Damage control of caval injuries in a porcine model using a retrievable Rescue stent

Abstract

A retrievable Rescue stent achieved rapid percutaneous hemorrhage control after a significant traumatic injury of the vena cava and allowed successful recovery of all injured animals. Further development of this approach may have utility in preoperative damage control of caval injuries.

The anchor point algorithm: A morphometric analysis of anatomic landmarks to guide placement of temporary aortic Rescue stent grafts for noncompressible torso hemorrhage

“…The logistics of noncompressible vascular trauma, however, are unforgiving in terms of rapid exsanguination and mortality. Retrievable stent grafts offer a unique "damage control" approach that may bridge patients to a permanent repair 3,10,11 without committing to an emergently placed, yet permanent stent. Since both ischemic organ damage and reperfusion contribute to poor outcome, a compromise of hemorrhage control but also visceral perfusion is required.…”

“…In summary, this study suggests that a morphometric algorithm for retrievable stent grafts is feasible for confronting the tremendous logistical challenges of noncompressible hemorrhage. Importantly, despite published experience in a porcine model, 3,10,11 the retrievable stent has not yet been examined in humans, pending regulatory approvals. Further validation of the efficacy and safety of this algorithm will be essential in the context of both larger-scale morphometry studies and ultimately human clinical trials.…”

“…As an alternative, the use of permanent stent grafts for hemorrhage control presents complex logistics related to vascular expertise, stent inventory, and image-guided placement. A retrievable stent-graft platform can achieve rapid damage control of the aorta or cava yet offer retrieval at the time of a dedicated permanent repair 3,10,11 . When the exact aortic injury site is unknown, a three-tier Rescue stent 3 provides a covered top and bottom stent tiers for hemorrhage control in the thoracic and infrarenal abdominal aorta, while a bare metal middle tier preserves visceral perfusion (Fig.…”

Gunshot wound to big blue

“…A swine model using endovascular occlusion of the suprahepatic IVC for a juxtahepatic IVC injury demonstrated an 83% survival in the control arm at 1 hour after injury 8. A more recent report in a swine model described the use of a stent graft for temporary control of uncontained hemorrhage from the IVC and noted that there was control of hemorrhage in all seven animals 9. In patient case reports, stent grafts have been inserted into hemodynamically stable patients with contained retroperitoneal hematomas.…”