<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_448"
                     title="Inflammatory Bowel Disease Linked to Dangerous VT (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Gastroenterology/InflammatoryBowelDisease/tb/18362?impressionId=1265758181802"
                     
      &lt;p&gt;Patients with active inflammatory bowel disease (IBD) could be at far greater risk for potentially deadly blood clots than doctors previously thought, a new British study found.&lt;/p&gt;
&lt;p&gt;Nonhospitalized patients with active IBD are 16 times more likely to suffer venous thromboembolism than the general population, with an occurrence rate of 6.4 per 1,000 person-years (HR 15.8, 95% CI 9.8 to 25.5, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), according to an online report in the Feb. 9 issue of &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The authors concluded that such patients could benefit from preventative treatment to prevent blood clotting.&lt;/p&gt;
&lt;p&gt;&quot;Despite the low absolute risks during nonhospitalised periods, these results suggest that active inflammatory bowel disease in ambulatory patients might be a far greater risk factor for venous thromboembolism than previously recognised,&quot; Matthew J. Grainge, MD, of the University of Nottingham, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Patients with venous thromboembolism in the leg have a short term-mortality rate of about 6%, increasing as high as 20% when the clot has circulated to the lung.&lt;/p&gt;
&lt;p&gt;Researchers believe that infection and inflammation, such as occur in IBD, predispose patients to this life-threatening condition, and those with inflammatory bowel disease seem to be at particular risk.&lt;/p&gt;
&lt;p&gt;Grainge and colleagues used records from the U.K. General Practice Research Database from November 1987 through July 2001, to match 13,756 patients with IBD against 71,672 controls without the disease.&lt;/p&gt;
&lt;p&gt;Of the subjects, 139 patients and 165 controls developed a blood clot during the study period.&lt;/p&gt;
&lt;p&gt;Their results agreed with previous studies indicating that patients hospitalized for IBD are at high risk for venous thromboembolism. However, the new study also found the danger extends to nonhospitalized IBD patients, particularly during a flare-up.&lt;/p&gt;
&lt;p&gt;Overall, the researchers reported, patients with IBD had three times as much risk of an embolism as controls (HR 3.4, 95% CI 2.7 to 4.3; &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) with an occurrence rate of 2.6 per 1,000 per person-years.&lt;/p&gt;
&lt;p&gt;During a flare-up, IBD patients were at dramatically greater risk.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the study excluded patients likely to have received corticosteroids for chronic respiratory disease and rheumatoid arthritis, so the results may not reflect blood clotting rates in these populations.&lt;/p&gt;
&lt;p&gt;They also noted that they relied on anonymous patient records and were dependent on family doctors&apos; diagnoses of inflammatory bowel disease, flare-ups and venous thromboembolism.&lt;/p&gt;
&lt;p&gt;Despite the limitations of the study, they argued that research into ways to prevent embolism in IBD outpatients is warranted.&lt;/p&gt;
&lt;p&gt;&quot;We believe that the medical profession needs to recognise the increased risk in people with inflammatory bowel disease when assessing the likelihood of venous thromboembolism and to address the difficulty of reducing this risk in patients with a flare who are not admitted to hospital,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They suggested that strategies used to prevent blood clots in hospitalized patients  --  courses of low molecular weight heparin or other newly available anticoagulants  --  might be also be used to prevent clots in nonhospitalized IBD patients experiencing a flare-up.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Geoffrey C. Nguyen, MD, and Erik L. Yeo, MD, of the University of Toronto, noted that &quot;the use of steroid prescriptions as a surrogate indicator of acute disease flare restricts the applicability of Grainge and colleagues&apos; findings to flares that are moderate to severe. Whether patients with mild flares are also at increased risk is not clear.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Recognition of venous thromboembolism might be increased during periods of frequent contact with doctors, such as during flares compared with during remission of inflammatory bowel disease, thus potentially introducing a bias in ascertainment of venous thromboembolism,&quot; they added.&lt;/p&gt;
&lt;p&gt;Nguyen and Yeo also argued that the clinical efficacy and cost-effectiveness of pharmacological prevention in patients with inflammatory bowel disease should be proven before it is routinely recommended during acute flares.&lt;/p&gt;
&lt;p&gt;However, they acknowledged that such evidence could be difficult to acquire, given the low numbers of nonhospitalized IBD patients who suffer venous thromboembolism.&lt;/p&gt;
&lt;p&gt;&quot;A pragmatic initial approach to reduction of the rates of morbidity and mortality resulting from venous thromboembolism in ambulatory patients with inflammatory bowel disease would be nonpharmacological thromboprophylaxis, including patients&apos; education and awareness of risk and signs and symptoms of venous thromboembolism, and use of support stockings,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Physicians should clinically assess for signs and symptoms of this embolism during visits for acute flare of inflammatory bowel disease.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Association for Colitis and Crohn&apos;s Disease.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;p&gt;Nguyen reported serving on advisory boards for Schering-Plough, Canada, and Abbott Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Yeo reported receiving an honorarium from sanofi-aventis.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.011"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265758181802"
                     
      &lt;p&gt;Representative John P. Murtha (D-Pa.), 77, long-time chairman of the House Appropriations Subcommittee on Defense, died yesterday afternoon from complications following a planned laparoscopic cholecystectomy, according to a statement from the congressman&apos;s office.&lt;/p&gt;
&lt;p&gt;He had been admitted to the intensive care unit at Virginia Hospital Center in Arlington on Jan. 31, days after surgeons at the National Naval Medical Center in Bethesda, Md., accidentally nicked his intestine during the operation, according to a report in &lt;em&gt;The Washington Post&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In that same report, Rep. Bob Brady (D-Pa.), a close friend of Murtha&apos;s, said the congressman developed an infection and fever.&lt;/p&gt;
&lt;p&gt;Citing a request for privacy from the Murtha family and patient privacy laws, a spokesperson for the National Naval Medical Center declined to provide information on the operation.&lt;/p&gt;
&lt;p&gt;In a statement, Virginia Hospital Center said Murtha died &quot;despite aggressive critical care interventions.&quot;&lt;/p&gt;


  &lt;p&gt;Mark Malangoni, MD, surgeon-in-chief at MetroHealth Medical Center in Cleveland, told &lt;em&gt;MedPage Today&lt;/em&gt; that serious complications, including bowel damage and death, are not common following cholecystectomy. More complicated patients, such as the obese and diabetics, have a greater risk of complications and of a switch to an open procedure.&lt;/p&gt;
    &lt;p&gt;Death is extremely rare in healthy individuals, occurring in no more than one per 1,000 patients, according to the American College of Surgeons (ACS).
    &lt;p&gt;More common, but still infrequent, are bleeding and leakage of bile, both of which can be treated fairly easily, said Malangoni, a regent of the ACS.&lt;/p&gt;


&lt;p&gt;When the bowel is damaged, as reportedly occurred in Murtha&apos;s case, it typically occurs in two ways -- either from a sharp injury when the trocars used for a laparoscopic procedure are inserted or from a cautery burn.
    &lt;p&gt;Both types of injury can go unnoticed by the surgeon and may not become apparent for days after the operation, Malangoni said.&lt;p&gt;
    &lt;p&gt;Although he did not know the details of Murtha&apos;s case, Malangoni said a patient would usually be admitted right away, at least overnight, if the surgeon realized that an injury had occurred. The procedure likely would have switched from a laparoscopic one to an open one as well.&lt;/p&gt;


&lt;p&gt;A 2009 Cochrane Review comparing laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis found no difference in mortality in 38 trials. No patients died in the laparoscopic group and only 0.09% died in the open group.&lt;/p&gt;
&lt;p&gt;Severe complications were reported in 2.2% of the laparoscopic patients and 6.8% of the open patients.&lt;/p&gt;


 &lt;p&gt;Malangoni said most surgeons become experienced with performing laparoscopic cholecystectomies before completing their residency; most will perform 40 or 50 by the end of training.&lt;p&gt;
    &lt;p&gt;&quot;It is a very common operation, so once out into practice, most general surgeons are doing dozens of these each year,&quot; he said. &quot;So your experience comes about pretty quickly.&quot;
    &lt;p&gt;It is unclear how much experience Murtha&apos;s surgeon had.&lt;/p&gt;

&lt;p&gt;Murtha had recently become the longest serving member of Congress in Pennsylvania state history.&lt;/p&gt;
&lt;p&gt;First elected in 1974, Murtha, a former Marine, was the first Vietnam War combat veteran to serve in Congress, and he served as an advocate for the military throughout his career. He was also a prominent critic of the Iraq War.&lt;/p&gt;
&lt;p&gt;Murtha is survived by his wife, Joyce, and three children.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_371"
                     title="Single Ultrasound for DVT May Suffice (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Cardiology/VenousThrombosis/tb/18257?impressionId=1265758181802"
                     
      &lt;p&gt;For patients with suspected deep vein thrombosis, the risk of symptomatic venous thromboembolism after a single, negative whole-leg compression ultrasound examination is low, a meta-analysis showed.&lt;/p&gt;
&lt;p&gt;Pooled results from seven studies showed the risk to be just 0.57% (95% CI 0.25% to 0.89%) through three months of follow-up in patients who were not given anticoagulants, Scott Stevens, MD, of Intermountain Medical Center in Murray, Utah, and colleagues reported in the Feb. 3 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The researchers suggested that a repeated compression ultrasound evaluation to detect distal thrombi moving upward  --  recommended in clinical practice guidelines five to seven days after a negative finding  --  may not be necessary.&lt;/p&gt;
&lt;p&gt;&quot;The efficiency and convenience of whole-leg compression ultrasound as a single study is superior to that of repeated ... evaluations,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;However, an accompanying editorial by Robert McNutt, MD, PhD, of Rush University Medical Center in Chicago, and Edward Livingston, MD, of the University of Texas Southwestern Medical Center in Dallas, cautioned against basing clinical decisions on a meta-analysis.&lt;/p&gt;
&lt;p&gt;They pointed to the variation in event rates among the seven included studies, ranging from 0.24% to 1.95%. The highest rate was found in hospitalized patients, although most of the studies included ambulatory patients.&lt;/p&gt;
&lt;p&gt;&quot;So using this average probability [0.57%] for clinical decision making in some clinical contexts may do more harm than good,&quot; they wrote. &quot;Greater detail about individual patient scenarios is necessary to facilitate better application of the study results to individual patients.&quot;&lt;/p&gt;
&lt;p&gt;Although whole-leg compression ultrasound reliably identifies the presence or absence of deep vein thrombosis above the knee, its accuracy for thrombi below the knee is less certain, according to Stevens and colleagues.&lt;/p&gt;
&lt;p&gt;So guidelines have recommended repeating the examination after a negative finding to rule out the upward propagation of a distal thrombus.&lt;/p&gt;
&lt;p&gt;But only 1% to 2% of those repeat exams actually detect thrombus propagation.&lt;/p&gt;
&lt;p&gt;Thus, a single whole-leg compression ultrasound may reliably exclude both proximal and distal deep vein thrombosis, the authors said.&lt;/p&gt;
&lt;p&gt;They reviewed the literature to assess the risk of venous thromboembolism in patients with suspected lower extremity deep vein thrombosis who had a single, negative whole-leg compression ultrasound and who had not received anticoagulation treatments for 90 days.&lt;/p&gt;
&lt;p&gt;Seven studies were included  --  one randomized controlled trial and six prospective cohort studies  --  comprising 4,731 patients, mostly from the ambulatory setting.&lt;/p&gt;
&lt;p&gt;Through three months of follow-up, 0.7% of patients had either confirmed venous thromboembolism or suspected venous thromboembolism-related death. All nine who died were either acutely ill, hospitalized patients, or patients with advanced cancer.&lt;/p&gt;
&lt;p&gt;The risk of having an event during follow-up increased with greater pretest probability of having deep vein thrombosis  --  0.29% for low risk, 0.82% for moderate risk, and 2.49% for high risk.&lt;/p&gt;
&lt;p&gt;However, because of low patient numbers, the researchers wrote, &quot;using a single negative whole-leg compression ultrasound result as the sole diagnostic modality in patients with high pretest probability of deep vein thrombosis requires further study.&quot;&lt;/p&gt;
&lt;p&gt;The authors listed several limitations of the analysis: &lt;ul&gt; &lt;li&gt;The variability in ultrasound techniques between the included studies may limit the validity and generalizability of the findings.&lt;/li&gt; &lt;li&gt;The pretest probability of deep vein thrombosis was not assessed using a standardized clinical prediction rule by most studies.&lt;/li&gt; &lt;li&gt;The findings might have limited generalizability to pregnant women, patients with cancer, and inpatients, who were underrepresented in the studies.&lt;/li&gt; &lt;li&gt;Longer-term outcomes were not assessed.&lt;/li&gt; &lt;li&gt;The findings might have been affected by verification bias, because only patients with symptoms were evaluated for venous thromboembolism during follow-up.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Steven did not report any conflicts of interest. One of his co-authors reported receiving consulting fees from AGEN Biomedical, Janssen-Ortho, Boehringer-Ingelheim, sanofi-aventis, and AstraZeneca, and receiving speaker&apos;s fees from Pfizer, Leo Pharma, and sanofi-aventis.&lt;/p&gt;&lt;p&gt;The editorialists did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_331"
                     title="Physicians Must Treat Transplant Tourists"
                     score="0.004"
                     href="http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/tb/18203?impressionId=1265758181802"
                     
      &lt;p&gt;Patients who travel to foreign countries for organ transplants may return with more problems than they left with  --  and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.&lt;/p&gt;
&lt;p&gt;&quot;Medical tourism&quot; has been on the rise as demand for organs outpaces supply and U.S. healthcare costs skyrocket, Thomas D. Schiano, MD, and Rosamond Rhodes, PhD, of Mount Sinai School of Medicine, reported in &lt;em&gt;Liver Transplantation&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Researchers have estimated that 300 medical tourism transplants occurred between 2004 and 2006, with more than 40% of transplant tourists residing in New York or California, which have only 18% of the total U.S. population. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; target=&quot;_blank&quot;&gt;International Medical Trade Turns Big Business&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Yet physicians have had little guidance on delivering care to these patients, and some transplant centers may turn them away, based on their actions, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Their questions about treatment arose with a 46-year-old Chinese patient who had been put on a waiting list for a liver transplant here because of end-stage liver disease.&lt;/p&gt;
&lt;p&gt;The patient waited on the list for a year as his disease progressed from 18 points to 21 points on a 40-point severity scale.&lt;/p&gt;
&lt;p&gt;Rather than wait any longer, the patient flew to China and had a liver transplant there.&lt;/p&gt;
&lt;p&gt;Many transplanted organs in China come from executed prisoners, raising concerns about disease. Also, foreign transplants may be compromised by poor organ matching, unhealthy donors, and post-transplant infections, while some transplant centers abroad may use substandard surgical techniques, the researchers said.&lt;/p&gt;
&lt;p&gt;Foreign centers are also less likely to send patients home with adequate records and education than centers here, they asserted.&lt;/p&gt;
&lt;p&gt;Three months after his transplant in China, the patient came back to the clinic at Mount Sinai for follow-up care because he was about to run out of imunosuppressive medication.&lt;/p&gt;
&lt;p&gt;Two months after that, the patient developed sepsis due to diffuse intrahepatic biliary stricturing related to hepatic artery thrombosis.&lt;/p&gt;
&lt;p&gt;He required three additional hospitalizations for biliary sepsis, and at that point, retransplantation was the only viable option, Schiano said.&lt;/p&gt;
&lt;p&gt;However, members of the medical team had conflicting views about giving the patient another new liver.&lt;/p&gt;
&lt;p&gt;&quot;He was a medically suitable candidate,&quot; Schiano and Rhodes wrote, &quot;but there was disagreement about whether it was morally right to provide him with a transplant.&quot;&lt;/p&gt;
&lt;p&gt;The clinicians had few ethical guidelines to refer to in making their decision because many deal solely with moral issues related to donors and foreign medical standards.&lt;/p&gt;
&lt;p&gt;For example, the International Society for Heart and Lung Transplantation issued a statement against accepting organs from prisoners in April 2007, and the American Association for the Study of Liver Diseases and the International Liver Transplant Society endorsed similar policies.&lt;/p&gt;
&lt;p&gt;The American Medical Association&apos;s guidelines on medical tourism focus on best practices  --  for example, the procedure must be voluntary, it can&apos;t limit the alternatives offered to patients, and patients should only be referred to accredited institutions.&lt;/p&gt;
&lt;p&gt;While the United Network for Organ Sharing (UNOS)&apos;s statement on medical tourism does maintain that the medical community has an obligation to provide care for these patients, it stops short of offering further direction to transplant programs.&lt;/p&gt;
&lt;p&gt;&quot;Little guidance is provided for dealing with the specific problems of patients who choose to become transplant tourists,&quot; Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Instead, they created some ethical guidance for the &quot;moral quandary.&quot;&lt;/p&gt;
&lt;p&gt;Physicians have a &quot;professional obligation to promote the good of patients&quot; as well as a &quot;professional responsibility to adhere to medicine&apos;s commitment to nonjudgmental regard,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Taken together, the moral principles of beneficence and nonjudgmental regard direct us to treat potential or returning transplant tourists as we would treat other patients under our care by focusing on providing the medical treatment and support they need,&quot; they continued.&lt;/p&gt;
&lt;p&gt;Physicians shouldn&apos;t deny patients post-transplantation care, and they ought to provide emergent care at the very least. They may refer the patient to another transplant center for long-term follow-up if they regard it as unethical to continue treatment.&lt;/p&gt;
&lt;p&gt;Patients should also be informed about the possibility of transplant tourism when they are not eligible for a transplant in the U.S. or when they are likely to die before reaching the top of the transplant list, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;&quot;Patients should not be threatened with abandonment by a center&apos;s refusal to provide care upon their return,&quot; they added.&lt;/p&gt;
&lt;p&gt;As for the 46-year-old patient who was transplanted in China, the Mount Sinai team decided a transplant program must treat all patients on the basis of their need &quot;regardless of what they might have done or how they secured their transplant organ.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Although [the patient] had a long, complicated transplantation course,&quot; they wrote, &quot;he is currently doing well.&quot;&lt;/p&gt;
&lt;p&gt;Mount Sinai has seen a total of nine patients who pursued transplants in China. Three of those had post-transplant problems but had been turned away elsewhere &quot;because several transplant centers in our region do not render care to transplant tourists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Seven of those nine patients have hepatitis B. Another three had had a renal transplant in India, and subsequently developed liver failure, the authors reported.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_316"
                     title="STS: Delay in Treating Blunt Aortic Trauma Works Best (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18180?impressionId=1265758181802"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Researchers here suggest that delaying treatment of selected blunt thoracic aortic injuries appears to improve overall survival of these critically ill patients.&lt;/p&gt;
&lt;p&gt;&quot;Although thoracic aortic injury still accounts for significant mortality during blunt trauma, patients reaching specialized trauma centers can achieve good results with thoracic aortic repair,&quot; said Anthony L. Estrera, MD, of the University of Texas Houston Medical School.&lt;/p&gt;
&lt;p&gt;In fact, since 1997, improved treatments have produced a 5.9% annual reduction in operative mortality and a 3% annual reduction among patients with blunt thoracic aorta injuries, he told colleagues at the annual meeting of the Society of Thoracic Surgeons here.&lt;/p&gt;
&lt;p&gt;Estrera reviewed the evolution of treatment, noting that between 1988 and 1996, his institution&apos;s doctors brought 75 patients to the operating room, 71 of whom had open surgery.&lt;/p&gt;
&lt;p&gt;Since then, treatment has changed with methods that include distal perfusion, the concept of treatment delay, and the development of thoracic endovascular aortic repair (TEVAR) using stent devices.&lt;/p&gt;
&lt;p&gt;At the Houston Level I trauma center, doctors treated 60,091 patients between January 1997 and March 2009, including 250 who were admitted with blunt thoracic aortic injury.&lt;/p&gt;
&lt;p&gt;Estrera said the average age of the patients was 32, and 70% were men. About three-fourths of the patients were riding in vehicles involved in accidents. Other victims included pedestrians and bicyclists, people who suffered falls, and one who was injured in a parachuting accident.&lt;/p&gt;
&lt;p&gt;About 35% died at or near time of admission; the others were ultimately repaired, Estrera reported.&lt;/p&gt;
&lt;p&gt;&quot;The overall mortality for the diagnosis of acute thoracic aorta injury was 44%,&quot; he said, including those who did not receive repair. &quot;Of those who underwent operative repair, mortality was 17%.&quot;&lt;/p&gt;
&lt;p&gt;Some 41% of the patients had delayed repair, which was associated with only one death, Estrata added. There was 28% mortality among those patients who underwent early surgery.&lt;/p&gt;
&lt;p&gt;He said 90 percent of the TEVAR cases involved delayed surgery  --  a median of four days from admission to the operating room.&lt;/p&gt;
&lt;p&gt;When researchers attempted to tease out what might be significant factors in reducing mortality, delayed repair &quot;was the only factor that was protective against mortality in this series,&quot; he said.&lt;/p&gt;
&lt;p&gt;Other surgeons agreed that delayed surgery is far more common now.&lt;/p&gt;
&lt;p&gt;&quot;It used to be that any time there was an indication of thoracic aorta disturbance, the patients was rushed to surgery and they underwent this massive surgery where you had to heparinize them,&quot; said Matthew Williams, MD, assistant professor of surgery at the University of Louisville.&lt;/p&gt;
&lt;p&gt;&quot;Since then, this idea of surgical delay has come forth. We let the patient&apos;s injuries calm down and take care of the other injuries and then do the thoracic aorta repair on sort of an elective basis.&lt;/p&gt;
&lt;p&gt;&quot;The combination of this idea and TEVAR has created the major chance in the management of blunt aortic thoracic injury. There is good data now to support this strategy, but if you have a patient that dies while you are waiting, there might be a problem with litigation. That may make some people a little bit reticent.&quot;&lt;/p&gt;
&lt;p&gt;Estrera said surgeons still have some concerns about TEVAR itself. &quot;The problem with TEVAR is the unknown factor of what is the durability of the TEVAR device especially in the younger patients,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Estrera and Williams did not have any relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>