T-acute Traumatic Aortic Inj

Question 1

Mechanism of aortic tear
Symptoms and cause
CXR(3)
CTA SITES(3)

Answer 1

Deceleration
Mediastinal irritation:cough and hoarseness Recurrent laryngeal nerve,chest/back pain
Mediastinal widening(>25%),shift,wide L paravertebral stripe
Aortic isthmus,ascending aorta,aortic hiatus.

Question 2

Grading and criteria for intervention:

Society of vascular surgery
Harborview grading

Answer 2

1=intimal tear
2=intramural hematoma
3=pseudoaneurysm
4=rupture

Minimal=no external contour abnormality,intimal tear/thrombus<10mm long……F/U imaging
Moderately=extermnal contour band,> 10mm long, semi-elective 72 hrs. Fix other injuries
Severe-active extrav,L subclavian hematoma> 15mm.Immediate repair…..stroke?

Question 3

Equipment(3)
Access size/management
Wire
Sheath,Location of tip of sheath
Cheats: difficult endoprosthesis passage
Added access

Answer 3

Gore or Medtronic approved,ivus
8 Fr 30 cm, perclose 10 and 2.
260 cm stiff lunderquist
Gore Dryseal with side arm/valve,below renals
R brachial approach to snare Lunderquist
Contralateral l groin for flush catheter

Question 4

Deployment technique

Types of complications(3)….risk factors

F/u reasons

Answer 4

2 operators, one for graft other for delivery system

Device associated: migration,infold,proximal collapse.. need additional graft. Oversized problem
Neurological: spinal cord ischemia,stroke. More not merrier,also covering L subclavian bad
Access site related: hematoma, pSeudoA

F/u: leaks,pSeudoA,migration,collapse. Aortic remodeling. 1 month, then like type B,3,6,12 mo