Jihad Abbas

Outcome after thoracic aortic injury: experience in a level-1 trauma center.

Traumatic rupture of the thoracic aorta is a potentially fatal injury that leads to death in 75-90% of cases at the time of injury. In this report, we present our experience with traumatic thoracic aortic injury and compare the outcome in patients with respect to their hemodynamic stability at presentation and the timing of surgical repair. We performed a retrospective data analysis of the medical records of 30 patients who had sustained a traumatic rupture of the thoracic aorta during the period from January 1, 2000 to October 30, 2005. The demographic data, mechanism of injury, modality of diagnosis, location of injury, other associated injuries, hemodynamic stability at presentation, response to resuscitation, timing of aortic repair, as well as the resultant morbidities and mortalities were reviewed. Traumatic rupture of the thoracic aorta was diagnosed in 30 patients. The injury was located in the ascending aorta in two patients, in the aortic isthmus in 25 patients, and in the descending aorta (distal to the isthmus) in three patients. Associated injuries included head injury (50%), C spine (23.3%), lung injury (80%), and visceral (63%) and extremity (60%) injury. Seven patients (23%) were pronounced dead on arrival to the emergency room, 14 patients (47%) were hemodynamically unstable upon arrival, and nine patients (30%) were hemodynamically stable. In the unstable group, two patients (14%) expired before operative repair, 11 patients (79%) underwent emergent repair of the thoracic aorta resulting in 46% mortality, and one patient (7%) underwent delayed repair after initial stabilization with a splenectomy for a splenic laceration. In the stable group, three patients (33%) underwent early (within 24 hr) aortic surgery, while repair was delayed in six (67%). The mean duration of time spent prior to delayed repair was 20.85 days (range 2-53, median = 25). There was no mortality in this group. Acute traumatic thoracic aortic rupture remains a highly fatal condition. Hemodynamic instability remains the main mortality risk factor. Delayed repair is safe and is not associated with increased risk of aortic rupture in hemodynamically stable patients.

Fractured Internal Carotid Artery Stent

Carotid artery stenting is gaining wider acceptance as an alternative option in the treatment of carotid artery stenosis. Conventional complications such as stroke and recurrent in-stent restenosis are well documented in the literature. However, we believe that carotid stent complications are underreported. The carotid artery segment has features that are relatively smilar to the femoropopliteal segment with respect to forces affecting the stented segment, which can contribute to stent complications such as fracture. In this article, we present a case of internal carotid artery stent fracture and thrombus formation after the patient was exposed to direct trauma to the chest and neck.

Celiac artery compression syndrome: a radiological finding without clinical symptoms?

The aim of the paper is to determine the incidence of celiac artery compression (CAC) based on computed tomography (CT) scan and correlate the findings to the clinical presentation of patients presenting for CT scan in a hospital. Abdominal CT scans of patients were reviewed between September 2010 and November 2010. CAC was diagnosed if the celiac axis appeared to have a hook or U-shaped appearance with stenosis. The medical records of the patients were reviewed for gastrointestinal symptoms (abdominal pain, nausea, vomiting, constipation, diarrhea), as well as food fear and weight loss. Patients with CAC had lower incidence of symptoms compared with those without CAC (42.1 versus 65.3%, P = 0.042). A total of 450 patients were evaluated. In the end, 284 had both complete medical records and CT scans. The mean age for all patients was 51.3 ± 1.2 years. There were 124 men (42.6%) and 160 (57.4%) women. Nineteen (6.7%) patients had radiological evidence of CAC. CAC is not an uncommon CT finding in patients presenting for CT scan.

A single center experience with retrievable IVC filters

Objective To evaluate retrievable IVC filters in our institution and assess their retrieval following a well-structured follow up program. Design Retrospective cohort study. Materials The medical records of patients implanted with retrievable IVC filters were reviewed. Methods All retrievable filter insertions between July 2007 and August 2011 at our institution were reviewed. Data was analyzed for age, gender, indication, complications, retrieval rate, and brand of filter inserted. Statistical analysis was done using SPSS software v19. Chi-square was used to compare discrete data and t-test for continuous data. P < 0.05 was significant. Results A total of 484 patients were reviewed of which 258 (53.1%) had a complete medical record. And 96 (37.2%) filters were placed as permanent at the time of insertion. An additional 40 (15.5%) filters were converted to permanent (total permanent filters 136; 52.7%). Death was reported in 26 (10%) patients and 96 (37.2%) out of the remaining 232 patients presented for potential retrieval. Also, 73 (28.2%) had an attempt to retrieve the filters, 69 (94.5%) were successful and 4 (5.4%) failed to retrieve. The remaining 23 (8.9%) patients declined retrieval. Filters studied include Celect (38%), Bard (31.4%), Option (26.2%), Tulip (4.1%), and Recovery (0.2%). Bard was more commonly used as a retrievable filter (80.9%). Retrieval on the first attempt was 90.4% (n = 66) successful. Of the remaining seven filters, three were successfully retrieved on a second attempt, and four failed to retrieve due to filter tilt. The success rates of retrieval for Celect and Tulip were significantly lower than for Bard (p = 0.04 and 0.023, respectively). Conclusion Our study showed that a variety of IVC filters can be retrieved successfully with minimal complication rates. In more than half of our patients, IVC filters were used as permanent. Failure of retrieval was most frequently due to filter tilting.

Complications Secondary to the Bard Retrievable Filter : A Case Report

Recent trials have demonstrated the efficacy of short-term insertion of inferior vena cava filters in the treatment and prophylaxis of venous thromboembolism certain populations, especially those with a reversible contraindication to anticoagulation. This has widened the use of retrievable filters in the hope of avoiding the long-term complications of permanent filters. However, no trials have demonstrated complications for each individual retrievable filter; and therefore, the decision for insertion of caval filter should be thoroughly studied and the benefit clearly determined. We discuss our experience with complications that we have encountered during retrieval of the Bard recovery filter in two patients.

Incidence and clinical significance of iliac vein compression.

Objectives To determine the frequency of left common iliac vein (CIV) compression by the right common iliac artery (CIA) based on CT scan images. Methods CT scan images were reviewed and the diameter of CIV was measured at the area of minimal diameter and compared to the distal adjacent segment and the contralateral CIV at the same level. Medical records were reviewed for symptoms, deep vein thrombosis (DVT) and risk factors that might be associated with DVT. Data were analyzed with SPSS program using both Chi square and t test. A p < 0.05 was considered statistically significant. Linear regression (R2) was used to evaluate correlation. Results A total of 300 complete records were reviewed. The mean age was 51.89 years, with 126 (42%) males. Comparison between the two groups (>70% vs <70%) showed similar clinical factors such as history of DVT, surgery, immobilization, malignancy, limb trauma, pregnancy, obesity, CHF, and smoking. There were more females with CIV compression of 70% or more than males (19.5% vs 11.1% P < .049). Conclusion Diameter stenosis more than 70% was present in 30.6% of cases with higher incidence in females. The presence of stenosis was not associated with the presence of clinical symptoms.

Stent fracture in the brachiocephalic trunk

Stents are commonly used as a tool for revascularization of different vascular beds in the body. However, many pitfalls have been reported with their use, such as thrombosis, migration, restenosis or fractures. The latter have been strongly correlated to in-stent restenosis with long-term follow-up. We report a rare case of an early stent fracture in the brachiocephalic trunk with in-stent restenosis and recurrence of symptoms. To our knowledge there has been only one case report of a delayed brachiocephalic stent fracture in the English literature. We believe that our case is the first report of an early stent fracture in the brachiocephalic trunk.

Internal Jugular Vein Hemangioma

Primary tumors of the major body veins arising intraluminally are rare clinical entities. As such, few cases have been reported in the literature. As a primary tumor, hemangiomas arising in the internal jugular vein are extremely rare, while those arising in the external jugular vein are only slightly more common. We present a case of an internal jugular vein hemangioma that was incidentally discovered during an ultrasound examination performed for the evaluation of the internal carotid arteries. We believe that this is the second case of internal jugular vein hemangioma reported in the English literature.

Carotid Artery Pseudoaneurysm as a Complication of Carotid Artery Stenting

Carotid artery stenting (CAS) has been adopted more in the treatment of carotid artery stenosis recently. The vast majority of studies about this procedure have concentrated mainly on the short- and long-term clinical complications, that is, stroke, myocardial infarction, and restenosis. However, mechanical complications including both stent fracture and carotid pseudoaneurysm are under-reported. In the present report, we present a patient with a common carotid artery psuedoaneurysm as a complication of CAS.