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Franciosi BM, Rodrigues EZ, de Oliveira IDP, Detanico MFO. Management of massive hemothorax due to internal mammary pseudoaneurysm treated with angioembolization post-cesarean section involving traumatic fetal extraction: A case report. Trauma Case Rep 2024; 51:101022. [PMID: 38694197 PMCID: PMC11061742 DOI: 10.1016/j.tcr.2024.101022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Pseudoaneurysm, or false aneurysm, is a clinical entity caused by rupture of the arterial wall, leading to blood leakage that is confined by sorroundig tissue. Massive hemothorax constitutes a life-threatening condition demanding timely and accurate medical response. Case report A puerperal presented with a massive hemothorax precipitated by a traumatic cesarean section due to hemorrhage from a pseudoaneurysm of the left internal thoracic artery. Initial treatment involved a sternotomy, followed by a conclusive therapy via angioembolization. Conclusion Precise assessment, including the measurement and localization of the ITA pseudoaneurysm is crucial to formulate an appropriate therapeutic strategy. Current medial practice favors endovascular embolization as a reliable and minimally invasive alternative to open surgery, establishing ir as the treatment of choice.
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Affiliation(s)
- Bruna Mohr Franciosi
- Trauma Surgery Resident, Department of Trauma Surgery, Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Zanotta Rodrigues
- Trauma Surgery Resident, Department of Trauma Surgery, Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Maria Fernanda Oliva Detanico
- Digestive and Trauma Surgeon, Department of Trauma Surgery, Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
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2
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Boccatonda A, Balletta M, D'Ardes D, Cocco G, Piscaglia F, Serra C, Vicari S, Schiavone C. Ultrasound diagnosis of a pseudoaneurysm of the internal right mammary artery. J Ultrasound 2024:10.1007/s40477-024-00889-6. [PMID: 38632171 DOI: 10.1007/s40477-024-00889-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
One of the principles of managing trauma patients is that of their continuous re-evaluation over the hours and days. Even if the execution of the computed tomography method is classically recommended, especially in the most serious cases and in polytraumas with major dynamics, the clinician can use or request an ultrasound examination, especially in subsequent re-evaluations. Here we report a clinical case demonstrating how an ultrasound re-evaluation after the acute event can lead to a correct diagnosis of a rare complication of thoracic trauma. The findings were suggestive for a pseudoaneurysm of the internal right mammary artery. Subsequently, an ultrasound-guided injection of thrombin was carried out until complete interruption of the flow within the formation. At subsequent follow-up, no arterial or venous blush was highlighted.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Via Marconi 35, Bentivoglio, Bologna, Italy.
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Marco Balletta
- Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging Science, Institute of "Clinica Medica", "G. d'Annunzio" University of Chieti, 66100, Chieti, Italy
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. D'Annunzio" University, 66100, Chieti, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Via Marconi 35, Bentivoglio, Bologna, Italy
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. D'Annunzio" University, 66100, Chieti, Italy
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3
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Aikins KA, Anderson ZN, Koci TM. Traumatic Pseudoaneurysms of the Internal Mammary Artery: Two Cases and Percutaneous Intervention. Diagnostics (Basel) 2023; 14:63. [PMID: 38201372 PMCID: PMC10802145 DOI: 10.3390/diagnostics14010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Pseudoaneurysms involving the internal mammary artery/internal thoracic artery (IMA/ITA) are rare occurrences, and the presentation and treatment approaches for such cases can be variable. Due to the potentially life-threatening risk of rupture, leading to conditions like hemothorax, it is important to have a comprehensive understanding of safe and effective diagnostic and therapeutic techniques. We present two cases of IMA/ITA artery pseudoaneurysms. A 91-year-old male presented to the emergency department following a motor vehicle accident. A CT scan of the chest revealed an anterior mediastinal hemorrhage with active extravasation. Percutaneous intervention revealed a pseudoaneurysm arising from a left IMA/ITA side branch. Coil embolization effectively treated the pseudoaneurysm. In the second case, a 79-year-old male presented with a sternal fracture after a ground-level fall, with parasternal hematoma and active bleeding (pseudoaneurysm) on Trauma Computerized Tomography of the chest with contrast. He underwent coil embolization, and subsequent post-procedure angiograms confirmed the effective occlusion of the left IMA/ITA, with no further visualization of the pseudoaneurysm. These two cases underscore the importance of tailored approaches in treating internal mammary artery pseudoaneurysms.
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Affiliation(s)
| | | | - Timothy M. Koci
- Reno School of Medicine, University of Nevada, Reno, NV 89557, USA; (K.A.A.); (Z.N.A.)
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Ko S, Kwon H, Kim CW, Lee H, Kim JH, Kim H, Park CI. Blunt Trauma in Children: Efficacy and Safety of Transarterial Embolization, 10-Year Experiences in a Single Trauma Center. Diagnostics (Basel) 2023; 13:3392. [PMID: 37958288 PMCID: PMC10650857 DOI: 10.3390/diagnostics13213392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) is an established approach for controlling hemorrhage in adults with acute abdominal and pelvic trauma. However, its application in pediatric trauma is not well established. This study aimed to evaluate the safety and effectiveness of TAE in a population of pediatric patients with blunt trauma. METHODS This retrospective study was conducted in pediatric patients (<18 years) who underwent TAE for blunt trauma between February 2014 and July 2022. The patients were categorized into subgroups based on age and body weight. Patient demographics, injury severity, transfusion requirements, and clinical outcomes were analyzed. RESULTS Exactly 73 patients underwent TAE. Technical success was achieved in all patients (100%), and clinical success was achieved in 83.6%. The mortality and complication rates were 4.1% and 1.4%, respectively. The mean duration of hospitalization was 19.3 days. Subgroup analysis showed that age, body weight, and sex did not significantly affect clinical success. The injury severity score and transfusion requirement were predictors of clinical success, with lower values associated with better outcomes. CONCLUSIONS TAE is effective and safe for managing blunt pediatric trauma in younger and lighter patients. Injury severity and transfusion requirement are predictors of clinical success.
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Affiliation(s)
- Seyoung Ko
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 49241, Republic of Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 49241, Republic of Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 49241, Republic of Korea
| | - Hojun Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 49241, Republic of Korea
| | - Jae Hun Kim
- Department of Trauma Surgery and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 43241, Republic of Korea
| | - Hohyun Kim
- Department of Trauma Surgery and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 43241, Republic of Korea
| | - Chan Ik Park
- Department of Trauma Surgery and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan 43241, Republic of Korea
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5
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Balakrishnan S. CT angiography of non-aortic thoracic arterial trauma. Emerg Radiol 2023; 30:667-681. [PMID: 37704920 DOI: 10.1007/s10140-023-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma.
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Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency and Trauma Imaging, Emory University School of Medicine, Atlanta, GA, USA.
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6
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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7
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Noh D, Chang SW, Ma DS. Extra-Pericardial Tamponade due to Internal Thoracic Artery Rupture after Blunt Trauma: A Case Report. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
<p>Cardiac tamponade is an acute life-threatening condition that predominantly involves the intra-pericardial space; however, an expanding mediastinal hematoma can also sometimes cause cardiac tamponade. Here we describe the case of a 45-year-old male driver in whom a traffic accident resulted in rupture of the left internal thoracic artery (ITA), extra-pericardial hematoma, and sternal fracture. After resuscitation, he was scheduled to undergo angio-embolization to repair the ruptured left ITA, but he suddenly developed cardiac tamponade that required a decompressive sternotomy. Nevertheless, the patient had an uncomplicated recovery, and this case suggests that extra-pericardial cardiac tamponade should be considered as a possible consequence of retro-sternal hematoma due to traumatic ITA rupture.</p>
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Jones KA, Sadri S, Ahmad N, Weintraub JR, Reis SP. Thoracic Trauma, Nonaortic Injuries. Semin Intervent Radiol 2021; 38:75-83. [PMID: 33883804 DOI: 10.1055/s-0041-1726005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trauma is one of the leading causes of death worldwide. Approximately two-thirds of trauma patients have thoracic injuries. Nonvascular injury to the chest is most common; however, while vascular injuries to the chest make up a small minority of injuries in thoracic trauma, these injuries are most likely to require intervention by interventional radiology (IR). IR plays a vital role, with much to offer, in the evaluation and management of patients with both vascular and nonvascular thoracic trauma; in many cases, IR treatments obviate the need for these patients to go to the operating room. This article reviews the role of IR in the treatment of vascular an nonvascular traumatic thoracic injuries.
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Affiliation(s)
- Kai A Jones
- Columbia University Vegelos College of Physicians and Surgeons, New York, New York
| | - Shirin Sadri
- Columbia University Vegelos College of Physicians and Surgeons, New York, New York
| | - Noor Ahmad
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York
| | | | - Stephen P Reis
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York
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9
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Adusumilli P, Hogg W, McPherson SJ. Isolated Internal Mammary Vein Traumatic Injury Causing Massive Mediastinal Hematoma Successfully Treated by Coil Embolization. J Vasc Interv Radiol 2020; 31:1900-1902. [DOI: 10.1016/j.jvir.2020.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 10/23/2022] Open
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10
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Morgan J, Bolanos A, Al‐Balas H, Paniagua D. Bilateral internal mammary artery laceration after cardiac pulmonary resuscitation. Catheter Cardiovasc Interv 2019; 93:1298-1300. [DOI: 10.1002/ccd.28180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/18/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Jacob Morgan
- Department of Internal Medicine, Department of MedicineBaylor College of Medicine Houston Texas
| | - Alexander Bolanos
- Department of Cardiology, Department of MedicineBaylor College of Medicine Houston Texas
| | - Hassan Al‐Balas
- Department of RadiologyMichael E. DeBakey Veteran Affairs Medical Center Houston Texas
| | - David Paniagua
- Department of Cardiology, Department of MedicineBaylor College of Medicine Houston Texas
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11
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Zeng Z, Chen Y, Song Y, Lin F. Internal mammary artery injury during percutaneous coronary intervention: a case report. BMC Cardiovasc Disord 2018; 18:222. [PMID: 30514236 PMCID: PMC6280442 DOI: 10.1186/s12872-018-0972-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease (CAD). However, complications of PCI are inevitable. Internal mammary artery (IMA) injury is an infrequent but potentially lethal complication of PCI. CASE PRESENTATION A 78-year-old man was diagnosed with multivessel lesions by coronary angiography. The IMA was injured during PCI, then cured by early identification and active rescue. CONCLUSIONS This is the first reported case, to our knowledge, of injury to the IMA during PCI. We we report this case to discuss how to treat this injury effectively and avoid this complication during clinical therapy.
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Affiliation(s)
- Zhicong Zeng
- Cardiology Department, Affiliated Baoan TCM Hospital, Guangzhou University of Traditional Chinese Medicine, No.25, Yuan Second Road, Shenzhen City, Guangdong Province, People's Republic of China
| | - Yaqin Chen
- Cardiology Department, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yinzhi Song
- Cardiology Department, Affiliated Baoan TCM Hospital, Guangzhou University of Traditional Chinese Medicine, No.25, Yuan Second Road, Shenzhen City, Guangdong Province, People's Republic of China
| | - Fengxia Lin
- Cardiology Department, Affiliated Baoan TCM Hospital, Guangzhou University of Traditional Chinese Medicine, No.25, Yuan Second Road, Shenzhen City, Guangdong Province, People's Republic of China.
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12
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Internal Mammary Artery Injury without Chest Wall Fractures after Cardiopulmonary Resuscitation: A Case Report. Case Rep Emerg Med 2018; 2018:1948151. [PMID: 30425861 PMCID: PMC6218792 DOI: 10.1155/2018/1948151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/29/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
High-quality cardiopulmonary resuscitation (CPR) is crucial for survival from cardiac arrest. However, various chest compression-associated injuries have been reported. Internal mammary artery (IMA) injury is one of the rare complications after CPR, and most of cases include rib and sternum fractures. In this report, we describe a rare case of IMA injury without chest wall fractures after CPR. An 85-year-old man with a history of acute myocardial infarction 2 weeks prior visited to our hospital for sustained ventricular tachycardia (VT). After admission, sustained VT requiring CPR occurred several times. Emergency coronary angiogram revealed 90% stenosis at the left anterior descending artery. Hence, emergency percutaneous coronary intervention (PCI) was performed. During the PCI, blood gas analysis showed decreasing serum hemoglobin levels. Contrast computed tomography revealed hemothorax and extravasation at the branch of the right IMA without chest wall fractures. The patient's deteriorating hemodynamic condition precluded thoracotomy or embolization to stop the bleeding. The patient died on the next day of hospitalization. IMA injury can occur after CPR, regardless of chest wall fractures and can be fatal without early diagnosis. For an emergency physician, IMA injury should be considered as a cause of unknown anemia after CPR.
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13
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Full realization of internal mammary artery injury after blunt chest trauma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:504-510. [PMID: 32082790 DOI: 10.5606/tgkdc.dergisi.2018.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
Abstract
Due to the substantial and continual increase in the number of motorized vehicles globally, clinicians are faced with an enormous population at risk for suffering internal mammary artery injuries after blunt chest trauma. Nevertheless, very little attention has been paid to this issue by relevant health practitioners. In addition, there is a scarcity of extant research data, as well as societal guidelines, regarding internal mammary artery injury. In cases with undetected internal mammary artery injury, however, the outcome may be catastrophic or fatal. Thus, investigating and reviewing the anatomy, etiology, diagnostic approaches, and treatment strategies for patients with internal mammary artery injury are urgently needed.
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14
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Yao F, Lu YQ, Jiang JK, Gu LH, Mou HZ. Immune recovery after fluid resuscitation in rats with severe hemorrhagic shock. J Zhejiang Univ Sci B 2018; 18:402-409. [PMID: 28471112 DOI: 10.1631/jzus.b1600370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of resuscitation with normal saline (NS), hypertonic saline (HTS), and hydroxyethyl starch (HES) on regulatory T cells (Tregs), helper T 1 (Th1)/Th2 and cytotoxic T 1 (Tc1)/Tc2 profiles in the treatment of hemorrhagic shock. METHODS Rats subjected to severe hemorrhagic shock were resuscitated for 30 min with NS (n=8), HTS (n=8), or HES (n=8); sham (n=8) and naive control (n=8) groups were used for comparison. Following fluid resuscitation, the whole shed blood was reinfused for 30 min, and the rats were observed with continuous hemodynamic monitoring for 120 min. CD4+CD25+Foxp3+ Treg proportions, Th1/Th2 and Tc1/Tc2 profiles in spleen were analyzed by three-color flow cytometry. RESULTS The proportion of CD4+CD25+Foxp3+ Tregs and ratios of Th1/Th2 and Tc1/Tc2 did not differ among control, sham, and HTS groups, but were significantly lower in NS and HES groups (both P<0.05 vs. sham); NS and HES levels were similar. The level of Tc1 was significantly increased in HTS (P<0.05 vs. sham), and levels of Tc2 were increased in NS, HES, and HTS groups compared to sham (all P<0.05), but did not differ from each other. CONCLUSIONS HTS resuscitation has a greater impact on immune system recovery than NS or HES by preserving the proportion of Tregs and maintaining the balance between Th1/Th2 and Tc1/Tc2 cells in the spleen. Thus, HTS resuscitation provides potential immunomodulatory activity in the early stage after hemorrhagic shock.
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Affiliation(s)
- Feng Yao
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jiu-Kun Jiang
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lin-Hui Gu
- Cancer Institute, Zhejiang Tumor Hospital, Hangzhou 310022, China
| | - Han-Zhou Mou
- Cancer Institute, Zhejiang Tumor Hospital, Hangzhou 310022, China
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15
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Haraguchi Y, Sakakura K, Yamamoto K, Taniguchi Y, Nakashima I, Wada H, Sanui M, Momomura SI, Fujita H. Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma. Int Heart J 2018; 59:407-412. [PMID: 29479014 DOI: 10.1536/ihj.17-173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.
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Affiliation(s)
- Yumiko Haraguchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Ikue Nakashima
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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16
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Corvino F, Giurazza F, Cangiano G, Cavaglià E, Amodio F, De Magistris G, Corvino A, Niola R. Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries. Radiol Med 2017; 123:369-377. [PMID: 29256083 DOI: 10.1007/s11547-017-0844-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/11/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Demonstrate the role of endovascular management in the treatment of internal mammary artery (IMA) injuries using transcatheter embolization reviewing our 7-year experience. MATERIALS AND METHODS Our retrospective analysis of cases consists of a total of 12 patients (8 M and 4 F; mean age 52 years) who underwent angiographic studies and transcatheter embolization for IMA injuries. Causes of vascular injury were divided in high-energy trauma (n = 6), iatrogenic (n = 3) and penetrating injuries (n = 3). Type of trauma, associated injury, imaging findings, treatments and complications were assessed. Imaging findings included active haemorrhage, pseudoaneurysm and focal dissection. RESULTS Embolization was performed with microcoils in all patients; complete thrombosis was obtained in four patients by additional injection of Spongostan pledgets and in two patients with 300-500 μm particles. The technical success rate was 100%. No patient died as a direct result of vascular injury; one died of myocardial contusion and one for severe multiorgan failure related to high-energy trauma. No major and minor complications were registered. No patient required emergency surgery or subsequent surgical treatment. CONCLUSION Transcatheter embolization offers an effective, efficient and safe alternative to conventional surgical management of IMA injuries.
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Affiliation(s)
- Fabio Corvino
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Francesco Giurazza
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Gianluca Cangiano
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Enrico Cavaglià
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Francesco Amodio
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Giuseppe De Magistris
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Antonio Corvino
- Department of Radiology, University of Naples Parthenope, Naples, Italy
| | - Raffaella Niola
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
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Cardiac tamponade due to internal mammary artery injury after cardiopulmonary resuscitation: A case report. Am J Emerg Med 2017; 36:525.e1-525.e2. [PMID: 29237544 DOI: 10.1016/j.ajem.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/28/2017] [Accepted: 12/02/2017] [Indexed: 11/22/2022] Open
Abstract
Vascular injuries caused by cardiopulmonary resuscitation (CPR) can be associated with major complications. If patients who have received CPR have sudden abnormal hemodynamic findings, it is necessary to consider the possibility of these injuries. We report a 73-year-old man who had cardiac tamponade due to an injury to the internal mammary artery following manual chest compression. This very rare injury was detected by computed tomography and was treated by thoracotomy and hematoma evacuation.
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18
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Yamagishi T, Kashiura M, Sugiyama K, Nakamura K, Ishida T, Yukawa T, Miyazaki K, Tanabe T, Hamabe Y. Chest compression-related fatal internal mammary artery injuries manifesting after venoarterial extracorporeal membrane oxygenation: a case series. J Med Case Rep 2017; 11:318. [PMID: 29126457 PMCID: PMC5681756 DOI: 10.1186/s13256-017-1485-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation-related bleeding, especially internal mammary artery injuries, can become life-threatening complications after initiating venoarterial extracorporeal membrane oxygenation owing to the frequent involvement of concomitant anticoagulant treatment, antiplatelet treatment, targeted temperature management, and bleeding coagulopathy. We report the cases of five patients who experienced this complication and discuss their management. CASE PRESENTATION We retrospectively evaluated five patients with cardiopulmonary resuscitation-related internal mammary artery injuries who were treated between February 2011 and February 2016 at our institution. All five patients were Asian men, aged 56 to 68-years old, who had received concomitant intravenously administered unfractionated heparin (3000 units) with antiplatelet therapy. Four patients received targeted temperature management. The injuries and hematomas were detected using contrast-enhanced computed tomography in all cases. Three patients were treated using transcatheter arterial embolization within 6 hours following cardiopulmonary arrest, and two were resuscitated and received appropriate treatment following early recognition of their injuries. Two patients died of hemorrhagic shock with delayed intervention. Four of the five patients had excessively prolonged activated partial thromboplastin times before their interventions. CONCLUSIONS Computed tomography should be performed as soon as possible after the return of spontaneous circulation to identify injuries and consider appropriate treatments for patients who have experienced cardiac arrest. Delayed bleeding may develop after treating hypovolemic shock and relieving arterial spasms; therefore, transcatheter arterial embolization should be performed aggressively to prevent delayed bleeding even in the absence of extravasation. This approach may be superior to thoracotomy because it is less invasive, causes less bleeding, and can selectively stop arterial bleeding sooner. A 3000-unit intravenous bolus of unfractionated heparin may be redundant; heparin-free extracorporeal cardiopulmonary resuscitation may be a more appropriate alternative. Unfractionated heparin treatment can commence after the bleeding has stopped.
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Affiliation(s)
- Toshinobu Yamagishi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuha Nakamura
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takahiro Yukawa
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuki Miyazaki
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takahiro Tanabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
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19
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Cirugía endovascular de seudoaneurisma de arteria mamaria interna post-implantación de marcapasos. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Santamarina MG, Beddings I, Lermanda Holmgren GV, Opazo Sanchez H, Volpacchio MM. Multidetector CT for Evaluation of the Extrapleural Space. Radiographics 2017; 37:1352-1370. [DOI: 10.1148/rg.2017160180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mario G. Santamarina
- From the Department of Radiology, Hospital Naval Almirante Nef, Subida Alessandri S/N, Viña del Mar 2520000, Chile (M.G.S., G.V.L.H.); Departments of Radiology (M.G.S.) and Pathology (H.O.S.), Hospital Dr Eduardo Pereira, Valparaíso, Chile; Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (I.B.); Department of Pathology, Universidad Andrés Bello, Viña del Mar, Chile (H.O.S.)
| | - Ignacio Beddings
- From the Department of Radiology, Hospital Naval Almirante Nef, Subida Alessandri S/N, Viña del Mar 2520000, Chile (M.G.S., G.V.L.H.); Departments of Radiology (M.G.S.) and Pathology (H.O.S.), Hospital Dr Eduardo Pereira, Valparaíso, Chile; Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (I.B.); Department of Pathology, Universidad Andrés Bello, Viña del Mar, Chile (H.O.S.)
| | - Guillermo V. Lermanda Holmgren
- From the Department of Radiology, Hospital Naval Almirante Nef, Subida Alessandri S/N, Viña del Mar 2520000, Chile (M.G.S., G.V.L.H.); Departments of Radiology (M.G.S.) and Pathology (H.O.S.), Hospital Dr Eduardo Pereira, Valparaíso, Chile; Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (I.B.); Department of Pathology, Universidad Andrés Bello, Viña del Mar, Chile (H.O.S.)
| | - Hector Opazo Sanchez
- From the Department of Radiology, Hospital Naval Almirante Nef, Subida Alessandri S/N, Viña del Mar 2520000, Chile (M.G.S., G.V.L.H.); Departments of Radiology (M.G.S.) and Pathology (H.O.S.), Hospital Dr Eduardo Pereira, Valparaíso, Chile; Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (I.B.); Department of Pathology, Universidad Andrés Bello, Viña del Mar, Chile (H.O.S.)
| | - Mariano M. Volpacchio
- From the Department of Radiology, Hospital Naval Almirante Nef, Subida Alessandri S/N, Viña del Mar 2520000, Chile (M.G.S., G.V.L.H.); Departments of Radiology (M.G.S.) and Pathology (H.O.S.), Hospital Dr Eduardo Pereira, Valparaíso, Chile; Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (I.B.); Department of Pathology, Universidad Andrés Bello, Viña del Mar, Chile (H.O.S.)
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21
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Khorasani H, Eiberg J, Bigaard J. Idiopathic pseudoaneurysm in a patient with breast implants. J Surg Case Rep 2016; 2016:rjw128. [PMID: 27470014 PMCID: PMC4964044 DOI: 10.1093/jscr/rjw128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aneurysms and pseudoaneurysms of the internal mammary artery (IMA) are rare and the etiology uncertain although iatrogenic causes have been described. A 64-year-old woman suffered hematoma and bleeding from a pseudoaneurysm probably originating from a branch of the right IMA 16 years after breast implant surgery. After clinical assessment, the patient underwent surgery with resection of the aneurysm and ligation of the arterial branch. No early postoperative complications were reported. Pseudoaneurysms in small vessels such as the IMA or its branches are not well described in the literature. Proper diagnosis with imaging is of importance in order to determine treatment as each case is unique. Some cases can be managed conservatively.
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Affiliation(s)
- Hoda Khorasani
- Department of Breast Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark University of Copenhagen, Copenhagen, Denmark Copenhagen Academy of Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Janne Bigaard
- Department of Breast Surgery, Rigshospitalet, Copenhagen, Denmark
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22
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Kawakami S, Noguchi T, Doi T, Tahara Y, Sanda Y, Fukuda T, Ogawa H, Yasuda S. Internal Mammary Artery Injury Related to Chest Compressions in a Patient with Post-cardiac Arrest Syndrome. Intern Med 2016; 55:1299-303. [PMID: 27181536 DOI: 10.2169/internalmedicine.55.5762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although high-quality cardiopulmonary resuscitation (CPR) is essential for survival from cardiac arrest, chest compressions can also sometimes lead to life-threatening chest injuries. In addition, post-cardiac arrest syndrome patients often have coagulopathy due to therapeutic hypothermia, mechanical hemodynamic support, or both. Therefore, when progressive anemia and prolonged shock are detected in patients who have received CPR, identifying the cause of hemorrhagic shock is crucial. We herein present an interesting case of hemorrhagic shock due to an internal mammary artery injury secondary to CPR that was detected by computed tomography and invasive angiography.
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Affiliation(s)
- Shoji Kawakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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23
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Datta S, Manoly I, Karangelis D, Hasan R. Pseudoaneurysm of the Right Internal Mammary Artery Post Vacuum-Assisted Closure Therapy: A Rare Complication and Literature Review. Ann Vasc Surg 2015; 31:207.e1-3. [PMID: 26597235 DOI: 10.1016/j.avsg.2015.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
Abstract
Vacuum-assisted closure (VAC) therapy in the management of sternal wound infection post cardiac surgery has gained popularity since last decade. It is very cost effective and has survival benefit compared with conventional management. Although there are few complications associated with VAC therapy including right ventricular free wall rupture and infectious erosion to aorta, there are now isolated reports of vein graft pseudoaneurysm associated with it. We describe an extremely rare complication of right internal mammary artery pseudoaneurysm post VAC therapy in a 56-year-old man which was successfully managed surgically. We also did a literature review on the possible complications of VAC therapy post cardiac surgery and its management.
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Affiliation(s)
- Subir Datta
- Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Imthiaz Manoly
- Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Dimos Karangelis
- Central Manchester University Hospitals Foundation Trust, Manchester, UK.
| | - Ragheb Hasan
- Central Manchester University Hospitals Foundation Trust, Manchester, UK
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