His watch strap hanging like that gives me anxiety and he evaluates our medic students in his sleep ubering back from the bar but I still love him especially when we go out to eat and they don’t realize he’s gay so we get the private corner VIP booth 👌🏼
For decades, the treatment of blunt injury to the thoracic aorta was open repair. The big debate at the time was use of cardiac bypass vs fast clamp and sew. But starting in 1997 with the introduction of thoracic endovascular aortic repair (TEVAR) of this injury, we have rapidly moved to the point where most traumatic aortic injuries are repaired using this technique.
A report that was written nearly a decade ago indic ated a relatively high complication rate for the procedure. Graft complications were reported in 18% of patients, with 14% showing endoleaks. Stroke and left arm ischemia were also reported.
The diagram above shows insertion for management of an aneurysm, but the technique is similar for trauma. Blunt aortic injury occurs closer to the left subclavian artery and care must be taken to place the endograft closer to but not covering its orifice.
As the insertion systems a nd stents improved, short term events have been on the decline. Unfortunately, long term followup data has been hard to come by.
Until now. An article that is not yet in print reports 11 years of experience and followup with patient undergoing TEVAR at the ShockTrauma center in Baltimore.
Here are the factoids:
- 88 patients underwent TEVAR during the study period, all from blunt trauma
- Average ISS was 38, showing these patients were severely injured
- Overall mortality was 7%, but none was due to the TEVAR procedure
- TEVAR-related complication rate was 9% Endoleaks at the ends of the graft occurred in 4 patients, and all required repair. There were 4 other minor leaks that resolved on their own.
- 26 had all or part of the left subclavian orifice covered at initial operation. None developed ischemia, although 2 had a prophylactic carotid-subclavian bypass before TEVAR.
- The longest followup imaging occurred 8 years after the procedure. No long-term complications were noted.
Bottom line: TEVAR has essentially replaced open repair of the aorta, except in special cases. We continue to learn from our experience, and the complication rate is still falling. Other than endoleaks recognized in the postop period, most other complications rarely occur. Long term followup is poor, but in the patients who do return, there were no complications. But remember, this is an expected sampling bias. If the patient had major problems and/or died, they would just be lost to followup. We would never know.
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I was tagged by @accidentallypatriotic for a throwback selfie. Not too far of a throwback. And not technically a selfie. But here I am with a real life hero. I served with Buck here in Afghanistan. Every time. Even this last deployment, after the Army finally forcibly made him retire, he was there as a contractor.
Buck joined the Army shortly after the Korean war as a private. Then he joined Special Forces as a medic. I once asked him what 18D class he graduated from. He said two. As in the second class ever. After Viet nam, he left the enlisted ranks as a Sergeant First Class and became a Warrant Officer. And progressed to the Rank of Chief Warrant Officer 3. In the 80’s, Buck left the Army for a brief time to attend PA school. He then rejoined the Army as a 2nd Lieutenant.
He participated in every major conflict since Vietnam. Pictured above as a Lieutenant Colonel at 63 years old and still on Active Duty. A true hero and badass.
Goddamn thats one hell of a career/life. Reminds me a bit of Billy Waugh.
He forgot to mention AN AMERICAN!!! 🇺🇸🇺🇸🇺🇸
ARIES: long eyelashes, leather jackets, candlelight, autumn leaves, sleeping in, greek mythology, waves crashing on the beach
TAURUS: plaid shirts, the smell of fresh baked bread, disney movies, the sound of a guitar strumming, mountain peaks at sunrise
GEMINI: the forest at night, cat’s eye sunglasses, 24/7 gas stations, floorboards creaking at night, the smell of fresh ink, going on a first date
CANCER: old books, the smell of fresh cut grass, the colour peach, messy buns, accent walls, hand holding, matte lipstick
LEO: long car rides, t hunder, the feeling of accomplishment, love poems, sunflowers, your favourite song on playing repeat
VIRGO: the first snow of the year, bright eyes, flowers in your hair, binge watching a new show, a warm mug of tea, fantasy books
LIBRA: iced coffee, the wind in your hair, string lights, the feeling of forgiveness, bonfires, a new crush
SCORPIO: the night sky, winged eyeliner, an old typewriter, speaking latin, wine stained lips, halloween costumes
SAGITTARIUS: bright houses, nude lipstick, the sound of laughter, watching musicals, forehead kisses
CAPRICORN: the full moon, the smell of clean laundry, new love, going to museums, shouting at the top of your lungs, watching the fog roll in
AQUARIUS: rain on pavement, a paint palette, the city at night, the colour cyan, falling stars, books written in french, ankle boots
PISCES: colourful flowers, sand between your toes, long hugs, ferris wheels, art galleries, cherry b lossoms in the wind, a cat purring
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