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40 (CR). Delayed Hybrid Repair of Major Vascular Injuries Following A Gunshot Wound To the Abdomen
Vol. 29, No. 4, May 2015
Abstracts Accepted for Presentation during the 25th Annual Winter Meeting Vascular and Endovascular Surgery Society
bare detachable platinum coils. Completion arteriogram demonstrated successful embolization of the ECA branches (Figure 1). Results: The patient had no periprocedural complications and was discharged home on postoperative day 1. At his initial follow up visit (10 days), he reported decreased pain, weight gain, and resolved dysphagia. CT imaging showed regression of the mass (Figure 2). While there was mixed growth of the tumor on imaging at 2 months, the patient symptoms remained resolved (continued weight gain, no dysphagia). Conclusions: ECA embolization is safe as a palliative procedure in patients with non-resectable symptomatic malignancies in the neck. Re-growth on imaging studies may not correlate with the patient’s symptoms. However, embolization may result in only a temporary benefit, and the patient’s care should continue in a multidisciplinary fashion.
from the hepatic artery was also visualized. Based on the suspected instability of the patient’s visceral aorta, a three-stage, hybrid operation was planned to include treatment of the mesenteric pseudoaneurysm, revascularization of the mesenteric branches of the abdominal aorta, and endovascular exclusion of the visceral aortic pseudoaneurysms. In the first stage, transbrachial angiogram confirmed visceral aortic pseudoaneurysms and revealed a gastroduodenal pseudoaneurysm (GDA) with associated portal venous fistulization (Figure 1A). Successful GDA coil embolization was performed with resolution of arteriovenous fistulization (Figure 1B). The patient was repositioned and a thoracoabdominal exposure of the visceral aorta was performed. A bifurcated aorto-mesenteric bypass was completed with sequential ligation of the celiac and superior mesenteric arteries, respectively. Antegrade aortic and mesenteric perfusion were maintained throughout the procedure. Stage three included the deployment of two aortic cuff stent grafts with resultant exclusion of the visceral aortic segment and associated pseudoaneurysms. Renal artery perfusion was maintained. Recovery was uneventful, and the patient was discharged home on postoperative day nine. CT scans at one and 12 months demonstrated exclusion of the gastroduodenal and aortic psuedoaneurysms, a patent aorto-mesenteric bypass graft, and the absence of endoleak or stent graft migration (Figure 2).
Figure 2. Preoperative and postoperative CT scans showing regression of the mass.
http://dx.doi.org/10.1016/j.avsg.2015.04.042
40 (CR). Delayed Hybrid Repair of Major Vascular Injuries Following A Gunshot Wound To the Abdomen Clayton Brinster, Elizabeth A. Blazick, Virendra Patel, Richard P. Cambria, Mark F. Conrad, and Glenn M. LaMuraglia Massachusetts General Hospital, Boston, MA. A 20-year-old man sustained a gunshot wound to the right upper quadrant and underwent exploratory laparotomy with repair of multiple injuries, including primary repair of a partial hepatic artery laceration. He re-presented on postoperative day seven with abdominal pain. CTA revealed anterior and posterior visceral aortic pseudoaneurysms with associated periaortic hematoma. A pseudoaneurysm thought to arise
641
http://dx.doi.org/10.1016/j.avsg.2015.04.041
Abstracts Accepted for Presentation during the 25th Annual Winter Meeting Vascular and Endovascular Surgery Society
bare detachable platinum coils. Completion arteriogram demonstrated successful embolization of the ECA branches (Figure 1). Results: The patient had no periprocedural complications and was discharged home on postoperative day 1. At his initial follow up visit (10 days), he reported decreased pain, weight gain, and resolved dysphagia. CT imaging showed regression of the mass (Figure 2). While there was mixed growth of the tumor on imaging at 2 months, the patient symptoms remained resolved (continued weight gain, no dysphagia). Conclusions: ECA embolization is safe as a palliative procedure in patients with non-resectable symptomatic malignancies in the neck. Re-growth on imaging studies may not correlate with the patient’s symptoms. However, embolization may result in only a temporary benefit, and the patient’s care should continue in a multidisciplinary fashion.
from the hepatic artery was also visualized. Based on the suspected instability of the patient’s visceral aorta, a three-stage, hybrid operation was planned to include treatment of the mesenteric pseudoaneurysm, revascularization of the mesenteric branches of the abdominal aorta, and endovascular exclusion of the visceral aortic pseudoaneurysms. In the first stage, transbrachial angiogram confirmed visceral aortic pseudoaneurysms and revealed a gastroduodenal pseudoaneurysm (GDA) with associated portal venous fistulization (Figure 1A). Successful GDA coil embolization was performed with resolution of arteriovenous fistulization (Figure 1B). The patient was repositioned and a thoracoabdominal exposure of the visceral aorta was performed. A bifurcated aorto-mesenteric bypass was completed with sequential ligation of the celiac and superior mesenteric arteries, respectively. Antegrade aortic and mesenteric perfusion were maintained throughout the procedure. Stage three included the deployment of two aortic cuff stent grafts with resultant exclusion of the visceral aortic segment and associated pseudoaneurysms. Renal artery perfusion was maintained. Recovery was uneventful, and the patient was discharged home on postoperative day nine. CT scans at one and 12 months demonstrated exclusion of the gastroduodenal and aortic psuedoaneurysms, a patent aorto-mesenteric bypass graft, and the absence of endoleak or stent graft migration (Figure 2).
Figure 2. Preoperative and postoperative CT scans showing regression of the mass.
http://dx.doi.org/10.1016/j.avsg.2015.04.042
40 (CR). Delayed Hybrid Repair of Major Vascular Injuries Following A Gunshot Wound To the Abdomen Clayton Brinster, Elizabeth A. Blazick, Virendra Patel, Richard P. Cambria, Mark F. Conrad, and Glenn M. LaMuraglia Massachusetts General Hospital, Boston, MA. A 20-year-old man sustained a gunshot wound to the right upper quadrant and underwent exploratory laparotomy with repair of multiple injuries, including primary repair of a partial hepatic artery laceration. He re-presented on postoperative day seven with abdominal pain. CTA revealed anterior and posterior visceral aortic pseudoaneurysms with associated periaortic hematoma. A pseudoaneurysm thought to arise
641
http://dx.doi.org/10.1016/j.avsg.2015.04.041