneal artery without a distal anastomotic vein cuff or an adjunctive arteriovenous fistula. Our results were then compared with those reported from infrapopliteal (crural) bypasses performed with alternate autologous vein sources or PTFE in conjunction with various recommended adjuncts. RESULTS: The 3- and 5-year cumulative primary graft patency rates for our PTFE infrapopliteal bypasses were 39%+/-7% and 28%+/-9%, respectively. Secondary graft patency rates were 55%+/-8% and 43%+/-10% at 3 and 5 years, respectively. Limb salvage rates were 71%+/-7% at 3 years and 66%+/-8% at 5 years. Two-year actuarial patient survival rate was only 67%+/-7%. CONCLUSIONS: These results indicate that a PTFE bypass to an infrapopliteal artery remains a worthwhile option in patients without usable autologous vein. The secondary patency and limb salvage rates were acceptable in this setting and were not significantly different from the best results reported with prosthetic tibial/peroneal bypasses with distal vein cuffs or patches (74% at 1 year; 58% at 3 years), arteriovenous fistulas (71% at 1 year) or composite arm vein grafts (39% and 29% at 3 and 5 years, respectively).

Actuarial Analysis↗
PubMed1996

Endovascular graft repair of penetrating subclavian artery injuries.

PURPOSE: Penetrating subclavian arterial injuries are often difficult to treat. Standard surgical techniques require wide exposure and dissection in traumatized areas, which is often challenging. This report summarizes the early results of endovascularly placed stented grafts for the treatment of penetrating subclavian arterial trauma. METHODS: Six patients with penetrating injuries of the subclavian artery had stented grafts inserted to repair five pseudoaneurysms and one arteriovenous fistula. The stented grafts consisted of a polytetrafluoroethylene graft sutured over a balloon-expandable Palmaz stent. The devices were inserted from an ipsilateral brachial arteriotomy and deployed using fluoroscopic guidance in the operating room. RESULTS: Immediate success was obtained in all procedures (100%). All patients continue to have patent grafts with a follow-up ranging from 7 to 30 months (mean 19 months). The only procedure-related complication was the need for a brachial artery patch angioplasty at the site of device insertion in the first patient. There was one other patient who developed a stent fracture at 8 months; a second stent was inserted. Duplex studies up to 24 months later show no recurrence in this patient. CONCLUSIONS: Endovascular stented grafts offer an effective, less invasive alternative to standard techniques in treating traumatic arterial lesions. Early results are encouraging, but long-term follow-up will be necessary to fully delineate the effectiveness of this technique.

Adult↗
PubMed1996

Pharmacoeconomics and formulary decision making.

Pharmacoeconomic assessment of formulary actions has become increasingly common in local, national, and international formulary decision making. Tactics for managing medication use include formulary management and drug policies. Pharmacoeconomic data can provide support for these formulary decisions. For example, pharmacoeconomic data can support the inclusion or exclusion of a drug on or from the formulary and support practice guidelines that promote the most cost-effective or appropriate utilisation of pharmaceutical products. Various strategies can be used to incorporate pharmacoeconomics into formulary decision making. These include using published pharmacoeconomic studies and economic modelling techniques, and conducting local pharmacoeconomic research. Criteria for evaluating the pharmacoeconomic literature, suggestions for employing economic models, and suggested guidelines for conducting pharmacoeconomic projects are discussed. Although most formularies are viewed as cost-containment tools, formularies should not be a list of the 'cheapest' alternatives. Today's formulary should contain agents that optimise therapeutic outcomes while controlling cost. Pharmacoeconomic assessments of formulary decisions help to ensure that the agents promoted by our formularies yield the highest outcome per dollar spent. A discussion of the process for formulary action in a US hospital, the influence of pharmacoeconomics on US formularies, and strategies for incorporating pharmacoeconomics into formulary decision making are presented in this paper.

Decision Making, Organizational↗
PubMed1995

Placement of endovascular stented grafts via remote access sites: a new approach to the treatment of failed aortoiliofemoral reconstructions.

Endovascular grafting is a technique that combines the use of intravascular stents and prosthetic grafts to fabricate devices with unique properties. The purpose of this study is to describe the use of endovascular graft technology in the treatment of failed or failing standard aortoiliofemoral reconstructions. Over a 15-month period five patients with limb-threatening ischemia and failed aortofemoral or iliofemoral reconstructions underwent successful placement of six endovascular grafts to revascularize seven severely ischemic lower extremities. Standard thin-walled 6 mm polytetrafluoroethylene grafts and Palmaz balloon-expandable stents were used to fashion each reconstruction. In addition to the primary endovascular grafts, three patients underwent immediate femoropopliteal bypasses to improve distal outflow and one patient had a femorofemoral bypass graft to restore circulation to the contralateral ischemic extremity. The ankle/brachial indices of all patients significantly improved after the procedure (from a mean of 0.32 to a mean of 0.75) and all grafts are patent to date (mean follow-up 10 months). There were no deaths or limb loss in this group of patients. These favorable results indicate that this minimally invasive approach, which permits a new arterial graft to be inserted through a remote access site, is a valuable method for providing unobstructed arterial inflow after aortoiliofemoral graft failure. This procedure may be particularly valuable when there are contraindications to the use of axillary arteries or the thoracic aorta as alternatives to complex reoperative abdominal aortic surgery.

Aged↗
PubMed1995

Transfemoral endovascular repair of iliac artery aneurysms.

PURPOSE: This report evaluates the application of transfemoral endovascular repair of iliac artery aneurysms. PATIENTS AND METHODS: Over a 20-month period, 11 patients with serious comorbid illnesses and a total of 14 iliac artery aneurysms were treated with endovascular grafts composed of polytetrafluoroethylene conduits combined with balloon expandable iliac artery stents (Palmaz). Nine right common, 3 left common, and 2 right internal iliac artery aneurysms were treated. The patients were men between 58 and 89 years of age (mean 72). Eight patients had isolated aneurysms and 3 had multiple iliac artery aneurysms. RESULTS: Endovascular iliac grafts were successfully placed in all 11 patients. No procedural deaths occurred. Follow-up ranged from 3 to 21 months (mean 11). No acute or late graft thromboses occurred. CONCLUSIONS: Transluminally placed endovascular stented grafts can be used to successfully exclude iliac artery aneurysms from the circulation while maintaining lower-extremity arterial perfusion. However, longer follow-up in more patients is necessary to confirm the durability of this technique.

Aged↗
PubMed1995

Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia: preliminary report.

PURPOSE: Occlusive disease of the aortoiliac segment may lead to limb-threatening ischemia, if coexisting disease is present in the femoral, popliteal, or tibial arteries. The combined treatment of severe aortoiliac and infrainguinal disease with standard techniques may be hazardous or contraindicated in patients with multiple previous reconstructions, severe comorbid medical illnesses, or both. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease. METHODS: Seventeen patients with multilevel aortoiliofemoral limb-threatening occlusive disease had an ESG inserted to treat long-segment occlusive disease followed by a conventional surgical bypass. ESGs originated from the aortoiliac junction (seven) or the common iliac artery (10) and were inserted into the common femoral (nine), superficial femoral (four), or deep femoral (four) artery. ESG lengths ranged from 16 to 30 cm (mean, 21 cm). Conventional surgical bypasses were constructed from polytetrafluoroethylene (15) or saphenous vein (two) and extended to the popliteal (12), tibial (two), or contralateral femoral (three) arteries. RESULTS: Technical success in graft insertion was achieved in 17 (94%) of 18 attempted ESG procedures. The 1-year primary and secondary cumulative patency rates for ESGs were 94% +/- 10% and 100%, respectively, whereas the 1- and 2-year patency rates for the extravascular grafts were 92% +/- 10% and 100%, respectively. Four patients had minor postprocedure complications (23%), and no deaths occurred. One patient lost his limb at 16 months because of severe pedal sepsis. CONCLUSIONS: Transluminally placed stented grafts in combination with conventional surgical infrainguinal bypasses are a technically feasible and potentially safe option for the treatment of limb-threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long-term follow-up will be necessary before widespread application of this technique is advocated.

Adult↗
PubMed1995

Human transluminally placed endovascular stented grafts: preliminary histopathologic analysis of healing grafts in aortoiliac and femoral artery occlusive disease.

PURPOSE: The purpose of this study was to perform a preliminary histopathologic analysis of explanted human endovascular stented grafts from patients treated for occlusive disease. METHODS: Over a 16-month period, 26 endovascular stented grafts were placed in 21 patients with limb-threatening ischemia caused by aortoiliac or femoral artery occlusive disease. All grafts were inserted through open arteriotomies remote from the region of primary disease. During the follow-up period, two patients died of preexisting heart disease 2 weeks and 7 months after grafting, and a portion of their endovascular grafts were the surrounding artery was explanted. Specimens from five other endovascular grafts were obtained during surgical revision for graft stenosis after 3 and 6 weeks and for outflow artery stenosis after 3, 5, and 6 months. All specimens were formalin fixed and studied with hematoxylin and eosin and trichrome staining and immunohistochemically for factor VIII-related antigen, alpha actin smooth muscle, macrophage antigen (MAC-387) and PC-10 (a mouse monoclonal antibody which specifically recognizes proliferating cell nuclear antigen in paraffin sections). RESULTS: Three weeks after placement of the stented grafts, organizing thrombus was present on both surfaces of the expanded polytetrafluoroethylene (PTFE) grafts. At 6 weeks, evidence of a neointima with overlying endothelium was seen in the perianastomotic region, and 3 months after grafting it was seen 1 to 3 cm from the anastomosis. The specimen explanted at 5 months demonstrated factor VIII-positive cells 8 cm from the anastomosis. The histopathologic condition of the external capsule appeared to vary, depending on the presence or absence of an external wrap on the PTFE graft and on which layer in the arterial wall the graft was inserted. A foreign body reaction characterized by multinucleated giant cells was seen adjacent to wrapped grafts or around those placed in an intraadventitial plane. Grafts inserted within the media were surrounded by orderly, arranged, smooth muscle cells and few mononuclear cells. Extensive smooth muscle cell proliferation (PC-10 activity) was not seen within native artery atherosclerotic plaques peripherally displaced and external to prosthetic endovascular grafts. CONCLUSIONS: These preliminary observations on the healing of PTFE endovascular stented grafts in human beings demonstrate limited plaque hyperplasia and the presence of endothelial cells on the luminal surface remote from the graft-artery anastomosis. It is unclear whether this is a unique manifestation of healing in prosthetic grafts inserted within the walls of arteries.

Actins↗
PubMed1995

Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

OBJECTIVES: Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients. PATIENTS AND METHODS: Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16[17%]), epidural (42[43%]), or general (38[40%]) anesthesia. RESULTS: Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%. CONCLUSIONS: This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction.

Adolescent↗
PubMed1994

Transluminally placed endovascular stented graft repair for arterial trauma.

PURPOSE: Intravascular stents have become important tools for the management of vascular lesions; however, stents in combination with vascular grafts have only recently reached clinical application. This report describes an experience with stented grafts for the treatment of penetrating arterial trauma. METHODS: Seven transluminally placed stented grafts were used to treat one arteriovenous fistula and six pseudoaneurysms. These grafts were successfully inserted percutaneously or through open arteriotomies that were remote from the site of vascular trauma. The devices were composed of balloon-expandable stainless steel stents covered with polytetrafluoroethylene grafts. RESULTS: Patency up to 14 months was achieved (mean follow-up 6.5 months) with these stented grafts. The use of stented grafts appears to be associated with decreased blood loss, a less invasive insertion procedure, reduced requirements for anesthesia, and a limited need for an extensive dissection in the traumatized field. These advantages are particularly important in patients with central arteriovenous fistulas or false aneurysms who are critically ill from other coexisting injuries or medical comorbidities. CONCLUSIONS: The use of stented grafts already appears justified to treat traumatic arterial lesions in critically ill patients. Although the early results with the seven cases in this report are encouraging, documentation of long-term effectiveness must be obtained before these devices can be recommended for widespread or generalized use in the treatment of major arterial injuries.

Adult↗