PMID- 33556520
OWN - NLM
STAT- MEDLINE
DCOM- 20211231
LR  - 20211231
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 75
DP  - 2021 Aug
TI  - Efficacy and Safety of Heparinization before Deployment of Endograft for Blunt 
      Traumatic Aortic Injury in Severely Injured Patients.
PG  - 341-348
LID - S0890-5096(21)00150-3 [pii]
LID - 10.1016/j.avsg.2021.01.096 [doi]
AB  - BACKGROUND: The administration of unfractionated heparin (UFH) during 
      endovascular repair of blunt traumatic aortic injury (BTAI) is controversial. The 
      aim of the study is to report the early outcomes of patients undergoing thoracic 
      endovascular aortic repair (TEVAR) for BTAI, and to assess the individualized 
      intraoperative use and dose of UFH. METHODS: This is a retrospective analysis 
      including consecutive patients treated with TEVAR for BTAI of the descending 
      aorta between January 1st, 2005 and December 31st, 2018. Intraoperative use and 
      doses of UFH were analyzed. Primary outcome included a reintervention because of 
      new onset bleeding and/or thromboembolic complication and 30-day mortality. 
      Technical success, injury severity score (ISS), timing of treatment, and 
      neurologic deterioration were secondary outcome. RESULTS: Thirty-six patients 
      with a mean age of 47 +/- 18 years, 30 males (83%), were included. Intraoperative 
      administration of UFH was recorded in 30/36 patients (83%) with a mean dose of 
      4750 +/- 2180 IU. Two patients had no UFH because of extensive intracranial 
      hemorrhage or suspected relevant liver laceration, respectively; 1 died in 
      theatre, 1 was already anticoagulated having a mechanical aortic valve, and in 2 
      no information about heparin use was found. During 30 days of follow-up, 3 
      patients died (8%; 3/36): 1 patient with completely transected aorta died 
      on-table and 2 on the fifth postoperative day, 1 from trauma-associated brain 
      injury and 1 with multi organ failure. No bleeding or thromboembolic complication 
      requiring reintervention occurred in any patient during 30 days follow-up. In 3 
      patients partial unintentional coverage of the left common carotid artery 
      occurred, resulting in technical success of 89% (32/36). Mean ISS was 43 +/- 15. 
      Thirty-five patients (97%) were severely injured having an ISS >/= 25. Twenty-nine 
      patients (81%) were treated within 24 hr and 6 patients (17%) within 1 week. No 
      stroke or spinal cord ischemia was observed. CONCLUSIONS: Systemic heparinization 
      in different doses during TEVAR for BTAI can be safe with no intraoperative 
      bleeding or thromboembolic complications in early postoperative period.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Makaloski, Vladimir
AU  - Makaloski V
AD  - Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, 
      University of Bern, Bern, Switzerland. Electronic address: 
      vladimir.makaloski@insel.ch.
FAU - Widenka, Hannah
AU  - Widenka H
AD  - Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, 
      University of Bern, Bern, Switzerland.
FAU - Schonhoff, Florian
AU  - Schonhoff F
AD  - Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, 
      University of Bern, Bern, Switzerland.
FAU - Spanos, Konstantinos
AU  - Spanos K
AD  - Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, 
      School of Health Sciences, University of Thessaly, Larissa, Greece.
FAU - Wyss, Thomas R
AU  - Wyss TR
AD  - Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, 
      University of Bern, Bern, Switzerland.
FAU - Schmidli, Jurg
AU  - Schmidli J
AD  - Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, 
      University of Bern, Bern, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20210205
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Aorta/diagnostic imaging/injuries/*surgery
MH  - Blood Loss, Surgical/prevention & control
MH  - Blood Vessel Prosthesis
MH  - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation
MH  - Drug Administration Schedule
MH  - *Endovascular Procedures/adverse effects/instrumentation
MH  - Female
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Thromboembolism/etiology/prevention & control
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular System Injuries/diagnostic imaging/*surgery
MH  - Wounds, Nonpenetrating/diagnostic imaging/*surgery
EDAT- 2021/02/09 06:00
MHDA- 2022/01/01 06:00
CRDT- 2021/02/08 20:12
PHST- 2020/09/26 00:00 [received]
PHST- 2021/01/17 00:00 [revised]
PHST- 2021/01/19 00:00 [accepted]
PHST- 2021/02/09 06:00 [pubmed]
PHST- 2022/01/01 06:00 [medline]
PHST- 2021/02/08 20:12 [entrez]
AID - S0890-5096(21)00150-3 [pii]
AID - 10.1016/j.avsg.2021.01.096 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2021 Aug;75:341-348. doi: 10.1016/j.avsg.2021.01.096. Epub 2021 
      Feb 5.