Cases Of Vascular Trauma Research Articles

Understanding Vascular Trauma at a Level One Trauma Center on Long Island, New York, a Prototypical American Suburb (2015-2021)

Vascular injuries represent a small minority of traumas, yet contribute to a significant portion of trauma-related morbidity and mortality. Few studies have explored vascular traumas on a regional scale in the United States. The present study explored the demographics, mechanisms, and outcomes of vascular trauma at a Level One trauma center in a suburban New York county. Data were collected from the institutional trauma registry on vascular trauma patients from 2015 to 2021 as determined by relevant International Classification of Diseases (ICD)-9 and ICD-10 codes. Descriptive statistics and multivariate analyses were then performed. The query returned 150 vascular trauma cases of 10,078 total trauma cases. Vascular trauma patients had a mortality rate of 23.30% and an amputation rate of 2.00%, were 76.67% male, and averaged 42.94 years of age. Black (26.00%) and Hispanic (26.70%) patients were disproportionately affected relative to the demographics of Nassau County. A total of 57.33% of patients suffered blunt injuries, which were associated with significantly greater severity as well as longer intensive care unit and hospital lengths of stay. The leading causes of vascular trauma were motor vehicle collisions (22.00%), followed by gunshot wounds (15.33%) and falls (12.67%). Truncal injuries demonstrated higher mortality rate vs neck and extremity injuries. Vascular trauma continues to demonstrate disproportionate morbidity and mortality when compared with general trauma. Further research is needed to better understand regional differences in the epidemiology of vascular trauma.

Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration.

Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration.

Five-Year Management of Vascular Injuries of the Extremities in the “Real-World” Setting in Northeastern Greece: The Role of Iatrogenic Traumas

Vascular trauma comprises a diagnostic and surgical challenge. Aim of this study was to present the vascular traumas treated in our Tertiary Hospital during the last 5 years. We retrospectively reviewed the surgical records of our vascular department and documented the site and type of vascular injuries of the extremities along with the concurrence of musculoskeletal injuries. The type and outcome of surgical interventions were also recorded. Fifty-eight cases of vascular trauma were recorded (39 in the upper and 19 in the lower extremities). Overall, iatrogenic traumas accounted for 41.3% of cases. The arterial injuries of the upper limb were blunt and penetrating in 27% and 67%, respectively. The most affected artery in the upper limb was the radial artery (37.8%), followed by the ulnar artery (27%) and the brachial artery (24.3%). Orthopedic injuries were recorded in 19% of patients. Management involved simple revascularization, bypass operations, patch arterioplasty and endovascular management in 48.7%, 33.3%, 5.1%, and 5.1%, respectively. The most affected site in the lower extremity was the common femoral artery (36.8%) followed by the popliteal artery (21%). Bone fractures were reported in 5 cases (26.3%). The surgical management involved bypass, simple revascularization, patch arterioplasty in 42.1%, 26.3%, and 21%, respectively. Endovascular management was performed in 10.5%. A considerable percentage of iatrogenic vascular injuries was recorded, affecting both the upper and lower limbs. Despite the trend toward centralization of vascular services, a basic service of vascular surgery should be available in most sites to ensure that patients with vascular injuries receive fast and appropriate care.

Patient outcomes after AF ablation using Ablation Index technology with oesophageal protection: insight from the IMPACT study

Abstract Background Atrio-oesophageal fistula formation accounts for the majority of AF ablation-related morbidity and mortality. Thermal injury to the oesophagus can be significantly reduced by application of oesophageal cooling for protection during AF ablation. The effect of this method of oesophageal protection in patients receiving radiofrequency (RF) ablation guided by Ablation Index technology is currently unknown. Objective To investigate the ability of a temperature control device to protect the oesophagus from ablation-related thermal injury in patients receiving AF ablation guided by Ablation Index technology. Methods The IMPACT study is a single-centre, prospective, double-blind randomized controlled trial, which investigated the ability of a controlled method of oesophageal cooling to protect the oesophagus from ablation-related thermal injury. The EnsoETM device was used to deliver oesophageal cooling. This method was compared in a 1:1 randomization to a control group of standard practice utilizing a single-sensor temperature probe. In the study group, the device was used to keep the luminal temperature at 4°C during RF ablation. All participants received AF ablation using Ablation Index technology at posterior and anterior settings (30W at 350–400 and 40W at 450–500, respectively). Endoscopic examination was performed within 7 days post-ablation and oesophageal injury was graded. The patient and the endoscopist were blinded to the randomization. Structured clinical follow up occurred after 3 months post-ablation; both patient and follow up clinician were blinded. Results We recruited 188 patients, of whom 120 underwent endoscopic evaluation. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 versus 2/60; P=0.008). There was no difference between groups in RF time, lesion duration, force, power and combined ablation index (P value range= 0.2–0.9). Procedure and fluoroscopy duration were similar (P=0.97, P=0.91 respectively). The majority of those who passed through the 1st follow up evaluation (n=136) did not have gastrointestinal or chest pain symptoms post ablation and there was no difference between the randomized groups. Only 4.4% overall had severe symptoms and they were poorly correlated against those who sustained mucosal lesions. AF recurrence was similar in both groups (8% vs 8.8%). There were 2 cases of vascular trauma needing intervention in the control group and 1 case of conservatively managed pericardial effusion in the protected group only. Clinical and endoscopy findings did not report any EnsoETM device-related trauma. Conclusion Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared to standard care when ablation is performed using radiofrequency with Ablation Index technology. This method of oesophageal protection is safe and does not compromise the efficacy of the ablation procedure. Endoscopy findings and patient symptoms. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): 1. Public hospital: St. George's NHS Foundation Trust; 2. Private company: Attune Medical (Chicago, IL)

Vascular Injuries Due to Penetrating Missile Trauma in Anti-Terrorism Ops

Purpose: Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India. Methods: A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed. Results: There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries. Conclusions: Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.

Epidemiology of lower limb musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India.

Background:Vascular trauma associated with bony injuries is an orthopaedic emergency. Lack of timely intervention can lead to loss of limb or even life. Inspite of the rising incidence of high speed road traffic accidents in India, there is paucity of literature regarding the demographic pattern, clinical morbidity, management strategies and outcome of arterial injuries associated with lower limb trauma. The aim of this study is to describe the epidemiology and outcome of lower extremity musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India.Materials and Methods:All individuals who presented to our tertiary care trauma center from July 2013 to December 2014 with lower extremity vascular injury associated with lower limb fractures were identified from a retrospective trauma database for this descriptive study. For the 17 months, there were 82 lower extremity vascular trauma cases admitted in our trauma center, of which 50 cases were included in the study. 32 patients with crush injuries, traumatic amputations, and those with head injury and blunt trauma to chest or abdomen were excluded from the study.Results:Out of the 50 cases of lower extremity vascular injury with associated lower limb fractures, 19 limbs were salvaged, 28 amputated, and three patients expired. Young males in the age group of 20–39 years were frequently injured. Motor vehicle accident (MVA) (82%) was found to be the most common cause followed by pedestrian injury. Popliteal artery (62%) was the most common vessel injured, followed by femoral artery (28%). The salvageability percentage was much higher (64%) in the femoral artery injury group when compared to popliteal artery injury group (25%). There were 32 open fractures, with amputation rates (60%) being higher and all three cases of death falling in this group. In addition, the limb salvageability percentage was 43.2% when the patient presented within 12 h of injury and this decreased to a mere 16.7% when the patient had presented more than 24 h after injury.Conclusion:MVAs are the leading cause of vascular injuries in India. Road safety measures and prevention programs are the need of the hour to prevent these kinds of injuries in the future.

A decade of major vascular trauma: Lessons learned from gang and civilian warfare.

INTRODUCTION Trinidad and Tobago is a trans-shipment point for the illegal trade of drugs, arms and ammunition and, as such, has a high incidence of gang-related warfare and drug-related crimes. This has led to a high incidence of gunshot and stab wounds, with associated major vascular injuries. We describe our management strategies learned from a decade of vascular trauma experience. METHODS A retrospective analysis of age, gender, type of trauma, vessel injured, procedure and outcome for all cases of vascular trauma between 2006 and 2015 at two surgical units in Trinidad and Tobago. RESULTS There were 198 vascular trauma cases (232 procedures), involving 159 (80%) males at a mean age of 33 years. Gunshots accounted for 103 (52%) cases, followed by stabs/chops (n=50; 25%) and lacerations (n=15; 8%). The most commonly injured vessels were the radial/ulnar arteries (n=39; 20%) and the superficial femoral artery (n=37; 19%). There were seven pseudoaneurysms and three traumatic arteriovenous fistulae. Repair techniques included primary (n=82; 35%), reversed vein (n=63; 27%), polytetrafluoroethylene (n=58; 25%), oversew (n=24; 10%) and endovascular (n=5; 2%) techniques. There were eight (4%) secondary amputations and eight (4%) deaths. CONCLUSIONS Major vascular trauma causes significant morbidity and mortality in Trinidad and Tobago, with the majority of cases due to gunshot injuries secondary to gang-related warfare and civilian violence. We compare our experience with that in the literature on the epidemiology and management of vascular trauma.

Terapia endovascular en trauma vascular periférico: experiencia inicial

ObjectivesTo show our initial experience in endovascular management of peripheral artery trauma. Materials and methodsWe retrospectively collected the data of seven cases of vascular trauma: two tibial artery pseudoaneurysms, one case of arteriovenous fistula (AVF) associated to iliac vessel pseudoaneurysm, one giant pseudoaneurysm of the popliteal artery, a popliteal vessel AVF, an acute occlusion of the popliteal artery due to blunt trauma and a case of iatrogenic lesion of the subclavian artery with pseudoaneurysm resulting from a central intra-arterial catheter. Coil embolization was performed in both cases of tibial artery pseudoaneurysms. The case of iliac vessel pseudoaneurysm and AVF was treated with a stent graft. A covered stent was used to exclude both the popliteal pseudoaneurysm and popliteal vessel AVF. A bare stent was used in the case of acute popliteal occlusion. The intra-arterial central catheter in the subclavian artery was managed by means of compression with an angioplasty balloon. ResultsAll patients were successfully treated with no immediate complications. Follow up ranges from 3 months to 3 years with no evidence of complication up to this point. DiscussionAlthough the classic approach to vascular trauma treatment is still very much an alternative, endovascular therapy, through all of its tools, allows either definitive treatment or transient management, improving local conditions and thus to proceed at a later date with an elective open vascular repair with fewer difficulties and complications.

Vascular Trauma Operative Experience is Inadequate in General Surgery Programs

Vascular injuries may be challenging, particularly for surgeons who have not received formal vascular surgery fellowship training. Lack of experience and improper technique can result in significant complications. The objective of this study was to examine changes in resident experience with operative vascular trauma over time. A retrospective review was performed using Accreditation Council for Graduate Medical Education (ACGME) case logs of general surgery residents graduating between 2004 and 2014 at 2 academic, university-affiliated institutions associated with level 1 trauma centers. The primary outcome was number of reported vascular trauma operations, stratified by year of graduation and institution. A total of 112 residents graduated in the study period with a median 7 (interquartile range 4.5-13.5) vascular trauma cases per resident. Fasciotomy and exposure and/or repair of peripheral vessels constituted the bulk of the operative volume. Linear regression showed no significant trend in cases with respect to year of graduation (P=0.266). Residents from program A (n=53) reported a significantly higher number of vascular trauma cases when compared with program B (n=59): 12.0 vs. 5.0 cases, respectively (P<0.001). Level 1 trauma center verification does not guarantee sufficient exposure to vascular trauma. The operative exposure in program B is reflective of the national average of 4.0 cases per resident as reported by the ACGME, and this trend is unlikely to change in the near future. Fellowship training may be critical for surgeons who plan to work in a trauma setting, particularly in areas lacking vascular surgeons.

Good Vascular and Neuromuscular Outcome Even in Delayed Repaired Extremities Vascular Trauma-100 Cases Experience

Objectives: To determine whether delayed vascular repair is feasible or has good results in delayed presented cases of vascular trauma, even after >48 h with ischemic changes in some cases. General literature said that Materials and Methods: Prospective analyses of 100 patients operated for peripheral vascular injuries between August 2011 and April 2014 were done. Diagnosis tools included physical examination, pulse oximeter and handheld Doppler alone or in combination with computed tomography angiography. Primary end-to-end vascular repairs or embolectomies were carried out where possible; if not possible, interposition vein graft was placed. Patients with injury > 48 h, with obviously unsalvageable lower extremity injury requiring primary amputation, severe other body organ injury, on ventilator support, vascular injury below trifurcation of popliteal artery, and having ischemic line of demarcation were excluded from the study. Results: Of the 100 patients, 86 were males (86%) and 14 (14%) were females (14%), and their age ranging from 5 to 80 years. Mean duration of the presentation of our study cases was 56 hours after the injury. The most common etiological reason was road traffic accidents; nearly 67% of the patients in penetrating trauma group and 58% among blunt traumas. The incidence of concomitant orthopedic injuries was 74%. The most common injured artery was brachial artery 36%, followed by popliteal artery 30% and femoral artery 22%. Surgical intervention included primary repair with end-to-end anastomosis in 45%, and embolectomy in 15%, whereas interposition of vein graft were placed in 40% cases. Final outcome was – 77% had viable and functional limbs and 15% had viable, but nonfunctional limbs and amputation after repair was 8%. Conclusions: Delayed surgery in vascular injuries has a prognostic value for salvaging the extremity/limb and life of the patient as well as vascular injuries require immediate surgical intervention, regardless of localization but the extent of time limitation for vascular intervention can be widened. Patients suffering from vascular injuries to the extremities should be transferred to vascular surgery centers as soon as possible and consider the patient for surgery even after the delayed presentation.

Trauma vascular na população pediátrica

CONTEXTO: O trauma vascular na população pediátrica apresenta-se como um desafio único, frente à sua incidência relativamente baixa, mesmo em centros médicos de referência. Devido à fragilidade dos tecidos, ao reduzido tamanho dos vasos e à sua baixa incidência, manifesta-se com taxas significativas de morbidade e mortalidade. OBJETIVO: Descrever e analisar os casos de trauma vascular em pacientes pediátricos admitidos em hospital terciário. MÉTODOS: Por meio de estudo retrospectivo, analisaram-se os casos de trauma vascular em pacientes menores de 18 anos, admitidos de janeiro de 2000 a julho de 2010, levando-se em conta dados demográficos, mecanismos de lesão, traumas associados, tratamentos empregados e complicações. RESULTADOS: Foram estudados 242 pacientes com trauma vascular, sendo 37 (15,2%) pertencentes à população pediátrica. A média de idade foi de 12,5 anos, sendo 81% dos participantes da pesquisa do sexo masculino. Entre os mecanismos de lesão, o trauma penetrante foi o mais comum (57%), seguido do contuso (38%) e do iatrogênico (5%). Das técnicas cirúrgicas empregadas, o enxerto arterial com veia autóloga foi o procedimento mais comum (13 casos). Houve um caso de amputação primária (infrapatelar) e quatro amputações no período pós-operatório precoce (três transfemorais e uma transtársica). Dos 11 pacientes admitidos com lesão de artéria poplítea, a taxa de amputação transfemoral pós-operatória foi de 27,3%. Houve apenas um óbito devido a trauma iatrogênico em lactente hemofílico. CONCLUSÕES: O trauma vascular pediátrico envolve vários desafios técnicos, como o vasoespasmo e o calibre dos vasos. As altas taxas de amputações observadas em pacientes com lesões de artéria poplítea, apesar das tentativas de revascularização, reforçam a gravidade desse tipo de trauma.

Twenty-year analysis of surgical resident operative trauma experiences

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) implemented new work-hour rules for all U.S. residency programs beginning on July 1, 2003. The ACGME-mandated work-hour reform may have affected operative trauma case volumes of general surgery residents. MethodsUsing ACGME aggregate data collected from general surgery residency programs from 1990 to 2010, we examined the effect of the 2003 work-hour reform on resident operative trauma case volumes. ResultsOverall trauma cases per year declined from 78.28 in 1990 to 38.73 in 2010. From 1990 to 2003, laparotomy, burn, and upper-gastrointestinal trauma cases fell at least 50%, from 9.97 to 4.85 cases/resident by 0.46 cases/y (95% confidence interval [CI], 0.456–0.459), 10.05 to 3.30 cases/resident by 0.61 cases/y (95% CI, 0.609–0.617), and 3.34 to 1.01 cases/resident by 0.189 cases/y (95% CI, 0.188–0.189), respectively. After 2003, laparotomy and burn cases began to rise by 0.23 cases/y (95% CI, 0.228–0.231) and 0.36 cases/y (95% CI, 0.358–0.368). Vascular trauma cases continued to decline from 8.63 cases/resident by 0.197 (95% CI, 0.196–0.198) pre-reform, but by 0.102 (95% CI, 0.099–0.105) post-reform. Junior surgical residents were increasingly involved in trauma operative cases from 67% in 1990 to 79% in 2010. Cardiac, pancreatic, genitourinary, and neurosurgical cases did not peak more than 1.95 cases/resident pre-reform. ConclusionsSecular trends before the 2003 work-hour reform caused a 50% decrease in operative trauma experience among general surgery residents. Since 1990, junior residents have increasingly performed operative trauma. Rare trauma subspecialty cases remain rare. Post work-hour reform, operative trauma volumes have stabilized.

Outcome after vascular trauma in a deployed military trauma system

Military injuries to named blood vessels are complex limb- and life-threatening wounds that pose significant difficulties in prehospital and surgical management. The aim of this study was to provide a comprehensive description of the epidemiology, treatment and outcome of vascular injury among service personnel deployed on operations in Afghanistan and Iraq. Data from the British Joint Theatre Trauma Registry were combined with hospital records to review all cases of vascular trauma in deployed service personnel over a 5-year interval ending in January 2008. Of 1203 injured service personnel, 110 sustained injuries to named vessels; 66 of them died before any surgical intervention. All 25 patients who sustained an injury to a named vessel in the abdomen or thorax died; 24 did not survive to undergo surgery and one casualty in extremis underwent a thoracotomy, but died. Six of 17 patients with cervical vascular injuries survived to surgical intervention; two died after surgery. Of 76 patients with extremity vascular injuries, 37 survived to surgery with one postoperative death. Interventions on 38 limbs included 19 damage control procedures (15 primary amputations, 4 vessel ligations) and 19 definitive limb revascularization procedures (11 interposition vein grafts, 8 direct repairs), four of which failed necessitating three amputations. In operable patients with extremity injury, amputation or ligation is often required for damage control and preservation of life. Favourable limb salvage rates are achievable in casualties able to withstand revascularization. Despite marked progress in contemporary battlefield trauma care, torso vascular injury is usually not amenable to surgical intervention.

An observational cohort study of the management and outcomes of vascular trauma

To evaluate aetiology, presentation, management and mortality following iatrogenic and non-iatrogenic vascular trauma in a regional vascular centre. Retrospective observational cohort study of patients presenting with vascular trauma during a seven year period between January 2000 and December 2006. 182 cases of vascular trauma were identified (averaging 26 cases p.a.). The majority (n=132, 73%) were iatrogenic and tended to occur in patients aged >45 years, while 50 (27%) were penetrating/blunt, non-iatrogenic and predominantly occurred in younger males. The majority of iatrogenic vascular injuries (80/132) (61%) followed a cardiac intervention (angiography n=56, angioplasty n=23, pacemaker insertion n=1) and are now increasingly treated by non-operative therapies (thrombin, coils and covered stents). Overall, non-iatrogenic vascular trauma was associated with 4% mortality, compared with 7% following iatrogenic injury. However, while iatrogenic trauma of cardiological origin was associated with a mortality of only 1.3% (1/80), iatrogenic trauma of non-cardiological origin incurred a mortality of 17% (9/52). The commonest cause of vascular trauma (and with the lowest mortality rate) was cardiological related iatrogenic injury. However, while non-cardiological iatrogenic injury occurred with the same incidence as penetrating/blunt trauma, it was associated with a fourfold excess mortality.

Peripheral Vascular Injuries Due to Firearms in Children

Vascular injuries caused by firearms are rare among children. In this paper we discuss the surgical methods of treating peripheral vascular injuries due to firearms in children. Forty-four patients with peripheral vascular injuries due to firearms were included in this retrospective study. The patients were under the age of 14 and treated in our clinic between January 1985 and December 2004. Vascular injuries due to firearms in children made up 4.9% of all cases of vascular trauma in our clinic. The male to female ratio was 38:6, and the age range was 3-14. The survival rate was 98% and the rate of limb salvage was 91%. For arterial and venous injuries, a saphenous vein interposition graft and interrupted sutures were often preferred surgically. Peripheral vascular injuries due to firearms in children and other accompanying traumas can be easily identified and treated, and have low morbidity and mortality with an acceptable limb salvage rate if a rapid and effective approach is used.

Medial Circumflex Femoral Artery Pseudoaneurysm Following Total Hip Replacement Treated by Coil Embolisation

Vascular injury is a rare complication following total hip arthroplasty. Most reported cases of vascular trauma around the hip concern fracture and its surgical correction. Pseudoaneurysm formation often presents late. Persistent hip pain, thigh swelling and anaemia should raise suspicion. We present a case of a pseudoaneurysm of the medial circumflex femoral artery that presented following a left total hip arthroplasty using a cemented Charnley Elite system via an antero-medial approach.

SURGICAL REPAIR OF ACUTE ARTERIAL OBSTRUCTION IN THE UPPER EXTREMITIES

Between 1976 and 1987, acute arterial reconstruction was performed to relieve acute upper arm ischemia in 23 cases. The clinical findings and results were as follows.1. Twenty-three cases were divided etiologically into vascular trauma (15), thrombosis (4) and embolism (4). Vascular trauma cases consisted of traumatic thrombosis (8), traumatic arterial rupture (5) and traumatic aneurysm (2).2. Fifteen cases (65%) were treated withih 3 days from onset.3. For thrombosis and embolism, the major procedure used was thorombectomy. For vascular trauma, angioplasty and arterial anastomosis were required in seven cases of traumatic rupture and thrombosis. Other procedures used were aneurysmectomy (2), bypass grafting (3) and thrombectomy (3).4. Prognosis was fair and amputation was not necessary in any case.

Traumatic Aneurysm of the Common Carotid Artery

THE UNEXPECTED finding of an aneurysm of the carotid artery during the biopsy of a mass in the neck for histologic diagnosis can be catastrophic. In this regard, a false (traumatic) aneurysm of the common carotid artery in a 37-year-old man is reported. A review of the literature and suggestions for management are presented. The first ligation of a common carotid artery aneurysm was reported in 1805 by Sir Astley Cooper.¹Makins²reviewed the British experience in the First World War of 86 cases of traumatic carotid aneurysms and found an overall mortality of 30%. Elkins and Shumacker³reported only five cases of cervical traumatic aneurysms in a review of 883 arterial injuries in the Second World War. In another World War II series of 364 cases of vascular trauma, Shumacker⁴reported four traumatic aneurysms. Two of those were "spontaneous cures" due to thrombosis of