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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The magnitude of injury necessary to cause a traumatic aortic tear often results in high mortality. Open surgery in these patients is often not well tolerated. The purpose of this study was to compare the outcomes of three different treatment options in patients with traumatic aortic injuries. This was a retrospective review of a prospectively maintained computer database. Over a period of 33 months, 27 patients were diagnosed with thoracic aortic tears on the basis of a computed tomogram or a diagnostic angiogram. All patients were initially seen by trauma surgery staff and managed nonoperatively ( n = 12) if the predicted mortality due to associated injuries approached 100%. Thoracic surgery staff were consulted on all other patients, and open surgical repair was performed in 10 patients. Thoracic stent grafts were used in five patients because of inability to ventilate following an attempted thoracotomy ( n = 2) or associated organ injury that prohibited anticoagulation (head +/- liver injury, n = 3). Overall, patients in the endovascular group had a higher injury severity score than that of the open surgical group (42 +/- 9 vs. 32 +/- 11). However, mortality was lowest in the endovascular group (20%), higher in the open surgical group (50%), and highest in the nonoperative group (92%). No paraplegia was noted, and all surviving patients have been free of complications during the follow-up period. Due to the small number of patients in each treatment, no strong recommendations can be made. However, the results of thoracic stent grafts for patients with traumatic thoracic pseudoaneurysms may prove to be a safer and less invasive treatment option.
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PMID:Acute thoracic aortic trauma: a comparison of endoluminal stent grafts with open repair and nonoperative management. 1456 31

An 11-year-old girl was admitted with back pain for 2 months, inability to walk for 15 days, and enuresis and encopresis for 2 days. She had been hospitalized with the diagnosis of brucellosis in another hospital. At presentation, she had paraplegia, sphincter dysfunction, and bilateral sensory loss below the T6 level, and was initially diagnosed with transverse myelitis caused by brucellosis. On the third day of hospitalization, however, agglutination test for brucella was negative, but it was positive for Salmonella. Therefore, transverse myelitis was considered to be due to salmonellosis. Thoracic spine magnetic resonance imaging showed an extradural, paraspinal mass at the level of T6-T7. The mass was totally extracted, and histopathological examination revealed Ewing's sarcoma. During follow-up, no improvement in paraplegia was noted and an enlarged presacral decubital ulcer developed. Aside from supportive care, local radiotherapy was applied. Unfortunately, the patient died from probable infection 9 months after the diagnosis. We emphasize that metastatic spinal Ewing's sarcoma may mimic brucellosis and transverse myelitis in childhood.
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PMID:A case of metastatic spinal Ewing's sarcoma misdiagnosed as brucellosis and transverse myelitis. 1476 89

Patent foramen ovale is considered as a potential risk factor for stroke owing to paradoxic embolism, leading to the question "to close or not to close the patent foramen ovale". We report a 26-year-old woman with chest pain, dyspnoea, sudden severe pain in both legs and paraplegia. Thoracic and abdominal computed tomography revealed massive pulmonary embolism and complete obstruction of the abdominal aorta. Interventional removal of the aortic thrombus was undertaken using the Fogarty catheter technique via the femoral arterial approach. As a result of worsening of cardiopulmonary function during the procedure, additional local thrombolysis, with a total of 50 mg recombinant tissue plasminogen activator, and fragmentation of the thrombus in the right pulmonary artery were performed via a femoral vein approach. Ultrasound studies revealed a patent foramen ovale of about 12 mm diameter with a significant right to left shunt. Under favourable conditions, a patent foramen ovale may allow the escape of a thrombus, sufficient to cause a potentially fatal pulmonary embolism, into the arterial system, where it can be removed by interventional manoeuvres.
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PMID:Patent foramen ovale as lifesaving purging valve. 1681 88

Thoracic aorta disease remains a challenging problem, and despite improvements, open repair techniques are still associated with significant morbidity and mortality. This is a retrospective review of 53 consecutive patients with thoracic aortic pathology who were treated with endovascular repair between September 1998 and December 2004 at a tertiary-care hospital. Endovascular stent graft placement was performed on 23 elective and 30 emergent patients (34 male patients, mean age 66 years, 21 to 85 years). Completion angiography revealed no endoleak in 47 (89%) patients, a type I endoleak in 4 patients, and a type II endoleak in 2 patients. Operative 30-day mortality for elective aneurysms (n = 22), emergent aneurysms (n = 10), dissection (n = 3), penetrating aortic ulcers (n = 7), and trauma (n = 11) was 0%, 40%, 0%, 29%, and 9%, respectively. In total, 46 (87%) patients survived 30 days, and 36 (78.3%) of the survivors were discharged home free of complications. Two patients (4%) experienced paraplegia. Median follow-up was 22 months (1 to 72 months). Intermediate-term results revealed 41 (89%) patients free of endoleak, stent migration, or aneurysmal expansion. Two (4%) patients required reintervention with an additional stent graft. There were 2 (4%) patients with late aortic-related deaths and four (9%) patients with non-aorticrelated late deaths. Endovascular stent graft placement for thoracic aorta disease can be performed successfully and safely with good perioperative and intermediate-term outcomes. Stent graft complication and reintervention rates are low, whereas intermediate survival rates are good. Long-term efficacy still needs to be evaluated.
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PMID:Endovascular repair of thoracic aortic disease: early and midterm experience. 1759 83

Thoracic aortic diseases (TAD) are relatively frequent conditions associated with high mortality. Recently, several reports have demonstrated the safety and efficacy of endovascular stent-graft (EVG) placement for TAD as an alternative to open surgery. We report our experience in management of thoracic aortic syndrome on 56 consecutive patients with TAD that underwent endovascular stent-graft repair. MDCT angiography was used in all patients to provide preprocedure evaluation and measurements. In particular it is necessary to evaluate the proximal and distal landing zones of the stent-graft. All EVGs in our series were placed successfully. Conversion to open surgery was never required. Six patients (10.7%) died early after the stent-graft deployment. During follow-up four more patients died. The endoleak rate was 16.7% (no. 10 pt). We did not observe any case of paraplegia. The present study shows the efficacy of EVG in the long-term follow-up, with an overall survival of 82.1%, which is comparable to that reported in recent studies. In conclusion this technique is emerging as an alternative approach in the treatment of TAD because this approach offers a less invasive therapeutic option to standard surgical techniques, even in patients who have associated diseases that make them poor surgical candidates.
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PMID:Endovascular stent-graft treatment of thoracic aortic syndromes: a 7-year experience. 1770 89

Thoracic aortic endografting is proving to be extremely useful for correcting a variety of lesions with few complications. Endovascular intervention avoids sternotomy or thoracotomy, the use of chest tubes, respirators, and general anesthesia, and limits blood loss. Compared with traditional open surgery, complications such as paraplegia, renal failure, and cardiac and pulmonary difficulties are minimized; hospital and rehabilitation times are also reduced. Selection of patients on the basis of favorable anatomy and pathology for a specific device is critical to procedural success. In some cases, a retroperitoneal conduit may be useful. In addition, left carotid-subclavian bypass or a transposition of the left subclavian artery to the left common carotid artery may be necessary before endografting, and spinal cord fluid drainage may be important when there is potential for cord ischemia.
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PMID:Technical tips for thoracic aortic endografting. 1834 29

Thoracic aortic endografting is proving to be extremely useful for correcting a variety of lesions with few complications, and several devices have recently been approved by the Food and Drug Administration (FDA). Endovascular intervention avoids sternotomy or thoracotomy, chest tubes, respirators, general anesthesia, and blood loss is limited. Compared with traditional open surgery, complications such as paraplegia, renal failure, and cardiac and pulmonary difficulties are minimized; hospital and rehabilitation times are also reduced. There is no Level-1 evidence of endografting's efficacy in the thoracic aorta, and the pathologies encountered in this vascular territory are complex and often associated with other injuries or lesions, making randomized comparisons between open and endovascular procedures virtually impossible. Nevertheless, series results from centers of excellence indicate thoracic aortic endografting in patients with favorable anatomy and pathology for a specific device yields excellent results. Thoracic aortic endografting is an important alternative to open repair and will likely become the preferred treatment modality as additional devices become available and more experience is achieved in this vascular region.
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PMID:Thoracic endografting is rapidly approaching trim time. 1904 91

An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T(1)- and T(2)-weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.
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PMID:Paraplegia caused by intratumoral hemorrhage within thoracic epidural granuloma. 1994 Apr 6

Thoracic aortic aneurysms represent a major health problem. Untreated thoracic aortic aneurysms may rupture, which has a dismal outcome. The standard treatment for thoracic aneurysms is open surgical repair, but it is associated with high mortality and morbidity. Endovascular repair provides a less invasive and safer alternative. A systematic review was performed of all published literature on the above subject. Our primary objective was to measure 30-day mortality for nonruptured thoracic aortic aneurysms. Studies describing other pathologies, such as aortic dissection, mycotic aneurysms, penetrating ulcers, traumatic transactions, and pseudoaneurysms, and studies from which independent data for thoracic aortic aneurysm could not be separately extracted were excluded. Case series describing less than 10 patients and all case series describing ruptures or concealed ruptures were excluded as well. Twenty-six case series and one comparative study were identified. This formed a cohort of 1,038 patients. Technical success was possible in more than 97% of patients. The 30-day mortality was calculated to be 5.1% even though the group under study was mostly those who were refused surgery by a surgeon or had a higher surgical risk. The incidence of paraplegia and stroke was 3.1% and 4.7%, respectively. Early endoleak was seen in 16.7% of patients, whereas 11.7% of patients developed late endoleak, but most did not require any additional procedure. The rate of reintervention was 14.9%. The 12-month mortality rate was 14.2%. Endovascular repair shows encouraging short-term results. It is associated with significantly less mortality and morbidity, but long-term results need to be further investigated.
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PMID:Endovascular repair of nonruptured thoracic aortic aneurysms: systematic review. 2012 57

Thoracic endografting has been proposed as an effective alternative to open repair to treat several aortic pathologies. Cranial migration is one of the critical issues concerning long-term durability. The scalloped thoracic endograft was proposed to improve distal sealing and fixation crossing the diaphragm. The objective of this study was to evaluate technical feasibility and experience with a custom-made scalloped thoracic endograft using the Relay platform (Bolton Medical, Sunrise, FL) in selected cases. From January 2006 to June 2009, 57 patients (40 men) were treated in Europe with a customized distal scalloped thoracic endograft. Forty-five patients presented with thoracic aortic aneurysm, nine presented with type B dissection, and three had a pseudoaneurysm. Successful and accurate deployment was achieved in all cases except one partial rotation in an extremely tortuous anatomy. Technical success was achieved in 96.4%. Good sealing and no mortality, paraplegia, or visceral embolization were observed. At a mean follow-up of 6 months, no complications were registered. The Relay endograft with the distal scallop represents a feasible alternative for distal short necks. This approach may increase the applicability and durability of the endograft in short distal necks.
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PMID:Experience with a scalloped thoracic stent graft: a good alternative to preserve flow to the celiac and superior mesenteric arteries and to improve distal fixation and sealing. 2047 Jun 86


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