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Background: Using emergency endovascular aortic repair to treat severe acute aortic disorders affecting the descending aorta is an appealing prospect. Aim: This study's objective was to evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in the management of acute surgical emergencies involving the descending thoracic aorta. Methods: The medical records of every patient who underwent TEVAR in a single centre since 2007 were retrospectively evaluated. Emergency criteria for inclusion were used to treat patients with aortic disease who had complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other symptoms calling for urgent treatment. The Society for Vascular Surgery reporting guidelines for thoracic endovascular aortic repair were used to evaluate the technical and clinical success with regard to patient mortality, survival, and re-operation rate (TEVAR). Results: In 74 cases (51.0%), emergency procedures were required, including those involving patients with traumatic aortic acute injuries (TAIs) (31.1%) and complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48). Aortic iatrogenic dissection (AID) in one case and two other fistulas following the prior stent graft were also identified as implantation's. While 2 hybrid operations required extra approaches, all procedures were performed through surgically exposed femoral arteries. The main technical success rate was 95.9%; endoleak was recorded in 3 instances. In 94.5% of cases, the main clinical success was achieved. All of the patients made it through the endovascular procedures, however one of them passed away in the hospital as a result of multi-organ failure (early mortality: 1.3%). 11 patients passed away throughout the follow-up period, which lasted 6 to 164 months (median 67). The probability of survival over one year, five years, and 10 years was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, following TAI (95.2%) compared to scAAS (63.4%), the rate of 5-year survival was significantly greater (p=0.008). One person experienced temporary para-paresis right after the operation (1.3%). Throughout the post-discharge follow-up period, no more severe stent-graft-related adverse events were reported. Conclusion: The probability of survival over one year, five years, and 10 years was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, following TAI (95.2%) compared to scAAS (63.4%), the rate of 5-year survival was significantly greater (p=0.008). One person experienced temporary para-paresis right after the operation (1.3%). Throughout the post-discharge follow-up period, no more severe stent-graft-related adverse events were reported.

Aim: Sepsis presents a problem for fluid management, and clinical consensus exists about intravenous (IV) volume requirements. When adult patients with sepsis who were not in shock presented to the emergency room, our goal was to assess if a 24-hour strategy restricting IV fluid was possible (ED). Methods: The REFACED Sepsis trial is an investigator-initiated, multicenter, randomised, open-label, feasibility study in which sepsis patients who are not in shock are randomly assigned to receive either conventional therapy or 24 hours of restrictive, crystal IV fluid delivery. Fluid boluses were only allowed in the IV fluid restriction group when certain conditions for hypoperfusion were met. The treating team determined the standard of care. Total IV crystalloid fluid volumes were the main result 24 hours after randomization. Total fluid volumes, feasibility tests, and patient-centered outcomes were also considered secondary outcomes. Results: In the initial analysis, we included 123 patients (61 patients under restrictive care and 62 patients under normal treatment). The proportion of eligible patients who met all inclusion criteria and no exclusion criteria was 32% (95% confidence interval [CI] 28%-37%). At 24hrs, the restriction versus standard care groups had mean (± SD) IV crystalloid fluid amounts of 562 (1076) ml and 1370 (1438) ml, respectively (mean difference -801 ml, 95% CI - 1257 to - 345 ml, p = 0.001). In the fluid-restrictive group, 21 (34%) of the patients experienced protocol violations. Adverse events, the need for mechanical breathing or vasopressors, acute renal failure, length of stay, or mortality did not differ across groups. Conclusions: In comparison to normal care, a regimen restricting IV crystalloid fluids in ED patients with sepsis resulted in lower 24-hour fluid amounts. It is possible that a future experiment may focus on patient-centered outcomes.

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