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A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR
BACKGROUND: Blunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI, lethal malperfusion caused by a pseudoaneurysm has rarely been reported. We p...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700754/ https://www.ncbi.nlm.nih.gov/pubmed/29166938 http://dx.doi.org/10.1186/s13049-017-0456-z |
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author | Wada, Daiki Hayakawa, Koichi Kanayama, Shuji Maruyama, Shuhei Iwamura, Hiromu Miyama, Noriyuki Saito, Fukuki Nakamori, Yasushi Kuwagata, Yasuyuki |
author_facet | Wada, Daiki Hayakawa, Koichi Kanayama, Shuji Maruyama, Shuhei Iwamura, Hiromu Miyama, Noriyuki Saito, Fukuki Nakamori, Yasushi Kuwagata, Yasuyuki |
author_sort | Wada, Daiki |
collection | PubMed |
description | BACKGROUND: Blunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI, lethal malperfusion caused by a pseudoaneurysm has rarely been reported. We present the first report of a successful case in which a pseudoaneurysm causing the infrequent occurrence of lethal malperfusion and subsequent acute severe ischaemia in the distal portion of the thoracic descending aorta was overcome by veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a bridging therapy until the initiation of TEVAR. CASE PRESENTATION: An adult woman was transferred to our emergency room after injuries sustained by falling from height. Her vital signs were unstable on admission. CT examination revealed the multiple injuries: traumatic subarachnoid haemorrhage, severe unstable pelvic fracture, and a grade III injury of the thoracic aorta. We made the decision to perform TEVAR after external fixation and transcatheter arterial embolization (TAE) for the pelvic injury. During preparations for TEVAR, her lower limbs rapidly felt cold, and her blood lactate level and serum potassium rapidly increased. By the clinical data and ultrasonography and lower extremity Doppler, we diagnosed severe ischaemia in distal portion of the descending aorta caused by a pseudoaneurysm proximal to the descending thoracic aorta. Because we still had not prepared for TEVAR, we immediately started VA ECMO until TEVAR could begin. After the initiation of VA ECMO, her lactate and potassium levels could be controlled. Under VA ECMO support, she underwent TEVAR. After inpatient rehabilitation, she was discharged home without neurologic sequelae. CONCLUSIONS: VA ECMO could be an important, less-invasive treatment as a bridging therapy for acute severe malperfusion syndrome until TEVAR is initiated for BTAI. |
format | Online Article Text |
id | pubmed-5700754 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57007542017-12-01 A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR Wada, Daiki Hayakawa, Koichi Kanayama, Shuji Maruyama, Shuhei Iwamura, Hiromu Miyama, Noriyuki Saito, Fukuki Nakamori, Yasushi Kuwagata, Yasuyuki Scand J Trauma Resusc Emerg Med Case Report BACKGROUND: Blunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI, lethal malperfusion caused by a pseudoaneurysm has rarely been reported. We present the first report of a successful case in which a pseudoaneurysm causing the infrequent occurrence of lethal malperfusion and subsequent acute severe ischaemia in the distal portion of the thoracic descending aorta was overcome by veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a bridging therapy until the initiation of TEVAR. CASE PRESENTATION: An adult woman was transferred to our emergency room after injuries sustained by falling from height. Her vital signs were unstable on admission. CT examination revealed the multiple injuries: traumatic subarachnoid haemorrhage, severe unstable pelvic fracture, and a grade III injury of the thoracic aorta. We made the decision to perform TEVAR after external fixation and transcatheter arterial embolization (TAE) for the pelvic injury. During preparations for TEVAR, her lower limbs rapidly felt cold, and her blood lactate level and serum potassium rapidly increased. By the clinical data and ultrasonography and lower extremity Doppler, we diagnosed severe ischaemia in distal portion of the descending aorta caused by a pseudoaneurysm proximal to the descending thoracic aorta. Because we still had not prepared for TEVAR, we immediately started VA ECMO until TEVAR could begin. After the initiation of VA ECMO, her lactate and potassium levels could be controlled. Under VA ECMO support, she underwent TEVAR. After inpatient rehabilitation, she was discharged home without neurologic sequelae. CONCLUSIONS: VA ECMO could be an important, less-invasive treatment as a bridging therapy for acute severe malperfusion syndrome until TEVAR is initiated for BTAI. BioMed Central 2017-11-22 /pmc/articles/PMC5700754/ /pubmed/29166938 http://dx.doi.org/10.1186/s13049-017-0456-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Wada, Daiki Hayakawa, Koichi Kanayama, Shuji Maruyama, Shuhei Iwamura, Hiromu Miyama, Noriyuki Saito, Fukuki Nakamori, Yasushi Kuwagata, Yasuyuki A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR |
title | A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR |
title_full | A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR |
title_fullStr | A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR |
title_full_unstemmed | A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR |
title_short | A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR |
title_sort | case of blunt thoracic aortic injury requiring ecmo for acute malperfusion before tevar |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700754/ https://www.ncbi.nlm.nih.gov/pubmed/29166938 http://dx.doi.org/10.1186/s13049-017-0456-z |
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