Laparoscopic versus open donor nephrectomy.
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Humans↗
Biomedical subjects
Ron Balm
Publications and source records attributed to Ron Balm.
Endovascular graft for late iatrogenic vascular complication after anterior spinal instrumentation: a case report.
STUDY DESIGN: Case report. OBJECTIVE: To describe an endovascular treatment option for (late) vascular complications after anterior spinal instrumentation. SUMMARY OF BACKGROUND DATA: Severe progressive scoliosis is a well-known feature in Marfan's disease. Although overall complication rate after surgical correction of the spinal deformity is rather high, late iatrogenic complications are less frequently identified. METHODS: A 40-year-old woman with Marfan's disease reported to our outpatient clinic with dyspnoe d'effort, 20 years after anterior spinal instrumentation of a thoracolumbar scoliosis. Routine screening identified a saccular aneurysm of the descending thoracic aorta. A contrast-enhanced CT scan revealed that the most proximal screw of the construct had perforated the vessel wall and caused a false aneurysm. An endovascular approach to the problem was chosen; by a transfemoral approach, an AneuRx endovascular graft was successfully implanted. RESULTS: The patient had an uneventful postoperative course and was discharged within 5 days. At 5-year follow-up, the patient still has no clinical complaints, nor radiographic leakage nor recurrence of the false aneurysm at contrast-enhanced CT screening. CONCLUSION: Use of an endovascular graft is an adequate alternative for treatment of late vascular complications after anterior spinal instrumentation.
Adult↗
Endovascular management of traumatic ruptures of the thoracic aorta: a retrospective multicenter analysis of 28 cases in The Netherlands.
BACKGROUND: Minimally invasive endovascular treatment of a traumatic rupture of the thoracic aorta is a new strategy in the care of multitrauma patients. We report the experience in The Netherlands with endovascular management of patients with acute traumatic ruptures of the thoracic aorta. METHODS: We reviewed 28 patients with a traumatic thoracic aortic rupture treated with a thoracic aortic endograft between June 2000 and April 2004. All patients underwent treatment at one of the four participating level 1 trauma centers. Data collected included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Follow-up data consisted of computed tomographic angiography and plain chest radiographs at regular intervals. RESULTS: All patients (mean age, 40.9 years; SD, 18.5 years) experienced severe traumatic injury, and the mean injury severity score was 37.1 (SD, 7.8). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 58 minutes (interquartile range, 47-88 minutes). The overall hospital mortality was 14.3% (n = 4), and all deaths were unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during a median follow-up of 26.5 months (interquartile range, 10-34.6 months). Postoperative data showed no severe endovascular graft- or procedure-related morbidity, except for one patient with an asymptomatic collapse of the endovascular graft during regular follow-up. This was corrected by placing a second graft. CONCLUSIONS: This study shows that the results of immediate endovascular repair of a traumatic aortic rupture are at least equal to those of conventional open surgical repair. Especially in these multitrauma patients with traumatic ruptures of the thoracic aorta, endovascular therapy seems to be preferable to conventional open surgical repair.
Aorta, Thoracic↗
Collapse of a stent-graft following treatment of a traumatic thoracic aortic rupture.
PURPOSE: To report a collapsed stent-graft used to treat a traumatic aortic rupture. CASE REPORT: A Gore TAG stent-graft was placed in a 20-year-old man with multiple injuries. Postimplantation computed tomographic angiography (CTA) demonstrated no contrast extravasation and total exclusion of the traumatic rupture. Routine CTA 3 months after implantation revealed a collapsed stent-graft located in the outer curve of the distal aortic arch. A Talent stent-graft was placed successfully within the collapsed prosthesis. Postimplantation CTA demonstrated no contrast extravasation and good apposition of the endograft to the aortic wall. At 6 months, the repair remains secure; there is no sign of graft collapse or endoleak. CONCLUSIONS: Collapse of stent-grafts can occur after treatment for traumatic aortic ruptures; endovascular methods can be used to restore a satisfactory luminal contour.
Accidents, Traffic↗
A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.
BACKGROUND: Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair. METHODS: We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. The outcome events analyzed were operative (30-day) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications. RESULTS: The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 patients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endovascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 percent), resulting in a risk ratio of 3.9 (95 percent confidence interval, 0.9 to 32.9). The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group (17 of 174 patients; 95 percent confidence interval, 5.8 to 15.2 percent) and 4.7 percent in the endovascular-repair group (8 of 171 patients; 95 percent confidence interval, 2.0 to 9.0 percent), resulting in a risk ratio of 2.1 (95 percent confidence interval, 0.9 to 5.4). CONCLUSIONS: On the basis of the overall results of this trial, endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter. Long-term follow-up is needed to determine whether this advantage is sustained.
Aged↗
Aortoesophageal fistula secondary to mycotic thoracic aortic aneurysm: endovascular repair and transhiatal esophagectomy.
PURPOSE: To report a case of aortoesophageal fistula secondary to a mycotic thoracic aortic aneurysm (TAA) successfully repaired by stent-grafting of the descending thoracic aorta. CASE REPORT: A 66-year-old woman with a recent history of hemicolectomy for colon cancer complicated by postoperative infection presented with midthoracic pain, fever, hoarseness, and blood chemistries consistent with an inflammatory process. Imaging showed a widened mediastinum and displacement of the trachea due to a mycotic thoracic aneurysm; endoscopy confirmed a large fistula in the esophageal wall. There was no active bleeding, so an Excluder thoracic endograft was positioned in the aortic arch, partially covering the left subclavian artery origin. Three days later, a transhiatal esophagectomy was performed. Intravenous antibiotic therapy was continued for 6 weeks. At 18 months, a minithoracotomy was performed because of extreme dyspnea. An aneurysm sac hygroma was drained in the thoracic cavity. At 2 years, the patient was well, and there were no signs of infection or dyspnea. CONCLUSIONS: Along with a transhiatal esophagectomy, we suggest that endovascular stent-grafting has a place as a minimally invasive technique in the treatment of aortoesophageal fistula secondary to aneurysm of the thoracic aorta.
Aged↗
Emergency endovascular treatment of thoracic aortic rupture in three accident victims with multiple injuries.
PURPOSE: To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients. CASE REPORTS: Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. Femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took approximately 50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency. CONCLUSIONS: Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.
Accidents, Traffic↗