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  • 1.
    Bilos, Linda
    et al.
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Vidlund, Mårten
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Cha, Soon Ok
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Hörer, Tal
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation2017In: Cardiovascular and Interventional Radiology, ISSN 0174-1551, E-ISSN 1432-086X, Vol. 40, no 1, p. 130-134Article in journal (Refereed)
    Abstract [en]

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  • 2.
    Coccolini, Federico
    et al.
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Ceresoli, Marco
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    McGreevy, David T.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Sadeghi, Mitra
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumura, Yosuke
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; R Adams Cowley Shock Trauma Center, University of Maryland, College Park, MD, USA.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, Russia; Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia.
    Maszkowski, Mariusz
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Fugazzola, Paola
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Tomasoni, Matteo
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Cicuttin, Enrico
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Ansaloni, Luca
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Zaghi, Claudia
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Sibilla, Maria Grazia
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Cremonini, Camilla
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Bersztel, Adam
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Falkenberg, Mårten
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Handolin, Lauri
    Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Oosthuizen, George
    Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, University of KwaZulu-Natal College of Health Sciences, KwaZulu-Natal, Pietermaritzburg, South Africa.
    Szarka, Endre
    Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Manchev, Vassil
    Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, University of KwaZulu-Natal College of Health Sciences, KwaZulu-Natal, Pietermaritzburg, South Africa.
    Wannatoop, Tongporn
    Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Chang, Sung Wook
    Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.
    Kessel, Boris
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Shaked, Gad
    Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
    Bala, Miklosh
    Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia.
    Hibert-Carius, Peter
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    Chiarugi, Massimo
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gamberini, Emiliano
    ICU Department Bufalini Hospital, Cesena, Italy.
    Agnoletti, Vanni
    ICU Department Bufalini Hospital, Cesena, Italy.
    Catena, Fausto
    Emergency Surgery Department, Parma University Hospital, Parma, Italy.
    Hörer, Tal M.
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry2020In: Updates in surgery, ISSN 2038-3312Article in journal (Refereed)
    Abstract [en]

    EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

  • 3. 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.

  • 4.
    Hammo, Sari
    et al.
    Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hultgren, Rebecka
    Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Wanhainen, Anders
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Resch, Timothy
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Falkenberg, Mårten
    Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Forssell, Claes
    Department of Thoracic and Vascular Surgery, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Sonesson, Björn
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Roos, Håkan
    Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hellgren, Tina
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Khan, Shazhad
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Höijer, Jonas
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wahlgren, Carl-Magnus
    Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm: A National Multicentre Study2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 6, p. 788-794Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this multicentre study was to analyse the outcome of thoracic endovascular aortic repair (TEVAR) in patients with ruptured descending thoracic aortic aneurysm (rDTAA).

    Methods: This is a nationwide retrospective study including all patients who underwent TEVAR for rDTAA at six major vascular university centres in Sweden between January 2000 and December 2015. Outcome measures were analysed using Kaplan-Meier estimator and multivariable Cox regression.

    Results: There were 140 patients (age [mean +/- SD] 74.1 +/- 8.8 years; 56% men; aneurysm size 64.8 +/- 19 mm), with rDTAA. In 53 patients (37.9%), the left subclavian artery was covered, and in 25 patients (17.9%) arch vessel revascularisation was performed. In total, 61/136 patients (45%) had a major complication within 30 days post TEVAR. Stroke (n = 20; 14.7%) was the most common complication, followed by paraplegia (n = 13; 9.6%) and major bleeding (n = 13; 9.6%). TEVAR related complications during follow up included endoleaks 22.1% (30/136; 14 type 1a, six type 1b, 10 not defined). In total, re-interventions (n = 31) were required in 27/137 (19.7%) patients. The median follow up time was 17.0 months (range 0-132 months). The Kaplan-Meier estimated survival was 80.0% at one month, 71.7% at three months, 65.3% at one year, 45.9% at three years, and 31.9% at five years. Age (HR 1.03; 95% CI 1.00-1.07; p = .046), history of stroke (HR 2.35; 95% CI 1.194.63; p = .014), previous aortic surgery (HR 2.11; 95% CI 1.15-3.87; p = .016) as well as post-operative major bleeding (HR 4.40; 95% CI 2.20-8.81; p = .001), stroke (HR 2.63; 95% CI 1.37-5.03; p = .004), and renal failure (HR 8.25; 95% CI 2.69-25.35; p = .001) were all associated with mortality.

    Conclusions: This nationwide multicentre study of patients with rDTAA undergoing TEVAR showed acceptable short- but poor long-term survival. Adequate proximal and distal aortic sealing zones are important for technical success. High risk patients and post-operative complications need to be further addressed in an effort to improve outcome.

  • 5.
    Hörer, Tal M.
    et al.
    Örebro University Hospital. Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University Hospital. Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm2012In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 19, no 2, p. 144-148Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA).

    Method: From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure.

    Results: In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique.

    Conclusion: tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments. J Endovasc Thor. 2012;19:144-148

  • 6.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Skoog, Per
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review2016In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 42, no 5, p. 585-592Article, review/survey (Refereed)
    Abstract [en]

    EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.

    We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.

    A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.

    Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.

    EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.

  • 7. McGreevy, David
    et al.
    Dogan, Emanuel
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Toivola, Asko
    Bilos, Linda
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Endovascular Resuscitation with Aortic Balloon Occlusion in Non-Trauma Cases: First use of ER-REBOA in Europe2017In: Journal of Endovascular Resuscitation and Trauma Management, ISSN 2002-7567, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is currently evolving and being used worldwide for trauma management. Smaller sheath devices for REBOA and new advances in endovascular resuscitation methods suggest the potential for the procedure to be utilized in hemodynamically unstable non-trau-matic patients.

    Methods: We describe five adult patients that underwent hemodynamic control using the 7 Fr sheath ER-REBOA™ catheters for non-traumatic hemorrhagic instability at Örebro University Hospital between February 2017 and June 2017.

    Results: The ER-REBOA™ catheter was inserted and used successfully for temporary blood pressure stabilization as part of an endovascular resuscitation process.

    Conclusion: The ER-REBOA™ catheter for endovascular resuscitation may be an additional method for temporary hemodynamic stabilization in the treatment of non-traumatic patients. Furthermore, the ER-REBOA™ catheter may be a potential addition to advanced cardiac life support in the management of non-traumatic cardiac arrest.

  • 8.
    McGreevy, David Thomas
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Abu-Zidan, Fikri M.
    Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
    Sadeghi, Mitra
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumura, Yosuke
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, RussiaDzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia .
    Maszkowski, Mariusz
    Västmanlands Hospital Västerås, Department of Vascular Surgery, Örebro University, Örebro, Sweden.
    Bersztel, Adam
    Västmanlands Hospital Västerås, Department of Vascular Surgery, Örebro University, Örebro, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Falkenberg, Mårten
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Handolin, Lauri
    Helsinki University Hospital, Department of Orthopedics and Traumatology, University of Helsinki, Helsinki, Finland.
    Oosthuizen, George
    Ngwelezana Surgery and Trauma, Department of Surgery, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa.
    Szarka, Endre
    Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal College of Health Sciences, Pietermaritzburg, KwaZulu-Natal, South Africa.
    Manchev, Vassil
    Department of Surgery. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Wannatoop, Tongporn
    Department of Surgery. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Chang, Sung Wook
    Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.
    Kessel, Boris
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Shaked, Gad
    Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
    Bala, Miklosh
    Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Coccolini, Federico
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Ansaloni, Luca
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Ordoñez, Carlos A
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Manning, James E.
    Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
    Hibert-Carius, Peter
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Hörer, Tal Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest2019In: Shock, ISSN 1073-2322, E-ISSN 1540-0514Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry.

    METHODS: Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients' demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome.

    RESULTS: There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7%, 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 minutes, 82.1% by ER doctors, trauma surgeons or vascular surgeons. SBP significantly improved to 90 mmHg following the inflation of REBOA. 36.6% of the patients survived.

    CONCLUSIONS: Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated and 36.6% of the patients survived if REBOA placement is successful.

  • 9.
    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.

  • 10.
    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.

  • 11.
    Sadeghi, Mitra
    et al.
    Örebro University, School of Medical Sciences. Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Department of Cardiothoracic and Vascular Surgery Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden .
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumara, Y.
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; R Adams Cowley Shock Trauma Center, University of Maryland, College Park MD, United States.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor A.
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, Russian Federation; Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russian Federation.
    Maszkowski, M.
    Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Bersztel, Adam
    Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Caragounis, Eva Corina
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Falkenberg, Mårten P.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Handolin, Lauri E.
    Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Kessel, Boris J.
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Coccolini, Federico
    Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Ansaloni, Luca
    Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Madurska, Marta J.
    Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
    Morrison, Jonathan James
    Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
    Hörer, Tal Martin
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry2018In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 491-501Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes.

    METHODS: REBOA practicing centers were invited to join this online register, which was established in September 2014. REBOA cases were reported, both retrospective and prospective. Demographics, injury patterns, hemodynamic variables, REBOA-specific data, complications and 30-days mortality were reported.

    RESULTS: Ninety-six cases from 6 different countries were reported between 2011 and 2016. Mean age was 52 ± 22 years and 88% of the cases were blunt trauma with a median injury severity score (ISS) of 41 (IQR 29-50). In the majority of the cases, Zone I REBOA was used. Median systolic blood pressure before balloon inflation was 60 mmHg (IQR 40-80), which increased to 100 mmHg (IQR 80-128) after inflation. Continuous occlusion was applied in 52% of the patients, and 48% received non-continuous occlusion. Occlusion time longer than 60 min was reported as 38 and 14% in the non-continuous and continuous groups, respectively. Complications, such as extremity compartment syndrome (n = 3), were only noted in the continuous occlusion group. The 30-day mortality for non-continuous REBOA was 48%, and 64% for continuous occlusion.

    CONCLUSIONS: This observational multicenter study presents results regarding continuous and non-continuous REBOA with favorable outcomes. However, further prospective studies are needed to be able to draw conclusions on morbidity and mortality.

  • 12.
    Sorelius, Karl
    et al.
    Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
    Mani, Kevin
    Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
    Björck, Martin
    Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
    Sedivy, Petr
    Dept Vasc Surg, Na Homolce Hosp, Prague, Czech Republic.
    Wahlgren, Carl-Magnus
    Dept Vasc Surg, Karolinska Hosp, Stockholm, Sweden.
    Taylor, Peter
    Dept Vasc Surg, Guys & St Thomas Hosp, London, England.
    Clough, Rachel E.
    Dept Vasc Surg, Guys & St Thomas Hosp, London, England.
    Lyons, Oliver
    Dept Vasc Surg, Guys & St Thomas Hosp, London, England.
    Thompson, Matt
    St Georges Vasc Inst, London, England.
    Brownrigg, Jack
    St Georges Vasc Inst, London, England..
    Ivancev, Krassi
    Dept Vasc Surg, Royal Free London NHS Fdn Trust, London, England..
    Davis, Meryl
    Dept Vasc Surg, Royal Free London NHS Fdn Trust, London, England..
    Jenkins, Michael P.
    Imperial Coll Healthcare NHS Trust, Reg Vasc Unit, St Marys Hosp, London, England..
    Jaffer, Usman
    Imperial Coll Healthcare NHS Trust, Reg Vasc Unit, St Marys Hosp, London, England..
    Bown, Matt
    Dept Cardiovasc Sci, Univ Leicester, Leicester, England; NIHR Leicester Cardiovasc Biomed Res Unit, Univ Leicester, Leicester, England.
    Rancic, Zoran
    Clin Cardiovasc Surg, Univ Zurich Hosp, Zurich, Switzerland.
    Mayer, Dieter
    Clin Cardiovasc Surg, Univ Zurich Hosp, Zurich, Switzerland.
    Brunkwall, Jan
    Dept Vasc Surg, Univ Cologne, Cologne, Germany.
    Gawenda, Michael
    Dept Vasc Surg, Univ Cologne, Cologne, Germany.
    Koelbel, Tilo
    Univ Heart Ctr, Dept Vasc Med, Univ Hosp Eppendorf, Hamburg, Germany.
    Jean-Baptiste, Elixene
    Sophia Antipolis, Div Vasc Surg, Univ Nice, Nice, France.
    Moll, Frans
    Dept Vasc Surg, Univ Med Ctr Utrecht, Utrecht, Netherlands..
    Berger, Paul
    Dept Vasc Surg, Univ Med Ctr Utrecht, Utrecht, Netherlands.
    Liapis, Christos D.
    Dept Vasc Surg, Attikon Univ Hosp, Athens, Greece.
    Moulakakis, Konstantinos G.
    Dept Vasc Surg, Attikon Univ Hosp, Athens, Greece.
    Langenskiold, Marcus
    Dept Vasc Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Roos, Håkan
    Larzon, Thomas
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Wanhainen, Anders
    Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
    Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study2014In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 24, p. 2136-2142Article in journal (Refereed)
    Abstract [en]

    Background: Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival.

    Methods and Results: All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death.

    Conclusions: Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonellapositive blood cultures were more likely to die from late infection.

  • 13.
    Sörelius, Karl
    et al.
    Department of Surgical Sciences Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Wanhainen, Anders
    Department of Surgical Sciences Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Wahlgren, Carl-Magnus
    Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden.
    Langenskiöld, Marcus
    Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Roos, Håkan
    Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Resch, Timothy
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Vaccarino, Roberta
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Arvidsson, Bengt
    Department of Thoracic and Vascular Surgery, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Gillgren, Peter
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Unit for Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Bilos, Linda
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Holsti, Mari
    Department of Surgical and Peri-operative Sciences, Surgery, Umeå University Hospital, Umeå, Sweden.
    Mani, Kevin
    Department of Surgical Sciences Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 2, p. 239-246Article in journal (Refereed)
    Abstract [en]

    Objective: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs). Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations. Results: Fifty-two patients (median age 71 +/- 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%). Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.

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