ABSTRACT
PURPOSE: As blunt thoracic aortic injury (BTAI) treatment has shifted from open to thoracic endovascular aortic repair (TEVAR), logistical challenges exist in creating and maintaining inventories of appropriately sized stent-grafts, including storage demands, shelf-life management and cost. We hypothesized that most injured aortas can be successfully repaired with a narrow range of stent-graft sizes and present a value-based anatomic approach to optimizing inventory. METHODS: CT-scans of all patients with BTAI admitted to our Level I trauma center from Apr 2010-Dec 2018 were reviewed. Patients with anatomy incompatible with TEVAR were excluded. For each patient, after aortic sizing a set of two stent-grafts most likely to be utilized was selected from a list of twenty commercially available GORE conformable TAG endografts based on manufacturer instructions. Stent-graft sizes were then ranked based on the number of cases they would be suitable for. MATLAB was utilized to determine the combinations of stent-grafts which would cover the most patients. RESULTS: Twenty-eight patients with BTAI were identified and three were excluded based on iliac diameter. Most patients were male (68%), mean age 42.3 ± 20.2 years, mean ISS 37.0 ± 9.8. Overall mortality was 25%. Of the 20 available stent-graft options, a combination of four stent-grafts would successfully treat 100% of the patients in this series. CONCLUSIONS: Based on actual CT-scan aortic measurements, we demonstrated that an inventory of four sent-graft sizes was sufficient to treat 100% of patients with BTAI. These data can be utilized as a value-based anatomic approach to aortic stent-graft institutional inventory creation and maintenance.
Subject(s)
Blood Vessel Prosthesis Implantation , Endovascular Procedures , Thoracic Injuries , Vascular System Injuries , Wounds, Nonpenetrating , Humans , Male , Young Adult , Adult , Middle Aged , Female , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aorta, Thoracic/injuries , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/surgery , Aorta/surgery , Stents , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
We employ a recently developed single-trajectory Lagrangian diagnostic tool, the trajectory rotation average ( TRA ¯ ), to visualize oceanic vortices (or eddies) from sparse drifter data. We apply the TRA ¯ to two drifter data sets that cover various oceanographic scales: the Grand Lagrangian Deployment and the Global Drifter Program. Based on the TRA ¯, we develop a general algorithm that extracts approximate eddy boundaries. We find that the TRA ¯ outperforms other available single-trajectory-based eddy detection methodologies on sparse drifter data and identifies eddies on scales that are unresolved by satellite-altimetry.
