FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2000586961> ?p ?o ?g. }

• W2000586961 endingPage "919" @default.
• W2000586961 startingPage "917" @default.
• W2000586961 abstract "Lung erosion represents a dreadful complication in patients affected by thoracic aortic aneurysms. Intraoperative occurrence of severe bleeding and extensive air leakage from the pulmonary erosion is usually quite particularly dangerous and challenging because of fragile lung tissue to be repaired, hypo-coagulative state, and the need for full mechanical ventilation. We report the case of a patient who had uncontrollable pulmonary bleeding and marked air leakage from an aortic aneurysm-induced lung erosion and laceration, which were effectively treated with a hemostatic patch (Tachosil, Nycomed, Linz, Austria) after unsuccessful conventional surgical approaches. Lung erosion represents a dreadful complication in patients affected by thoracic aortic aneurysms. Intraoperative occurrence of severe bleeding and extensive air leakage from the pulmonary erosion is usually quite particularly dangerous and challenging because of fragile lung tissue to be repaired, hypo-coagulative state, and the need for full mechanical ventilation. We report the case of a patient who had uncontrollable pulmonary bleeding and marked air leakage from an aortic aneurysm-induced lung erosion and laceration, which were effectively treated with a hemostatic patch (Tachosil, Nycomed, Linz, Austria) after unsuccessful conventional surgical approaches. Pulmonary adherence to voluminous aneurysms of the thoracic descending aorta complicated by parenchymal erosion may represent a surgical challenge if leading to intraoperative severe bleeding and air leakage. These events are often cumbersome to treat due to prolonged lung compression and extracorporeal circulation (ECC)-related hypo-coagulative state. Indeed, fragile lung tissue and extensive bleeding may account for difficult surgical control sometimes leading to parenchymal lobectomy or pneumonectomy [1Killen D.K. Muehlebach G.F. Wathanacharoen S. Aortopulmonary fistula.South Med J. 2000; 93: 195-198PubMed Google Scholar, 2Daitoku K. Takahashi K. Sudo T. Ruptured thoracic aortic aneurysm presenting as massive epistaxis: report of a case.Kyobu Geka. 2004; 57: 398-401PubMed Google Scholar], or even to patient death. The hemostatic agent may be helpful in these circumstances and avoid or limit stitch application, which may further damage the lung tissue. We report the successful treatment of an uncontrollable hemorrhage and marked air leak from lung parenchyma from the aneurysmal-related erosion and likely exacerbated by anatomical exposure, occurring soon after the aortic replacement for a ruptured aortic aneurysm. After unsuccessful conventional bail-out surgical maneuvers, the application of fibrinogen/thrombin-coated collagen patch (Tachosil, Nycomed, Linz, Austria) enhanced full control of bleeding and air leaking allowing favorable patient outcome and avoiding extreme reparative procedures. A 67-year-old man was urgently admitted to our ward because of recent appearance of a cough, and rapid deterioration of shortness of breath and hemoptysis. Three years before he had undergone replacement of the ascending aorta with valve re-suspension due to acute aortic dissection. A thoracic computed tomographic scan and transthoracic echocardiography performed 6 months prior to the patient's last hospital admission had shown no aneurysm of the thoracic aorta, stable dimensions of the perfused false lumen and of the uncompressed true lumen, no aortic valve incompetence, and preserved biventricular function. Because of renal failure (plasma creatinin, 3.2 mg/dL) found at the hospital admittance, the patient underwent urgent thoracic magnetic resonance imaging, which revealed huge aortic aneurysm and contained rupture just below the aortic isthmus. Ipsilateral lung was severely compressed, as was the left pulmonary artery. An urgent replacement of the descending thoracic aorta was undertaken. At the thoracic opening, a huge (10 × 6 cm) aortic aneurysm involving the aortic isthmus and the proximal descending thoracic aorta was found compressing and eroding the left upper lobe with parenchymal involvement towards the left hilum. Dissection of the aneurysmal sac from the lung was undertaken with care and without complications. No sign of bleeding or air leak was observed at that stage. Aortic vessel replacement was carried out under deep circulatory arrest with femoro-femoral cannulation. After aortic replacement, during extracorporeal circulation discontinuation and at the moment of instituting lung ventilation, a sudden and marked hemorrhage occurred at the site of the lung erosion induced by the aneurysmal sac, in association with extensive air leakage and a large amount of blood from the tracheal tube. The parenchymal lesion was most likely enlarged by the lung compression applied to expose the aortic vessel. Several attempts to control bleeding were carried out using Teflon-pledge u-stitches (4-0 and 3-0 Prolene; Ethicon, Somerville, NJ), which proved unsuccessful despite selective lung exclusion and protamine administration. The extreme fragility and concealed site of bleeding was impossible to control, with some sign of extension of the parenchymal damage toward the hilum of the left lung due to suture tearing, even with the aid of sponge compression for several minutes. Lobectomy or heparin-less extracorporeal membrane oxygenation with sponge compression were considered because the combination of remarkable air leakage and profound venous hemorrhage induced rapid deterioration of patient hematocrit and gas exchange. Another attempt was made by applying several layers of Tachosil (Nycomed, Linz, Austria) with manual compression for several minutes while preparing ECMO circuit or planning alternative procedure to the injured lung. Successful control of the venous bleeding, and complete disappearance of air leakage was unexpectedly achieved after a few minutes from Tachosil application. The artificial fibrin-collagen barrier was shown to effectively stick to the lung parenchyma, also after reinstitution of full and adequate mechanical ventilation. There was no further bleeding at the erosion site, as well as from the tracheal tube, and gradual improvement of the gas exchange was observed. The patient was intubated for 4 days, with no recurrence of bleeding or air leak. He was discharged on postoperative day 20. Uncontrollable pulmonary hemorrhage represents one of the most dreadful complications after surgical treatment of thoracic aortic aneurysms. Parenchymal erosion and fragility involving the alveolar tissue, prolonged extracorporeal circulation with severe hypocoagulative state, insufficient ventilation of one lung, and the need of patient ventilation avoiding reinstitution of extracorporeal circulation and heparin administration are major drawbacks in this kind of bleeding from the pulmonary parenchyma. Difficult access to the location of the bleeding, often arising from fissural sites, the concomittance of severe air leakage and intrabronchial bleeding are additional factors making such conditions extremely challenging and often not susceptible of effective control. Extreme maneuvers, such as pulmonary lobectomy [1Killen D.K. Muehlebach G.F. Wathanacharoen S. Aortopulmonary fistula.South Med J. 2000; 93: 195-198PubMed Google Scholar], pneumonectomy, or extracorporeal membrane oxygenation institution while compressing bleeding site with sponges and greatly reducing or avoiding lung ventilation, have been applied in these events. In our case, after conventional surgical approaches, the encountered complications were faced by applying several layers of a hemostatic compound, which created an effective barrier to severe lung bleeding and air leaking that could withstand subsequent lung ventilation and allowed the void of more complicated treatments and patient management. The use of human fibrinogen/thrombin-coated collagen sealing has been shown to be effective in treating air leaks in lung surgery in prospective randomized trial [3Anegg U. Lindenmann J. Matzi V. Smolle J. Maier A. Smolle-Juttner F. Efficiency of fleece-boumd sealing (Tachosil) of air leaks in lungs surgery : a prospective randomised trial.Eur J Cardio-Thorac Surg. 2007; 31: 198-202Crossref PubMed Scopus (126) Google Scholar, 4Rena O. Papalia E. Mineo T.C. et al.Air-leak management after upper lobe lobectomy in patients with fused fissure and chronic obstructive pulmonary disease: a pilot trial comparing sealant and standard treatment.Interact J Thorac Cardiovasc Surg. 2009; 9: 973-977Crossref PubMed Scopus (27) Google Scholar]. Furthermore, facing a lacerated or severely injured lung parenchyma, usually troublesome conditions to manage with conventional techniques (ie, pledge sutures or stapling), the association of fragile tissue, severe bleeding and air leakage impose additional technical challenge to a life-threatening situation, which may lead to patient death. Also, in this case, fleece-bound sealing has been shown to provide effective sealing in the presence of pulmonary destruction [5Molnar T.F. Farkas A. Stankovics J. Horvath O.P. A new method for coping with lung parenchyma destruction in paedriatic thoracic surgery.Eur J Cardio-Thorac Surg. 2008; 34: 675-676Crossref PubMed Scopus (6) Google Scholar]. Fibrinogen/thrombin-coated collagen patches have been shown to effectively control bleeding after routine cardiac surgery procedures or cumbersome complications in abdominal surgery [6Maisano F. Kiaergard H.K. Bauernschimitt R. et al.Tachosil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial.Eur J Cardio-Thorac Surg. 2009; 36: 708-714Crossref PubMed Scopus (78) Google Scholar, 7Apestegui C. Breitenstein S. Dutkowski P. Clavien P.A. Control of severe portal bleeding by carrier-bound fibrin sealant.Surg Today. 2009; 39: 363-365Crossref PubMed Scopus (3) Google Scholar]. Therefore, the fibrin-collagen barrier seems to be an invaluable tool to treat refractory bleeding from the lung parenchyma, also taking into account that biodegradation occurs within 2 to 4 weeks, therefore avoiding potential adverse events, such as chronic adhesions or compression. Last, but not least, the use of such compounds has shown to reduce chest drain indwelling time, as well as hospitalization after lung surgery to treat air leaks [3Anegg U. Lindenmann J. Matzi V. Smolle J. Maier A. Smolle-Juttner F. Efficiency of fleece-boumd sealing (Tachosil) of air leaks in lungs surgery : a prospective randomised trial.Eur J Cardio-Thorac Surg. 2007; 31: 198-202Crossref PubMed Scopus (126) Google Scholar], indicating that in association with reduce blood-related products, such sealing agents may also prove to be cost-effective in these circumstances." @default.
• W2000586961 created "2016-06-24" @default.
• W2000586961 creator A5013375655 @default.
• W2000586961 creator A5043650751 @default.
• W2000586961 creator A5044866592 @default.
• W2000586961 creator A5061512474 @default.
• W2000586961 date "2011-03-01" @default.
• W2000586961 modified "2023-09-24" @default.
• W2000586961 title "Human Fibrinogen/Thrombin-Coated Collagen Patch to Control Intraoperative Severe Pulmonary Hemorrhage and Air Leakage After Correction of a Ruptured Thoracic Aortic Aneurysm" @default.
• W2000586961 cites W2008174181 @default.
• W2000586961 cites W2104142715 @default.
• W2000586961 cites W2143284313 @default.
• W2000586961 cites W2152480269 @default.
• W2000586961 cites W2152748846 @default.
• W2000586961 cites W2400778644 @default.
• W2000586961 doi "https://doi.org/10.1016/j.athoracsur.2010.08.015" @default.
• W2000586961 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21353031" @default.
• W2000586961 hasPublicationYear "2011" @default.
• W2000586961 type Work @default.
• W2000586961 sameAs 2000586961 @default.
• W2000586961 citedByCount "12" @default.
• W2000586961 countsByYear W20005869612012 @default.
• W2000586961 countsByYear W20005869612013 @default.
• W2000586961 countsByYear W20005869612014 @default.
• W2000586961 countsByYear W20005869612015 @default.
• W2000586961 countsByYear W20005869612017 @default.
• W2000586961 countsByYear W20005869612018 @default.
• W2000586961 countsByYear W20005869612019 @default.
• W2000586961 countsByYear W20005869612020 @default.
• W2000586961 crossrefType "journal-article" @default.
• W2000586961 hasAuthorship W2000586961A5013375655 @default.
• W2000586961 hasAuthorship W2000586961A5043650751 @default.
• W2000586961 hasAuthorship W2000586961A5044866592 @default.
• W2000586961 hasAuthorship W2000586961A5061512474 @default.
• W2000586961 hasBestOaLocation W20005869611 @default.
• W2000586961 hasConcept C126322002 @default.
• W2000586961 hasConcept C141071460 @default.
• W2000586961 hasConcept C160022790 @default.
• W2000586961 hasConcept C2776098176 @default.
• W2000586961 hasConcept C2777050789 @default.
• W2000586961 hasConcept C2777292125 @default.
• W2000586961 hasConcept C2777323849 @default.
• W2000586961 hasConcept C2777714996 @default.
• W2000586961 hasConcept C2779036427 @default.
• W2000586961 hasConcept C2780847584 @default.
• W2000586961 hasConcept C42219234 @default.
• W2000586961 hasConcept C71924100 @default.
• W2000586961 hasConcept C89560881 @default.
• W2000586961 hasConceptScore W2000586961C126322002 @default.
• W2000586961 hasConceptScore W2000586961C141071460 @default.
• W2000586961 hasConceptScore W2000586961C160022790 @default.
• W2000586961 hasConceptScore W2000586961C2776098176 @default.
• W2000586961 hasConceptScore W2000586961C2777050789 @default.
• W2000586961 hasConceptScore W2000586961C2777292125 @default.
• W2000586961 hasConceptScore W2000586961C2777323849 @default.
• W2000586961 hasConceptScore W2000586961C2777714996 @default.
• W2000586961 hasConceptScore W2000586961C2779036427 @default.
• W2000586961 hasConceptScore W2000586961C2780847584 @default.
• W2000586961 hasConceptScore W2000586961C42219234 @default.
• W2000586961 hasConceptScore W2000586961C71924100 @default.
• W2000586961 hasConceptScore W2000586961C89560881 @default.
• W2000586961 hasIssue "3" @default.
• W2000586961 hasLocation W20005869611 @default.
• W2000586961 hasLocation W20005869612 @default.
• W2000586961 hasOpenAccess W2000586961 @default.
• W2000586961 hasPrimaryLocation W20005869611 @default.
• W2000586961 hasRelatedWork W1994110388 @default.
• W2000586961 hasRelatedWork W2054634849 @default.
• W2000586961 hasRelatedWork W2066361067 @default.
• W2000586961 hasRelatedWork W2383868857 @default.
• W2000586961 hasRelatedWork W2409718499 @default.
• W2000586961 hasRelatedWork W2860514319 @default.
• W2000586961 hasRelatedWork W4212838221 @default.
• W2000586961 hasRelatedWork W4281720035 @default.
• W2000586961 hasRelatedWork W4285724196 @default.
• W2000586961 hasRelatedWork W4298629755 @default.
• W2000586961 hasVolume "91" @default.
• W2000586961 isParatext "false" @default.
• W2000586961 isRetracted "false" @default.
• W2000586961 magId "2000586961" @default.
• W2000586961 workType "article" @default.