ABSTRACT
Blunt thoracic aortic injury (BTAI) in a patient with an aberrant right subclavian artery (ARSA) presents unique challenges for patient management and aortic repair. Specific considerations include the need to treat coincidental ARSA, subclavian revascularization, and ARSA exclusion. Despite the rise of endovascular repair as the primary modality for aortic repair for BTAI, reports of this technique in the setting of ARSA are limited. Here we describe 3 patients with ARSA who underwent TEVAR for BTAI, and discuss critical management and technical issues in these patients.
Subject(s)
Accidents, Traffic , Aneurysm/complications , Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Cardiovascular Abnormalities/complications , Endovascular Procedures , Subclavian Artery/abnormalities , Thoracic Injuries/surgery , Vascular System Injuries/surgery , Wounds, Nonpenetrating/surgery , Adult , Aneurysm/diagnostic imaging , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/injuries , Aortography/methods , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Cardiovascular Abnormalities/diagnostic imaging , Computed Tomography Angiography , Endovascular Procedures/instrumentation , Female , Humans , Male , Middle Aged , Prosthesis Design , Subclavian Artery/diagnostic imaging , Thoracic Injuries/diagnostic imaging , Thoracic Injuries/etiology , Treatment Outcome , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/etiology , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/etiologyABSTRACT
OBJECTIVE: Cardiac arrest in patients with ruptured abdominal aortic aneurysm (rAAA) is not uncommon and associated with significantly increased mortality. Although it has been suggested as a contraindication to aortic repair, the prognostic implications of preoperative cardiac arrest in the face of rAAA are controversial. The purpose of this structured review is to analyze the reported outcomes of patients with rAAA and preoperative cardiac arrest. METHODS: English language single- and multi-institutional series reporting outcomes of patients with rAAA and cardiac arrest were identified by systematic literature search and review. An aggregate analysis and structured review of outcomes after subsequent aortic repair was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The primary outcome was short-term overall mortality. RESULTS: Sixteen studies involving 2669 patients with rAAA were analyzed, including 334 (13%) with preoperative cardiac arrest. Cardiac arrest was associated with significantly increased mortality compared with patients with rAAA without arrest (86% vs 44%; P < .0001), although cardiac arrest in isolation was poorly predictive of mortality. Four patients were treated by endovascular aortic repair, and all survived. Shorter resuscitation times and return of signs of life prior to aortic repair are associated with improved survival, and long-term functional outcomes among survivors have been reported. CONCLUSIONS: Mortality among patients with rAAA and preoperative cardiac arrest is high but not prohibitive. Aortic repair should not be withheld from such patients who are otherwise reasonable candidates for intervention, provided resources for emergent aortic repair are available.