Acute Vascular Injuries Research Articles

Acute pelvic trauma and vascular injuries: the key role of interventional radiology

Acute pelvic trauma and vascular injuries: the key role of interventional radiology

Rectal avulsion associated with complex open pelvic fracture following rollover injury

Background: We present a rare case of complete rectal avulsion from the external anal sphincter complex associated with unstable pelvic ring disruption, including spinopelvic dissociation, following rollover by tractor. In the context of major pelvic trauma, evaluating for unstable bony, acute vascular, urethral and bladder injuries is essential. However, a detailed search for anorectal injury is also required by the reporting radiologist. Case Report: In this case report we highlight specific pelvic floor anatomy on CT, with a focus on gross morphology and the presence of peri-rectal free gas as primary evidence for injury. Secondary radiological evidence which should trigger the search for anorectal injury includes bony posterior pelvic ring disruption (sacrum or coccyx fractures) or associated Morel-Lavallee lesions. Conclusion: The presence of radiological abnormality should prompt direct clinical inspection for corroboration. Early recognition is crucial for joint colorectal and orthopaedic management and the avoidance of delayed pelvic sepsis, which may become intractable.

Initial experience with a novel ePTFE-covered balloon expandable stent in patients with near-atretic or severe aortic coarctation and small femoral arterial access.

We report our experience of using the Bentley BeGraft Aortic stent in patients with severe or near-atretic aortic coarctation and small femoral arterial access. Use of covered stent is recommended in some settings such as aortic coarctation with associated aneurysm, Turner syndrome, and coarctation with aortic atresia. However, currently available covered stents need larger sheaths that may limit their use in children and patients with smaller arterial access. Newer stents may overcome this limitation. Single-centre retrospective study of patients with severe or near-atretic aortic coarctation and small femoral arterial access. Between July and October, 2019, five patients (median age 15 years) with near-atretic or severe coarctation were treated with a Bentley BeGraft Aortic stent. Long sheaths between 9 and 11 Fr were used to implant stents, which were dilated up to 12-16 mm. None of the patients had residual coarctation (gradient >20 mm of mercury) after stenting. None of the patients developed acute vascular injuries or local access related complications at the end of the procedure or during follow-up (range 6-10 months). Bentley BeGraft aortic stents are important to consider in patients with severe coarctation and provided acute procedural success in patients with small femoral arterial access and widen the applicability in this patient population.

A Histopathological Study of Cisplatin-induced Acute Vascular Injuries in Vital Organs and Protective Effect of Achillea millefolium

The aim was to study the protective effect of ethanolic extract of Achillea millefolium on acute vascular injuries induced by cisplatin in liver, heart and renal tissues 24 hour after administration and using histopathological surveys in wistar rats. 24 adult male wistar rats were randomly divided into four groups. Group I (control group) received physiological saline for 10 days. Animals of group II had single dose of injection of CP (cisplatin) (6 mg/kg, IP) on the ninth day. Group III received Achillea millefolium extract (250 mg/kg, gavage) for 10 consecutive days. Group IV had both Achillea millefolium extract (250 mg/kg, gavage) for 10 consecutive days and a single dose of injection of CP (6 mg/kg, IP) on the ninth day. Kidney, liver and heart organs were collected on 10th day from sacrificed rats and subjected to histopathological analysis. Then the possible histopathological vascular effects of cisplatin on liver, heart, kidney tissues and the protective effect of Achillea millefolium extract was analysed. Obtained data showed the vascular injuries in CP group as congestion of cardiac capillaries (p=0.00) and interstitial edema (p=0.03). In the kidney, shrinkage of glomeruli (p=0.04), widening of Bowman's space (p=0.04), dilatation of cortical capillaries (p=0.01) were significantly altered. The findings of liver organ were increased sinusoidal space (p=0.00) and infiltration of neutrophils in portal space (p=0.01). Pretreatment with ethanolic extract of Achillea millefolium could attenuate these vascular injuries. Briefly, 24 hour after single injection of cisplatin the inflammatory process was seen in vital organs and administration of Achillea millefolium could mitigate these side effects.

GW29-e0939 Transcatheter treatment of acute renal vascular injuries after nefrobiopsy

Renal biopsy, percutaneous nephrostomy, percutaneous nephrolithtomy are minimally invasive and useful renal procedures for the diagnosis and treatment of different renal pathologies. But sometimes different complications such as bleeding, microhematuria, macrohematuria, decrease of kidney function,

Lesiones vasculares asociadas con accidentes de motocicleta. Serie de casos

BackgroundGiven the increase in motor vehicles in Bogota city in recent years, caused by lack of effective means of transportation and adequate roads; associated with recklessness of motorcyclists, a new type of patient has emerged, all members of trauma response must be coordinated to save the patient's life and injured limb. Motorcycle accidents are high energy traumas that in most cases affect limbs and acute vascular injuries that lead to amputation or late complications are frequent. Early diagnostic arteriography is very important to detect complex lesions and allows us a therapeutic planning. The aim of the study is to determine the type of vascular injuries associated with motorcycle accidents and their treatment. Materials and methodsWe performed a retrospective descriptive study, analyzing the patients who had motorcycle accidents. Variables were analyzed: Age, sex, type of orthopedic lesion, type of associated vascular lesion, lesioned artery, surgical or endovascular management, need for fasciotomies, indication and complications of arteriography, amputation and mortality at 30 days. ResultsA total of 81 patients, with 32 patients with major vascular injury (39%), 21 patients (25%) with a graft-graft, 5 patients by methods endovascular (6%), 7 patients required major amputation due to trauma (8.6%), mortality in 3 patients (3.7%). DiscussionEarly detection and specialized management of vascular injuries associated with motorcycles accidents is key for limb salvage. The incidence of amputation in spite of serious injuries is low. The integral management of the patient is very important to reduce morbidity and mortality. Level of evidenceIV.

Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma.

The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.

Unique bilateral symmetrical accessory renal artery – A case report

Supracondylar humerus fractures in childhood may be accompanied by a vascular injury that is worse than the fracture. The early recognition of the vascular complications is crucial to perform an adequate, and rapid treatment that provides a good prognosis. Early and precise treatment of acute vascular injuries is necessary to avoid a delay which may lead to a permanent disability. In this article, a pediatric case of supracondylar humerus fracture with a brachial artery impairment and the successful surgical treatment is presented.

Anatomical study of supratrochlear foramen of humerus and its clinical significance

Supracondylar humerus fractures in childhood may be accompanied by a vascular injury that is worse than the fracture. The early recognition of the vascular complications is crucial to perform an adequate, and rapid treatment that provides a good prognosis. Early and precise treatment of acute vascular injuries is necessary to avoid a delay which may lead to a permanent disability. In this article, a pediatric case of supracondylar humerus fracture with a brachial artery impairment and the successful surgical treatment is presented.

Diagnosis and Surgical Treatment of Extremity Vascular Injuries: Error Analysis

Актуальность Вопросы ранней диагностики и тактики лечения острой травмы магистральных артерий конечностей в мирное время – нерешённая проблема сосудистой хирургии. Это проявляется продолжающимся увеличением хирургических ошибок, высокой общей летальностью, большой частотой первичных ампутаций и обусловлено отсутствием нужных знаний и практических навыков у медицинских работников, плохо знакомых с принципами организации медицинской помощи данной категории пациентов на этапах эвакуации.Цель исследования Поиск эффективных способов профилактики хирургических ошибок и осложнений при лечении больных с ангиотравмой конечностей.Материалы и методы Проведён ретроспективный анализ 606 историй болезни и ангиограмм пациентов с повреждением артерий конечностей, лечившихся в хирургических отделениях г. Твери и Тверской области в 1966–2013 гг. Мужчин было 593, женщин – 13. Возраст больных колебался от 5 до 76 лет. Изолированная травма составила 19,3% от всех случаев, сочетанная – 80,7%, повреждения острым предметом и огнестрельные ранения – 41,6%, тупая травма – 54,8%, ятрогенная травма – 2%, аррозия сосудов – 1,6%. Результаты и их обсуждение Восстановительные операции выполнены у 47,5% пациентов, лигатурные – у 32,2%, первичные ампутации конечностей – у 20,3%. Выздоровело 96,9% пострадавших, умерло – 3,1%. У 222 (36,6%) больных на госпитальном этапе выявлено 41,4% диагностических, 33,8% тактических и 24,8% технических ошибок. Наиболее часто ошибки допускались при сочетании повреждений магистральных артерий с нарушением целости нервных стволов, костей и мышечных массивов.Выводы Большое количество ошибок в диагностике и лечении повреждений магистральных сосудов конечностей во многом обусловлено недочетами оказания больным неотложной, квалифицированной и специализированной медицинской помощи. Клиническая картина ранений и травм магистральных артерий в сочетании с современными методами ангиографического исследования позволяет достоверно, точно и информативно оценить состояние магистрального кровотока и функцию коллекторов коллатерального кровообращения. Риск неудовлетворительных исходов лечения больных с повреж-дениями магистральных сосудов конечностей можно уменьшить за счет снижения числа диагностических, тактических, технических и организационных ошибок. Восстановительные операции на магистральных артериях конечностей должны производиться только сосудистыми хирургами или травматологами, имеющими специальную подготовку по ангиологии и практический опыт работы в сосудистой хирургии.

Rare Case of Post Traumatic Carotico-Juglar-Vertebral Fistula with Pseudo Aneurysm

Arteriovenous fistula (AVF) is usually seen after acute vascular injuries. An AVF with pseudo aneurysm may present soon after the vascular injury or later. Since the AVF are associated with direct shunting of blood between artery and vein thus bypassing the capillaries, they are usually associated with significant haemodynamic instability. Uncorrected large AVF lead to significant morbidity and may finally land up in high output cardiac failure in rare cases. Proper diagnosis of AVF needs careful clinical examination and imaging modalities like ultrasound and CT angiography.

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications.

Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.

Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: Urgent management and therapeutic consensus

No consensus exists regarding pulseless otherwise well-perfused hand in pediatric Gartland type III fractures. The purpose of this retrospective study was to describe our strategy and to determine the guidelines of therapeutic consensus. Patients and methods404 children were treated for a type III supracondylar humeral fracture. Extension fractures-induced acute vascular injuries were noticed in 68 patients and nerve injuries were associated in 32 of them. The radial pulse was absent in all patients with two clinical situations at the initial presentation: well-perfused hand with ‘pink and warm’ hand in 63 patients and ischemia with ‘white and cold’ hand in five. Urgent closed reduction of the fracture and stabilization were performed in 63 patients with pink pulseless hand, and immediate surgical exploration in the five patients with ischemia. Results63 patients with vascular injury had posterolateral displacement and 5 had posteromedial displacement. Sixty-three of 68 patients had posterolateral displacement of whom 28 had concomitant median nerve injury and 4 had a deficit to both median and ulnar nerves. The palpable radial pulse was immediately restored in 42 patients and between few hours to eleven days later in eighteen. Three patients with ischemia after unsuccessful reduction required immediate surgical exploration revealing incarceration of the brachial artery at the fracture site. Release and decompression of the brachial artery restored a normal limb perfusion. The five patients with primary ischemia underwent immediate open exploration and vascular repair. One of them had a compartment syndrome and required anterior fasciotomy. The restoration of blood flow with palpable radial pulse was observed in all patients. Full spontaneous nerve recovery was observed in all patients. At an average follow-up of 8.4 years, all patients had normal circulatory status, including a palpable radial pulse. DiscussionThis study highlighted the reliability of non invasive strategy with good outcomes. We recommend urgent closed reduction of fracture. Close observation and monitoring is mandatory if pulseless hand remains warm and well-perfused. If the patients develop blood circulation disturbances or compartment syndrome following closed reduction, immediate vascular exploration is recommend.

Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review.

Acute vascular injuries have been described in relation to high-energy trauma accidents or in patients undergoing surgery in the femoral area. We describe a healthy patient who sustained a direct, low-energy contusion in the thigh and presented haemodynamic instability. Arteriography was used to locate the point of bleeding, and embolisation and vessel occlusion were carried out to stop the haemorrhage. The genetic study identified the COL3A1 gene mutation; accordingly, the patient was diagnosed with the Ehlers-Danlos syndrome type IV (vascular type).

Traumatic vascular injuries: who are repairing them and what are the outcomes?

BackgroundTraumatic vascular injuries are infrequent but can be devastating. This study characterized their incidence and the need for vascular surgeons in their repair. Outcomes for patients repaired by vascular and trauma surgeons were compared. MethodsPatients age ≥14, needing operations for acute traumatic vascular injuries from January 1, 2008 to December 31, 2013 were included. ResultsOf the 27,224 adult trauma patients, 1.4% had vascular injuries needing operations. Trauma surgeons treated 40% of them. The need for repair by vascular surgeons varied based on mechanism, transfer status, injury location, time of injury, trauma staff practice, and experience (P < .05). Patients repaired by vascular surgeons had more transfusions, longer arrival-to-operation time, surgery duration, hospital stay but lower mortality (P < .05). This mortality difference dissipated after excluding early deaths. ConclusionsApproximately 3% of trauma patients had vascular injuries. Trauma surgeons treated a significant portion of them; using less resources and achieving similar outcomes in select patients when compared with vascular surgeons.

Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine

ObjectivesDiagnostic errors are common in the emergency department (ED), but few studies have comprehensively evaluated their types and origins. We analysed incidents reported by ED physicians to determine disease conditions,...

Missed vascular injuries: presentation and outcome.

To describe the different presentation, diagnostic evaluation, management and outcome of complications of missed vascular injuries. A case series. Combined Military Hospital, Rawalpindi and Combined Military Hospital, Kharian Cantt, from June 2009 to June 2012. All the patients with vascular injuries missed at the time of causative trauma who reported during this study period were included. Patients presented with acute vascular injuries and iatrogenic aneurysm at the vascular anastomosis site were excluded. All cases were evaluated with either CT or conventional angiography and managed with various open vascular surgical techniques and their results were assessed. Twenty eight patients with missed vascular injury underwent various vascular repairs. Age of patients ranged from 16 to 78 years (mean = 33.7 ± 15.4 years). Male to female ratio was 6:1. Twelve (42.8%) patients presented with pseudoaneurysm alone, 10 (35.7%) with traumatic arteriovenous fistulae, 4 (14.3%) with post-traumatic thrombosis and occlusion and 2 (7.1%) with pseudoaneurysm and hemorrhage. Penetrating injuries were the commonest cause in 19 (67.8%). The time interval between injury and presentation in hospital ranged from 2 to 1300 weeks (mean 228 weeks). Lower limb vessels were affected in 20 (71.4%), the upper limb in 5 (17.8%) and neck vessels in 3 (10.7%). Superficial femoral artery was the most frequently involved artery in 9 (32.1%) cases. Interposition reverse autogenous saphenous vein graft was most common type of repair in all types of missed vascular injuries. One (3.5%) patient had amputation after secondary hemorrhage. Low velocity penetrating trauma was the common cause of missed vascular injury. Pseudoaneurysm was the most common presentation.

Subclavian artery injury following blunt trauma: A report of three cases

Subclavian artery injuries are rare in blunt chest trauma, constituting just 1–2 percent of all acute vascular injuries. The diagnosis of injury to the subclavian artery is challenging as a good percentage of patients with such vascular injuries have palpable distal pulses, no signs of any external local trauma and associated injuries often divert the attention of treating physicians. Subclavian artery injuries are the second most common injuries to occur to the aortic arch vessels. The mechanism of injury to these vessels varies from deceleration to traction on upper extremity and neck. Angiography is vital in diagnosis and surgical planning of these patients depends on the site and side of the vascular injuries. Early surgical treatment is an important part of management of these patients. Endovascular treatment is of value in a selected subgroup of subclavian artery injury patients. Reported mortality of subclavian artery injuries varies according to haemodynamic status of patient, time of presentation and other associated injuries. A high degree of suspicion is key to diagnosing these vascular injuries. Early appropriate surgical repair of vascular injury, in combination with aggressive treatment of associated injuries, is important for the optimal outcome of these cases. Here we report three cases of subclavian artery injury, which were successfully treated in Hamad General Hospital by vascular surgery and intensive care teams.

Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment.

The purpose of this study was to analyze the multidetector computed tomography (MDCT) morphologic characteristics of non-aortic acute vascular injuries (AVI) in patients with blunt abdominopelvic trauma that predict treatment. CT scans of 65 trauma patients with non-aortic AVI were reviewed. AVI morphology was categorized as linear or round. The organ of involvement, location of hemorrhage, initial size of hematoma, and hemodynamic status were recorded. Expansion rates of the hematoma were calculated in 40 patients who had delayed imaging. Multivariate regression was used to analyze the morphologic features of AVI and treatment. Patients with linear AVI were four times more likely to require aggressive treatment (surgery or embolization) than those with a round morphology, independent of the hemodynamic status. There was no main effect of the organ involved, location of hemorrhage, initial bleed size, or expansion rate on the probability of aggressive treatment. The location, initial size, and expansion rate of AVI are not significant predictors of aggressive treatment with surgery or embolization. Linear morphology of AVI, however, is more likely to require aggressive treatment than round AVI, independent of the hemodynamic status. Linear AVI likely reflects a spurting jet of active extravasation, whereas round AVI likely represents a pseudoaneurysm or slow bleed.

The Effectiveness of a Damage Control Resuscitation Strategy for Vascular Injury in a Combat Support Hospital: Results of a Case Control Study

Major vascular injury is a leading cause of potentially preventable hemorrhagic death in modern combat operations. An optimal resuscitation approach for military trauma should offer both rapid hemorrhage control and early reversal of metabolic derangements. The objective of this report is to establish the use and effectiveness of a damage control resuscitation (DCR) strategy in the setting of wartime vascular injury. A retrospective two-cohort case control study was performed using the Joint Theater Trauma Registry to identify patients with an extremity vascular injury treated at two different points in time: group 1 (n = 16) from April to June 2006 when DCR concepts were put into practice and group 2 (n = 24) 1 year later in a period when DCR strategies were not employed. Baseline demographics, injury severity, admission physiology, and operative details were similar between groups 1 and 2. Group 1 patients received more total blood products (23 vs. 12 units, p < 0.05), fresh frozen plasma (16 vs. 7 units, p < 0.01), cryoprecipitate (11 vs. 1.2 units, p < 0.05), whole blood (19% vs. 0%, p = 0.06), and early recombinant factor VIIa (75% vs. 0%, p < 0.001) than group 2 patients. Group 1 patients had a more complete early physiologic recovery after vascular reconstruction (heart rate: 38 vs. 12, p < 0.001; systolic blood pressure, 39 vs. 14, p < 0.001; base deficit: 7.36 vs. 2.72, p < 0.001; International Normalized Ratio, 0.3 vs. 0.1, p < 0.001). There was no significant difference in early amputation rates (group 1: 6.2% vs. group 2: 4.2%) or 7-day mortality (0% in both groups). This study was the first to use the Joint Theater Trauma Registry for follow-up on an established clinical practice guideline. DCR goals appear now to be met during the management of acute wartime vascular injuries with effective correction of physiologic shock. The overall impact of this resuscitation strategy on long-term outcomes such as limb salvage and mortality remains to be determined.