Endoscopic-assisted aortic replacement of the descending aorta through the 8th intercostal space to preserve collateral vessels: a case report

We present the case of a 75-year-old man with repeated lower limb hematoma caused by consumptive coagulopathy from a type B chronic aortic dissection. His abdominal aorta was replaced with a Y-shaped graft 30  years prior to admission. As his previous aortic stent graft treatment failed, he underwent open surgical prosthetic graft replacement of the descending aorta under deep hypothermia. To reduce intra- and postoperative bleeding, we avoided cutting the ribs and intercostal arteries. The aneurysm was approached only through the 8th intercostal space; however, as the proximal descending aorta was inaccessible from this site, total endoscopic or endoscopic-assisted procedure was performed to approach the proximal descending aorta. All intercostal arterial orifices were securely closed by suture. The postoperative course was uneventful, and he was discharged home on postoperative day 11. The endoscopic surgery reduced impairment of collateral vessels during surgery and might have reduced the risk of paraplegia.
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

Related Links:

CONCLUSION: The frozen elephant trunk procedure can be used for a single-stage treatment of patients with extensive aortic pathology, due to chronic degenerative aneurysms or post-dissection aneurysms involving the aortic arch and the descending aorta, with acceptable mortality and morbidity. PMID: 32990581 [PubMed - as supplied by publisher]
Source: The Heart Surgery Forum - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Heart Surg Forum Source Type: research
AbstractA 49-year-old woman was found dead in her apartment after a fire began in her building. During the forensic autopsy, 3rd to 4th degree burns were found on the woman ’s body, but there were no indications that she was alive when the fire started. Interestingly, hemorrhagic gastric mucosa erosions, as well as bloody contents in the esophagus, stomach, and intestines, were observed. However, the source of the bleeding could not be found. The cause of death was t herefore determined to be hypothermia with postmortem fire exposure. The cause of the hypothermia could possibly have been high internal blood loss. The...
Source: Forensic Science, Medicine, and Pathology - Category: Forensic Medicine Source Type: research
CONCLUSIONS: Critical incidents lead to longer length of stay in the PACU. Regular inspection and immediate response for critical incidents in the PACU is essential for the maintenance of the quality of the immediate postoperative care. PMID: 32778494 [PubMed - as supplied by publisher]
Source: Journal of Perianesthesia Nursing - Category: Nursing Authors: Tags: J Perianesth Nurs Source Type: research
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely.  When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA.    ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
ConclusionsAs compared to standard of care, systemic therapeutic hypothermia in acute MI patients treated with PCI provided similar mortality with a signal toward more frequent repeat revascularization. Among patients assigned to hypothermia, those effectively achieving the protocol-defined target temperature displayed smaller infarct size.Trial RegistrationPROSPERO, CRD42019138754.
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Conclusion AKI is still a common complication of perinatal asphyxia despite treatment with therapeutic hypothermia. Identification of risk factors associated with the development of AKI in asphyxiated infants would be potentially beneficial to reduce morbidity and mortality. Besides perinatal risk factors, initial and 12-hour lactate concentrations can be used for the early prediction of AKI. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: American Journal of Perinatology - Category: Perinatology & Neonatology Authors: Tags: Original Article Source Type: research
Authors: Buraimoh MA, Nash A, Howard B, Yousaf I, Koh E, Banagan K, Gelb D, Schreibman D, Ludwig SC Abstract Background: Perioperative hypothermia is linked to multiple postoperative complications including increased surgical bleeding, surgical site infection, myocardial events, and increased length of hospital stay. The purpose of this study is to determine the effects of forced-air warming blanket position, above the shoulders versus under the trunk/legs, on intraoperative core body temperature and perioperative complications in elective lumbar spine surgery. Methods: After IRB approval, patients were enrolle...
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Source: Committee for Tactical Emergency Casualty Care (C-TECC). Published: 1/2/2020. This five-page document provides 11 tactical emergency casualty care actions for active bystanders to take, including for severe bleeding, airway management, hypothermia, burns, pain control, and shock. It also provides definitions for related terms. (PDF)
Source: Disaster Lit: Resource Guide for Disaster Medicine and Public Health - Category: International Medicine & Public Health Source Type: news
CONCLUSION: Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high-quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited. PMID: 31903592 [PubMed - in process]
Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
This study proposes a multi-center RCT in order to compare outcomes of warmer hypothermic strategies during aortic hemiarch surgery on a composite endpoint of neurologic and acute kidney injury (AKI).Methods/designThis is a prospective multi-center, single-blind two-arm RCT comparing mild (32  °C) versus moderate (26 °C) hypothermic cardiac arrest in patients (n = 282) undergoing hemiarch surgery with antegrade cerebral perfusion (ACP). The primary endpoint is a composite of neurological injury (incidence of transient ischemic attack and/or stroke) and Kidney Disease Improving Global Out...
Source: Trials - Category: Research Source Type: clinical trials
More News: Bleeding | Cardiology | Cardiovascular | Cardiovascular & Thoracic Surgery | Heart | Hypothermia | Lower Endoscopy