Acute Vascular Injuries Research Articles

Hypothermic circulatory arrest for repair of injuries of the thoracic aorta and great vessels

Traumatic great vessel injuries are frequently lethal events. Expedient diagnosis and prompt repair by clamping and replacing the affected segment of aorta (often with left-heart bypass) can salvage many patients. Rarely, due to the location of the injury or delayed presentation, standard techniques cannot be used and hypothermic circulatory arrest (HCA) is required for access, exposure and repair. The results of surgical reconstruction of acute and chronic traumatic thoracic vascular injuries under these circumstances are not well described. We reviewed all operations on the great vessels at our institution over a 16-year period that had a traumatic etiology and used HCA. Fourteen cases were identified (10 male, 4 female, age 46+/-4 years), arising from three acute and eleven remote traumatic events. All repairs were performed with cardiopulmonary bypass (mean CPB time was 155+/-13 min), deep hypothermia, and an interval of circulatory arrest (mean circulatory arrest interval 31+/-4 min). One patient died in the perioperative period from a stroke (7% 30-day mortality). Another patient exsanguinated from a recurrent pseudoaneurysm 3 months post-repair. No patient developed paraplegia. HCA can be a useful adjunct in managing complex post-traumatic great vessel injuries. Acute injuries of the ascending aorta and transverse arch usually require this technique, but HCA also offers a safe way to manage repair of the descending thoracic aorta when proximal aortic control is compromised.

Endovascular Management of Vascular Trauma

Over the past several decades, catheter-based and endovascular techniques have been used with increasing frequency for the management of trauma. This is particularly true for the management of solid organ injury and vascular injuries resulting from pelvic fracture with the use of embolization techniques for successful arrest of active hemorrhage. Likewise, there is a large body of literature regarding the management of acute traumatic vascular injuries involving traditional open surgical techniques. Currently, however, there is sparse literature on the management of vascular trauma with endovascular techniques. The endovascular management of vascular trauma seems particularly appealing in the management of blunt truncal injuries, especially in the setting of severe concomitant brain and lung injury. Extremity and neck injuries are probably best handled by traditional methods of surgical proximal and distal control, the exception to this being base of skull injuries where there is no ability for distal vessel control, and "watershed" areas between the trunk and extremities where proximal vascular control can be quite difficult. This chapter reviews current literature with regard to the endovascular management of traumatic vascular injuries with regions being broadly defined as neck, trunk, and extremity.

The Management of Acute Vascular Injuries. M. O. Perry. 260 × 172mm. Pp. 148 + x. Illustrated. 1981. Baltimore: Williams & Wilkins. £27·75

The Management of Acute Vascular Injuries. M. O. Perry. 260 × 172mm. Pp. 148 + x. Illustrated. 1981. Baltimore: Williams & Wilkins. £27·75 Get access The Management of Acute Vascular Injuries. M O Perry. 260 × 172mm. Pp. 148 + x. Illustrated. 1981. Baltimore: Williams & Wilkins. £27·75. R Baird R Baird Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 68, Issue 12, December 1981, Page 888, https://doi.org/10.1002/bjs.1800681222 Published: 07 December 2005

Transcatheter Arterial Embolization in the Trauma Patient: A Review

Blunt and penetrating traumatic injuries may result in acute or subacute vascular injuries. These injuries to solid organs and extremity vessels are often managed in a conservative fashion. Acuity and hemodynamic compromise may dictate a surgical course; however, interventional techniques first popularized in the early 1970s now offer a wide range of solutions principally using transcatheter arterial embolization. There are a wide range of materials and clinical scenarios for which embolization is appropriate. Embolic agents such as coils, Gelfoam, and particles may be used individually or in combination to stop or control bleeding. In this way, embolotherapy may prove to be the safest and most effective form of therapy. The purpose of this article is to review the indications for embolization in the trauma patient and to provide guidelines regarding techniques and material selection.

Management of Acute Vascular Injuries

Vascular injury of the head and neck region occurred not very frequent but can be potentially life treatening with very high morbidity and mortality, especially if prompt diagnosis and treatment decision are not accurately made on time. Mechanism of injury and pathophysilogy of the vascular wall damages of the patients were analysed including management of this group of patients.

Treatment of acute neonatal vascular injuries—The utility of multiple interventions

Background/Purpose: Vascular injuries in neonates are a rare complication of the varied invasive procedures performed in these small children. Unfortunately there remains a reluctance to repair these injuries early, often because of the relative small size of the affected vessels and the nature of the patient's underlying medical condition. The authors report a consecutive series of patients treated for arterial and venous injuries early in their course using a variety of microsurgical techniques. Methods: A retrospective chart review was performed of consecutive patients (n = 7) treated over a 2-year period. All had injury as a result of invasive procedures performed in the neonatal period. Both arterial and venous injuries that required some form of intervention were included. Results: Five arterial and two venous injuries were identified. Surgical thrombectomy and microvascular repair was required in two patients. Primary healing occurred despite prolonged (>13 hours) warm ischemia time. Pseudoaneurysms of the brachial artery and radial artery were controlled with surgical ligation, and one patient required bilateral fasciotomies for compartment syndromes related to severe spasm of the common femoral arteries. Phlegmasia cerulea dolens of the lower extremity (n = 2) was treated with leech therapy. All patients healed without tissue loss or functional deficit. Conclusions: A variety of microvascular interventions have application to the treatment of acute vascular injuries in neonates. Early, aggressive use of these techniques can provide effective therapy for these potentially devastating injuries and allow for complete limb recovery without tissue loss.

Carvedilol, a novel multiple action antihypertensive agent with antioxidant activity and the potential for myocardial and vascular protection.

Carvedilol is a vasodilating, beta-adrenoceptor antagonist currently marketed for the treatment of mild to moderate hypertension. Carvedilol acts to reduce total peripheral resistance by blocking peripheral vascular alpha 1-adrenoceptors, thereby producing systemic arterial vasodilation, while at the same time inhibiting reflex tachycardia through the blockade of myocardial beta-adrenoceptors. In addition to its established efficacy and safety as an antihypertensive agent, carvedilol has been shown to produce significant cardioprotection in experimental animal models of acute myocardial infarction, with the most dramatic effect being observed in the pig model of myocardial ischaemia and reperfusion, where the reduction in infarct size reached 91%. Recent pharmacological studies have revealed additional novel properties of carvedilol which may account for the marked protection produced by the drug in the ischaemic myocardium and which may also result in protection against other chronic pathological processes, such as atherosclerosis and acute vascular injuries. The latter arise from surgical procedures, such as percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. Specifically, carvedilol, as well as some of its hydroxylated metabolites, are potent antioxidants. In physicochemical, biochemical and cellular assays, carvedilol and several of its metabolites prevent lipid peroxidation and the depletion of endogenous antioxidants, such as vitamin E and glutathione. Moreover, carvedilol and its metabolites prevent the oxidation of LDL to oxidized LDL, the latter being directly cytotoxic and known to activate monocytes/macrophages and to stimulate foam cell formation. In addition, carvedilol was found to inhibit both rat and human vascular smooth muscle cell proliferation and migration.(ABSTRACT TRUNCATED AT 250 WORDS)

Minimally invasive operative and endovascular management of acute vascular brain injuries

Minimally invasive operative and endovascular management of acute vascular brain injuries

Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern.

During a period of six years, 765 consecutive patients were treated by the trauma service at Allegheny General Hospital for closed mid-shaft femur fractures that were a component of their injury complex. Thirty-one patients underwent angiography of the involved extremity for indications including loss of pulses in eleven and large hematomas or deformities of the thigh in the remainder. Ten patients (1.3%) were found to have acute vascular injuries. In nine patients there was an intimal flap of the superficial femoral artery (SFA), and in one, a pseudoaneurysm. Two patients had injuries of the femoral nerve. Three patients had no other associated major injuries (Injury Severity Score range, 10-19). Twelve months after the initial injury, one patient developed an arteriovenous fistula of the SFA. Detailed, repeated physical examinations, early utilization of angiography, and intensive follow-up by the trauma surgeon or orthopedic surgeon of patients with closed mid-shaft femur fractures should lead to early recognition of this potentially serious association.

Unusual cause of acute superficial posterior compartment syndrome

Bulkley G. B., Zuidema G. D., Hamilton S. R. et al. (1981) Intraoperative determination of intestinal viability following ischemic injury: a prospective, controlled trial of two adjuvant methods (Doppler and fluorescein) compared to standard clinical judgement. Ann. Surg. 193, 628. DeBakey M. F. and Simeone F. A. (1946) Battle injuries of the arteries in World War II. An analysis of 2471 cases. Ann. Surg, 123,534. Feliciano D. V. (1988) Abdominal vascular injuries. Surg. Clin. North Am. 68, 741. Garett J. W. and Braunstein P. W. (1962) The seat-belt syndrome. J. Trauma 2,220. Graham J. M., Mattox K. L., Beall A. C. et al. (1978) Injuries to the visceral arteries. Surgery 84, 835. Jahnke E. J. and Seeley S. F. (1953) Acute vascular injuries in the Korean war: an analysis of 77 consecutive cases. Ann. Surg. 138, •58. McCullough C. j. (1976) Isolated mesenteric injury due to blunt abdominal trauma. Injury 7, 295. Rich N. M., Baugh J. H. and Hughes C. W. (1970) acute arterial injuries in Vietnam: 1000 cases. J. Trauma 10, 359. Ziperman H. H. (1954) Acute arterial injuries in the Korean war: a statistical study. Ann. Surg. 139, 1.

Advances in the Management of Acute Popliteal Vascular Blunt Injuries

This report evaluates critical points in the management of 30 consecutive blunt traumatic popliteal vascular injuries. All arterial injuries were diagnosed both clinically and by Doppler and PVR examinations. Twenty-eight of the 30 arterial reconstructions required interposition bypass grafts, nine of which were PTFE and the remainder were autogenous saphenous veins. In 19 patients the distal anastomosis was made to the distal popliteal artery and in nine patients to the tibial-peroneal arteries. In ten patients in whom limb survival was threatened, the ischemic time was shortened by the use of temporary Silastic shunt for rapid restoration of arterial flow. Nine patients had associated venous injuries which were repaired. Nine of the first 14 patients required fasciotomy but the last 16 patients were treated with hypertonic mannitol and only two of them required fasciotomy. There were no amputations, but in four limbs there were functional losses. In spite of the more extensive damage of blunt trauma, prompt and aggressive management aided by vascular laboratory tests, indwelling shunt, and hypertonic mannitol is rewarded with preservation of limbs following acute popliteal vascular injuries.

Management of Acute Civilian Vascular Injuries

Vascular trauma continues to be an exciting and formidable challenge to surgeons. Increasing numbers of survivors of major vascular trauma such as suprarenal aortic and caval injuries are being reported in the literature. Successful repair of venous injuries rather than ligation is being achieved in significant numbers of cases. Combined team approaches utilizing new techniques of microvascular surgery and orthopedic fixation have dramatically improved the results of revascularization in extremity injuries and subsequent restoration of limb function.

The Management of Acute Vascular Injuries

The Management of Acute Vascular Injuries

Management of acute cervicothoracic vascular injuries

One hundred eighty-one patients with 218 acute cervicothoracic vascular injuries underwent operations for diagnosis, resuscitation, and control of hemorrhage. The patients were divided into three clinical groups depending on their clinical status. Group I consisted of 105 patients who were hemodynamically stable and able to undergo diagnostic measures: Group II consisted of 41 patients who remained unstable and required immediate operation; Group III consisted of 35 patients who were moribund and underwent emergency room thoracotomy. The mortality rates were 4% for Group I, 15% for Group II, and 80% for Group III with an overall mortality rate of 21%. Angiography was performed in 53% of the stable Group I patients. This allowed specific identification of lesions such as arteriovenous fistula in eight patients and aortic disruption in 12 patients. Thirty-five Group III patients had thoracotomy performed in the emergency room and seven survived (20%). A vigorous clinical approach is recommended to minimize morbidity. A different approach is described for each of the three clinical groups of patients.

Management of major acute thoracic vascular injuries

Management of major acute thoracic vascular injuries

Management of major acute thoracic vascular injuries

This report concerns thirty-nine cases of thoracic vascular injury. There were twenty-one cases of great vessel injuries in area I (thoracic inlet and upper thorax) including the ascending aorta (one), innominate artery (six), left common carotid artery (two), aortic arch (one), left subclavian artery (four), right subclavian artery (one), superior vena cava (two), innominate veins (one), and axillary arteries (three). Six were due to blunt trauma and fifteen were due to penetrating trauma including tracheal-innominate artery fistulas. There were seven injuries in area II (pulmonary arteries and veins). In area III there were eleven injuries of the descending thoracic aorta. Nine of these ruptured secondary to blunt trauma, one was a penetrating injury of the heart and aorta, and one was a penetrating aortic injury with a bullet embolus. A discussion is presented of the surgical approaches for the different vascular injuries of the thorax including different methods of repair of ruptures of the descending thoracic aorta.

Management of major acute thoracic vascular injuries

This report concerns thirty-nine cases of thoracic vascular injury. There were twenty-one cases of great vessel injuries in area I (thoracic inlet and upper thorax) including the ascending aorta (one), innominate artery (six), left common carotid artery (two), aortic arch (one), left subclavian artery (four), right subclavian artery (one), superior vena cava (two), innominate veins (one), and axillary arteries (three). Six were due to blunt trauma and fifteen were due to penetrating trauma including tracheal-innominate artery fistulas. There were seven injuries in area II (pulmonary arteries and veins). In area III there were eleven injuries of the descending thoracic aorta. Nine of these ruptured secondary to blunt trauma, one was a penetrating injury of the heart and aorta, and one was a penetrating aortic injury with a bullet embolus. A discussion is presented of the surgical approaches for the different vascular injuries of the thorax including different methods of repair of ruptures of the descending thoracic aorta.

Popliteal artery injuries in Vietnam

1. 1. Although generally good results have been obtained in managing more than 2,000 acute vascular injuries in Vietnam, repair of popliteal arteries remains a problem. 2. 2. One hundred fifty of the 300 injuries of the popliteal artery listed in the Vascular Registry are reviewed. 3. 3. Forty-two per cent of patients with these injuries were evaluated at Walter Reed General Hospital, and the remaining patients were evaluated at other hospitals. 4. 4. Associated injuries to bone, nerves, soft tissue, and veins are frequent and have a significant effect on the outcome in extremities with popliteal artery injuries. 5. 5. Of the 124 initial repairs performed in Vietnam, early thrombosis occurred in 34. 6. 6. Delayed recognition of injuries occurred in 7.3 per cent of the patients (eleven false aneurysms and arteriovenous fistulas). 7. 7. The over-all amputation rate for 150 popliteal artery injuries was 32 per cent.

Technical Considerations in Acute Military Vascular Injuries of the Extremities

Technical Considerations in Acute Military Vascular Injuries of the Extremities

Acute vascular trauma: A fifteen year study

Three hundred seventy-nine acute vascular injuries occurring over a fifteen year period are reviewed. During the past five years the incidence of vascular trauma has doubled in comparison with that of the previous ten years and has been associated with more severe injuries and an increasing frequency of wounds due to missiles and blunt trauma. We are disappointed that our mortality has increased 6.8 per cent during the past five years. The majority of patients who died had extensive injuries involving multiple organ systems. Nevertheless, five patients who died from hemorrhage were in the hospital more than two hours and were not operated upon. Improvement in survival can result only from prompt recognition of vascular injury, rapid institution of resuscitative measures, and operative control of hemorrhage. Despite a marked decrease in ligation of wounded arteries and concomitant increase in attempts at surgical repair, we have not significantly altered our amputation rate. Most of the poor results have been due to the severity of the local injury with irreversible damage to the limb. Some limbs, however, may be saved from amputation by use of the Fogarty embolectomy catheter to remove distal clot and operative arteriography to insure patency of the arterial runoff. Prompt reoperation, if the initial repair fails, may be the most important measure in salvaging an extremity. In conclusion, we think the aggressive surgical approach undertaken during the past five years has been justified and must be extended if the results from acute vascular trauma are to be improved. Three hundred seventy-nine acute vascular injuries occurring over a fifteen year period are reviewed. During the past five years the incidence of vascular trauma has doubled in comparison with that of the previous ten years and has been associated with more severe injuries and an increasing frequency of wounds due to missiles and blunt trauma. We are disappointed that our mortality has increased 6.8 per cent during the past five years. The majority of patients who died had extensive injuries involving multiple organ systems. Nevertheless, five patients who died from hemorrhage were in the hospital more than two hours and were not operated upon. Improvement in survival can result only from prompt recognition of vascular injury, rapid institution of resuscitative measures, and operative control of hemorrhage. Despite a marked decrease in ligation of wounded arteries and concomitant increase in attempts at surgical repair, we have not significantly altered our amputation rate. Most of the poor results have been due to the severity of the local injury with irreversible damage to the limb. Some limbs, however, may be saved from amputation by use of the Fogarty embolectomy catheter to remove distal clot and operative arteriography to insure patency of the arterial runoff. Prompt reoperation, if the initial repair fails, may be the most important measure in salvaging an extremity. In conclusion, we think the aggressive surgical approach undertaken during the past five years has been justified and must be extended if the results from acute vascular trauma are to be improved.