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  • 1. Fujita, Satoko
    et al.
    Hörer, Tal
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences.
    Toivola, Asko
    Gruber, Göran
    Larzon, Thomas
    Onyx Embolization as Single Rescue Treatment for Ruptured Abdominal Aortic After EVAR2016In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 11, no 5, p. 370-372Article in journal (Refereed)
    Abstract [en]

    A 76-year-old man who had undergone endovascular repair for an infrarenal aortic aneurysm, presented with a late type Ia endoleak 3 years after his operation. Deployment of an aortic cuff did not achieve a better seal at the proximal neck, and the aneurysm developed a rupture. We successfully treated the ruptured aneurysm using transcatheter Onyx embolization only. At 6-month and 1-year follow-ups with contrast-enhanced duplex scanning, no endoleak was seen and sac shrinkage was observed. Onyx is a relatively new liquid embolic agent that is slowly transformed into a solid state by contact with blood. Owing to this unique characteristic, Onyx embolization can be a useful technique for stopping bleeding from an aneurysm in an emergency situation. This is a unique case of the use of an embolization agent in the treatment of aortic aneurysm rupture.

  • 2.
    Hörer, Tal M
    et al.
    Örebro University Hospital.
    Hammo, Sari
    Örebro University Hospital, Örebro, Sweden.
    Lönn, Lars
    National Hospital, University of Copenhagen, Copenhagen, Denmark.
    Skoog, Per
    Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University Hospital.
    Unipuncture double-access method in emergent endovascular procedures.2013In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 8, no 3, p. 245-247Article in journal (Refereed)
    Abstract [en]

    We describe a technique to gain an additional endovascular access in acute situations in which a large-bore introducer is already inserted or in situations in which multiple accesses are impaired because of other reasons. Using an existing percutaneous femoral artery access, a second guide wire is inserted into the introducer, which is later withdrawn and applied onto one of the two guide wires. A double-wire access is then achieved. This access can be used, for example, for angiography or embolization catheters. This method might be useful in situations in which a quick and unplanned extra access is needed. It is, for example, applicable in hemodynamically unstable patients in whom percutaneous access can be difficult to obtain or in aortic endovascular procedures when an unplanned access is needed to insert an additional catheter for angiography and embolization.

  • 3.
    Hörer, Tal
    et al.
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Toivola, Asko
    Endovascular Repair of a Ruptured Aortic Extra-anatomic Bypass Pseudoaneurysm After Previous Coarctation Surgery2015In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 10, no 5, p. 370-372Article in journal (Refereed)
    Abstract [en]

    We present a short case of a total endovascular repair of a ruptured thoracic pseudoaneurysm after previous coarctation aortic conduit bypass surgery. A 67-year-old man with two previous coarctation repairs many years ago was admitted with chest pain, dyspnea, and hemoptysis. Computed tomography showed a rupture in the distal anastomosis of the thoracic extra-anatomic graft. Successful treatment was achieved by placement of an endovascular stent graft between the old graft and the native aorta and with a vascular plug occlusion of the native aorta.

  • 4.
    Hörer, Tal
    et al.
    Örebro University, School of Health and Medical Sciences.
    Toivola, Asko
    Larzon, Thomas
    Embolisation with Onyx in iatrogenic bleeding of the gluteal region2011In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 6, no 4, p. 267-270Article in journal (Refereed)
    Abstract [en]

    Purpose: We report a unique method using transcatheter Onyx embolization in a bleeding due to morphineinjection in the gluteal region.Case report: A 47 year-old man with a rare blood type presented a painful glutealhematoma due to iatrogenic injury. A Computed Tomographic Angiography (CTA) verified bleedingfrom a suspected branch of the deep femoral artery. Due to the unbearable pain, the hematoma wasevacuated by means of CT guided puncture and the insertion of a pigtail catheter combined with theinjection of a human plasminogen activation agent (t-PA). The initial result was positive. In order tostop the bleeding, angiographic embolization with Onyx was successfully used.Conclusions:Onyx can be used insmall vessel bleedings and might offer the advantage of selective embolization in cases where theaccess to the bleeding vessel is challenging or time consuming.

  • 5.
    Mannion, John D
    et al.
    Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, Dover, DE, USA.
    Marelli, Daniel
    Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, Dover DE, USA.
    Brandt, Todd
    Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, Dover DE, USA.
    Stallings, Megan
    Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, Dover DE, USA.
    Cirks, Jeffery
    Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, Dover DE, USA.
    Dreifaldt, Mats
    Örebro University Hospital. Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Souza, Domingos S. R.
    Örebro University Hospital. Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    "No-touch" versus "endo" vein harvest: early patency on symptom-directed catheterization and harvest site complications.2014In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 9, no 4, p. 306-11Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: "No-touch" (NT) saphenous vein harvesting preserves the adventitial vasa vasorum, prevents medial ischemia, and is associated with an improved short-term and long-term vein graft patency. It may also be associated with a higher rate of harvest site complications. Endovascular vein harvesting (endo-vein) has a low rate of harvest site complications but also a tendency toward a lower patency rate.

    METHODS: During a 2-year period (2011-2012), we compared the vein graft patency at symptom-directed cardiac catheterization as well as wound complication rates in 210 patients who received either NT (87 patients) or endo-vein (123 patients).

    RESULTS: The recatheterization rate for the two groups was similar: 9 (10.3%) of 87 of the NT patients versus 11 (9.0%) of 123 of the endo-vein patients. There was a significant difference in vein graft patency between the groups: 15 (94%) of 16 NT vein grafts were patent versus 6 (27%) of 22 of endo-veins (P < 0.02). The endo-vein graft patency during this 2-year period was similar to the total endo-vein patency (37%) during a 4-year period. A comparison between a more experienced and a less experienced harvester revealed no difference in patency rate. Harvest site complications were significantly higher with the NT harvest: 18% of the NT patients requiring vacuum-assisted wound closure or intravenous antibiotics versus 2% of the endo-vein patients (P < 0.0001). The application of platelet-rich plasma did not significantly lower wound complication rates (P = 0.27).

    CONCLUSIONS: These results suggest that NT vein harvesting may be associated with improved graft patency, but methods should be developed to lower wound complication rates.

  • 6.
    Nilsson, Carolina
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, Örebro, Sweden.
    Bilos, Linda
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Multidisciplinary Approach2017In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 12, no 4, p. E1-E2Article in journal (Refereed)
    Abstract [en]

    The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach.

  • 7.
    Pirouzram, Artai
    et al.
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal Martin
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Conduit-Free Retroperitoneal Access to the Iliac Artery in Endovascular Aortic Repair in Patients With Improper Access Vessels2016In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 11, no 2, p. 150-153Article in journal (Refereed)
    Abstract [en]

    Successful endovascular aortic repair is highly dependent on the quality of the iliac access vessels. Patients with poor access vessels can be turned down from endovascular aortic repair or thoracic endovascular aortic repair by the treating physician. Perioperative complications such as failure to deliver the device or iliac rupture can be addressed to improper access vessels. In this article, we describe a novel technique to access the common iliac artery when access vessels are poor in diameter or quality. This sutureless conduit-free access technique can be used in TEVAR or EVAR and requires less surgical exposure of the iliac arteries.

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