Experimental Assessment of Physician Modified Proximal Scalloped Stent Graft to Extend Proximal Landing Zone in the Aortic Arch.

OBJECTIVE/BACKGROUND: The aim of the study was to assess a model of physician modified scalloped stent graft (PMSG) on currently available thoracic aortic devices to extend the proximal landing zone in either zone 2, 1 or 0 of the aortic arch while preserving flow in the supra-aortic vessels on human cadaveric aorta. METHODS: Fresh human aortas were harvested at autopsy from adult subjects. A proximal scallop was made on the stent grafts based on direct measurements on the aortas to extend the proximal landing zone in zone 0 (n = 5), zone 1 (n = 5), and zone 2 (n = 5). A previously described benchtop closed system pulsatile flow model was used to mimic flow and pressure conditions in the aorta to deploy the stent graft as close to physiological conditions as possible. Deployment accuracy of the scallop opposite the aortic arch branch ostia was assessed by completion angiography and post-procedural analysis of the aortas. RESULTS: Fifteen proximal scalloped stent grafts were deployed in the aortic arch of 15 human cadaveric aortas under fluoroscopy. The expected proximal landing zone was achieved in all cases (zone 2 = 5; zone 1 = 5; zone 0 = 5). Post-procedural angiography and direct visual analysis showed supra-aortic vessel patency and deployment of the scallop opposite the aortic arch branch ostia in all cases. CONCLUSION: PMSG to extend the proximal landing zone in zone 2, 1, or 0 in order to treat urgent diseases of the proximal descending aorta or the inner circumference of the aortic arch by a totally endovascular approach while preserving flow in the supra-aortic trunks is experimentally feasible.

Wrist fracture in a 6-year-old girl after an accidental electric shock at low voltages.

Bone injuries related to electric shocks are usually seen with high-voltage current exposure or with additional traumas, such as falls. Few cases of fractures after electric shocks at low-voltages (with no direct blunt trauma) are reported in the literature. They result from electrically-induced tetanic muscle contractions. Most of them involve the proximal appendicular skeleton, while distal fractures of limbs are uncommon. We report the case of a 6-year-old girl who suffered local superficial burns of the hand and a distal radius buckle-type fracture after sustaining a 230-V electric shock. The accident occurred while the girl was touching with the right hand the metallic stand of a non-insulated street lamp. She felt a sudden jolt and managed to pull her hand free quickly, without falling or losing consciousness. The superficial burns of the hand were consistent with Jellinek's electric marks, while the buckle fracture of the radius was consistent with a forceful contraction of the flexor muscles of the hand. Only four cases of radius fractures resulting from accidental electric shocks at low voltages have been previously reported in the literature. All of them involved pediatric patients, suggesting that a child's vulnerability to this kind of fracture may exist. The present case is the youngest one ever described.