Increasing use of endovascular therapy in pediatric arterial trauma

Branco, Bernardino C.; Naik‐Mathuria, Bindi; Montero-Baker, Miguel; Gilani, Ramyar; West, Charles A.; Mills, Joseph L.; Chung, Jayer

doi:10.1016/j.jvs.2017.04.072

Cited by 39 publications

(19 citation statements)

References 18 publications

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“…At present, trauma to the visceral aorta (Case 5) is an absolute contradiction to EVT Angioembolisation for bleeding is a standard procedure in paediatric arterial trauma. 3 In contrast, thromboaspiration is rare but has been successfully performed in the pulmonary artery, iliac artery, central veins and femoral arteries 12 13 for traumatic and non-traumatic aetiology. There is limited literature on thromboaspiration of visceral arteries which makes our case of renal artery thrombectomy unique.…”

Section: Discussionmentioning

confidence: 99%

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Pictorial review on the endovascular management of paediatric aortic injuries

Nicholas

Shaw²,

Puppala³

2020

The British Journal of Radiology

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Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.

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Section: Discussionmentioning

confidence: 99%

“…Traumatic aortic injury (TAI) can be catastrophic when of the severe grade, and 73% of patients die en-route to the hospital. 3 Patients with TAI also have severe concurrent injuries of the cranium, torso and the extremities. 4 Both the low incidence and the presence of multi-system trauma make recognition and management of this condition very challenging.…”

mentioning

confidence: 99%

Pictorial review on the endovascular management of paediatric aortic injuries

Nicholas

Shaw²,

Puppala³

2020

The British Journal of Radiology

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“…The use of endovascular therapy has increased in pediatric patients since 2007. Another review of the NTDB including 2007-2014 reported increase in this technique from 7% to 12% [7].…”

Section: Epidemiologymentioning

confidence: 99%

Vascular Injuries in Children

Naik‐Mathuria¹,

Fallon²

2021

Vascular Complications of Surgery and Intervention

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“…The incorporation of endovascular techniques such as temporary balloon control and stent grafting to traditional open surgery has not only enhanced management options for bleeding trauma patients, but has also positively impacted morbidity and mortality after these injuries. [7][8][9][10][11][12] Studies supporting the use of endovascular therapy continue to emerge in the literature as resources for endovascular therapy become more readily available at trauma centers and endovascular providers continue to get acquainted with this new technology. [7][8][9][10][11][12][13][14][15][16][17] The purpose of this study was to explore patterns in modern epidemiology and mortality after IVC and aortic injuries in the United States.…”

mentioning

confidence: 99%

“…[7][8][9][10][11][12] Studies supporting the use of endovascular therapy continue to emerge in the literature as resources for endovascular therapy become more readily available at trauma centers and endovascular providers continue to get acquainted with this new technology. [7][8][9][10][11][12][13][14][15][16][17] The purpose of this study was to explore patterns in modern epidemiology and mortality after IVC and aortic injuries in the United States. We hypothesized that these injuries would remain highly lethal in the contemporary civilian setting, despite the ongoing endovascular revolution and other advancements in trauma care.…”

mentioning

confidence: 99%

Survival trends after inferior vena cava and aortic injuries in the United States

Branco

Musonza

Long

et al. 2018

Journal of Vascular Surgery

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Objective: Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such as to the inferior vena cava (IVC) and aortic injuries remain responsible for a significant proportion of early trauma deaths in modern trauma care. The purpose of this study was to explore patterns in epidemiology and mortality after IVC and aortic injuries in the United States.Methods: A 13-year analysis of the National Trauma Databank (2002Databank ( -2014 was performed to extract all patients who sustained IVC, abdominal aortic, or thoracic aortic injuries. Demographics, clinical data, and outcomes were extracted.Patients were analyzed according to injury mechanism.Results: A total of 25,428 patients were included in this analysis. Overall, the mean age was 39.8 6 19.1 years, 70.3% were male, and 14.1% sustained a penetrating trauma. Although the incidence of all three injuries remained constant throughout the study period, for blunt trauma, mortality decreased over the study period (from 48.8% in 2002 to 28.7% in 2014; P < .001), in particular for thoracic aortic injuries (from 46.1% in 2002 to 23.7% in 2014; P < .001) and abdominal aortic injuries (from 58.3% in 2002 to 26.2% in 2014; P < .001). This decrease in mortality after blunt trauma was accompanied by an increase in endovascular procedures over the study period (from 1.0% in 2002 to 30.4% in 2014; P < .001), in particular for blunt thoracic aortic injuries (from 0.7% in 2002 to 41.4% in 2014; P < .001). When penetrating trauma patients were analyzed, overall there was an increase in mortality (from 43.8% in 2002 to 50.6% in 2014; P < .001), in particular after abdominal aortic injury (from 30.4% in 2002 to 66.0% in 2014; P < .001). Similar trends were observed for IVC injuries. No increase in endovascular use in penetrating trauma was identified (from 0.1% in 2002 to 3.4% in 2014; P < .001).Conclusions: The present study demonstrates an overall decrease in mortality after blunt aortic injuries in the United States. This decrease was accompanied by an increase in the use of endovascular procedures. After penetrating trauma, however, despite contemporary advances in trauma care, mortality has increased over the study period, in particular after abdominal aortic injury. No increase in endovascular use in penetrating trauma was demonstrated.

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Increasing use of endovascular therapy in pediatric arterial trauma

Cited by 39 publications

References 18 publications

Pictorial review on the endovascular management of paediatric aortic injuries

Pictorial review on the endovascular management of paediatric aortic injuries

Vascular Injuries in Children

Survival trends after inferior vena cava and aortic injuries in the United States

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