Iliac Vessel Injury Research Articles

External iliac vessel injury necessitating thrombectomy after laparoscopic endometrial cancer surgery: A case report

External iliac vessel injury necessitating thrombectomy after laparoscopic endometrial cancer surgery: A case report

MP15-07 ANALYSIS OF PERIOPERATIVE COMPLICATIONS IN PATIENTS WITH PROSTATE CANCER BASED ON EXTENSION OF PELVIC LYMPH NODE DISSECTION

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-07 ANALYSIS OF PERIOPERATIVE COMPLICATIONS IN PATIENTS WITH PROSTATE CANCER BASED ON EXTENSION OF PELVIC LYMPH NODE DISSECTION Marissa Maas, Nima Nassiri, Paolo Dell’Oglio, George Thalmann, Axel Heidenreich, James Eastham, Christopher Evans, Jeffrey Karnes, Andre Abreu, Alberto Briganti, Walter Artibani, Inderbir Gill, Francesco Montorsi, and Giovanni Cacciamani Marissa MaasMarissa Maas More articles by this author , Nima NassiriNima Nassiri More articles by this author , Paolo Dell’OglioPaolo Dell’Oglio More articles by this author , George ThalmannGeorge Thalmann More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , James EasthamJames Eastham More articles by this author , Christopher EvansChristopher Evans More articles by this author , Jeffrey KarnesJeffrey Karnes More articles by this author , Andre AbreuAndre Abreu More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Walter ArtibaniWalter Artibani More articles by this author , Inderbir GillInderbir Gill More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Giovanni CacciamaniGiovanni Cacciamani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While there is consensus on the importance of pelvic lymph node dissection (PLND) in the staging and management of clinically localized prostate cancer, there is controversy regarding the optimal extent of PLND. The European Association of Urology (EAU) currently recommends an extended PLND (ePLND) for high-risk patients. In this study, we evaluated the difference in non-oncologic complication rates following standard PLND (sPLND) vs. ePLND. METHODS: A systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Metanalysis guidelines was conducted. Our team queried Medline, Web of Science, Scopus, and Embase for all papers reporting intra- or postoperative outcomes of radical prostatectomy and PLND. We defined sPLND and ePLND according to EAU guidelines. Data was collected for patient demographics, quality of complication reporting, intraoperative, and postoperative complications. RESULTS: 3,645 papers were collected and 176 met inclusion criteria. 84 described intraoperative complications with a total of 28,428 patients. 534 (1.8%) patients suffered at least one intraoperative complication and rectal injury was most common. The rate of intraoperative complications strongly related to PLND was 11.6%, including obturator nerve and iliac vessel injury. 151 papers with a total of 73,629 patients analyzed postoperative complications. 19 papers reported the complication rates following sPLND vs. ePLND. 10,401 (14.1%) patients reported at least one postoperative complication. Lymphatic system morbidities were most common. The most frequently reported complication strongly related to PLND was lymphocele (90.6%). According to metanalysis, there was a statistically significant decreased risk of intraoperative (RR:0.55; p=0.01) and PLND-related postoperative complications (RR:0.55; p=0.01) with standard/limited PLND compared to extended/super-extended. Extent of PLND is an independent predictor of lymphocele (RR:1.77, p>0.0001). CONCLUSIONS: While there may be an oncologic benefit conferred by ePLND, it is associated with increased risk of intraoperative and postoperative complications, especially lymphocele formation. It is imperative that shared decision is undertaken when deciding extent of PLND. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e266-e266 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marissa Maas More articles by this author Nima Nassiri More articles by this author Paolo Dell’Oglio More articles by this author George Thalmann More articles by this author Axel Heidenreich More articles by this author James Eastham More articles by this author Christopher Evans More articles by this author Jeffrey Karnes More articles by this author Andre Abreu More articles by this author Alberto Briganti More articles by this author Walter Artibani More articles by this author Inderbir Gill More articles by this author Francesco Montorsi More articles by this author Giovanni Cacciamani More articles by this author Expand All Advertisement Loading ...

Factors Associated With Increased Mortality in Severe Abdominopelvic Injury.

Associated injuries are thought to increase mortality in patients with severe abdominopelvic trauma. This study aimed to identify clinical factors contributing to increased mortality in patients with severe abdominopelvic trauma, with the hypothesis that a greater number of concomitant injuries would result in increased mortality. This was a retrospective review of the Trauma Quality Improvement Program (TQIP) database of patients ≥ 18 years with severe abdominopelvic trauma defined as having an abdominal Abbreviated Injury Score (AIS) ≥ 3 with pelvic fractures and/or iliac vessel injury (2015-2017). Primary outcome was in-hospital mortality based on concomitant body region injuries. Secondary outcomes included mortality at 6 h, 6 to 24 h, and after 24 h based on concomitant injuries, procedures performed, and transfusion requirements. A total of 185,257 patients were included in this study. Survivors had more severely injured body regions than non-survivors (4 vs. 3, P < 0.001). Among those who died within 6 h, 28.5% of patients required a thoracic procedure and 43% required laparotomy compared to 6.3% and 22.1% among those who died after 24 h (P < 0.001). Head AIS ≥ 3 was the only body region that significantly contributed to overall mortality (OR 1.26, P < 0.001) along with laparotomy (OR 3.02, P < 0.001), neurosurgical procedures (2.82, P < 0.001) and thoracic procedures (2.28, P < 0.001). Non-survivors who died in < 6 h and 6-24 h had greater pRBC requirements than those who died after 24 h (15.5 and 19.5 vs. 8 units, P < 0.001). Increased number of body regions injured does not contribute to greater mortality. Uncontrolled noncompressible torso hemorrhage rather than the burden of concomitant injuries is the major contributor to the high mortality associated with severe abdominopelvic injury.

Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

BackgroundAlthough damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes).MethodsWe searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions.ResultsAmong 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications.ConclusionsFew indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

Management of Iatrogenic Injury to the Inferior Vena Cava and Right Common Iliac Artery for Drainage of Psoas Abscess.

Iatrogenic simultaneous inferior vena cava (IVC) and iliac vessel injury is a rare entity. Ligation of the IVC in a life-threatening situation is well reported in the literature. Our case demonstrates that such a clinical situation requires optimization of fluid volume and management of sequelae such as deep vein thrombosis.

IP241. Associated Bowel Injury Does Not Affect Outcomes of Traumatic Iliac Vessel Injuries

IP241. Associated Bowel Injury Does Not Affect Outcomes of Traumatic Iliac Vessel Injuries

Outcomes after External Iliac and Femoral Vascular Injuries

Vascular injuries occurring at the junction of the trunk and lower extremity are uncommon yet challenging because of their location and potential for associated truncal injuries. The purpose of this study was to examine and compare outcomes among patients sustaining external iliac and femoral vascular injuries. We performed a 13-year retrospective analysis of our level 1 trauma center database to identify and compare patients with external iliac and femoral vessel injuries. Multiple logistic regression analysis was performed to identify independent predictors for mortality. During the study period, 135 patients with a median (interquartile range [IQR]) age of 25 (20-35) years were identified with external iliac (n=29) and femoral vascular injuries (n=106). The majority were male (85.9%) with a penetrating mechanism (84.5%), and the median (IQR) Injury Severity Score (ISS) was 16 (11-26). The overall mortality rate was 14.1%. In comparison with patients with femoral vascular injuries, patients with external iliac injuries presented with higher ISS (25 vs. 16, P<0.001), lower Glasgow Coma Scale (14 vs. 15, P=0.001) and had a higher incidence of mortality (41.4% vs. 6.6%, P<0.001) and disability (13.8% vs. 1%, P=0.007). Shunts were used in only 7 patients (5.2%). Stepwise logistic regression consistently identified external iliac injury (odds ratio, 15.6; 95% confidence interval, 1.72-141, P=0.014 in best-fitted model) as independently associated with mortality. In comparison with femoral vascular injuries, external iliac vascular injuries are associated with higher blood loss, more intense resuscitation, higher disability and mortality in patients sustaining junctional groin injuries. Early recognition and application of damage control techniques and resuscitative practices may result in improved outcomes.

Endovascular Stenting for Traumatic Common Iliac Pseudoaneurysm as an Adjunct following Exploratory Laparotomy in a Stab Injury Patient

ABSTRACT Traumatic iliac vessel injuries, especially secondary to penetrating wounds, are often associated with a very high mortality rate. The patients usually present to the trauma bay in profound hemorrhagic shock, which, in turn, triggers the vicious cycle of hypothermia, coagulopathy, and acidosis. Iliac artery injuries should be managed promptly because of the high incidence of late complications of pseudoaneurysm and arteriovenous fistulae and risks of subsequent arterial thrombosis and distal ischemia. We report a case of a 17-year-old female who was brought in following a stab wound in the right lower quadrant (RLQ). A postlaparotomy computed tomography (CT) scan performed revealed a pseudoaneurysm on the right common iliac. A pelvic angiography was performed, which was followed by an endovascular placement of a covered stent on the right common iliac artery. We discuss an interesting case along with discussion of relevant literature. How to cite this article Biswas S, Nagarakanti N. Endovascular Stenting for Traumatic Common Iliac Pseudoaneurysm as an Adjunct following Exploratory Laparotomy in a Stab Injury Patient. Panam J Trauma Crit Care Emerg Surg 2016;5(3):172-176.

The Role of Completion Surgery in Ovarian Cancer.

Patients referred with inadequately staged ovarian malignancies present a clinical dilemma. We report our experience with completion surgery in ovarian cancer. To determine the benefits and risks of completion surgery in women with ovarian cancer who presented after having had inadequate primary surgery. A retrospective case series of 30 women with ovarian cancer and one with fallopian tube cancer who had inadequate primary surgery underwent completion surgery at gynaecologic oncology unit in a tertiary level hospital in Tamil Nadu, India. Electronic medical records of patients with ovarian cancer who underwent completion surgery between January 2011 and September 2014 for ovarian were reviewed. Forty-five patients with initial inadequate surgery were identified of whom 31 underwent completion surgery; the remaining 14 did not return to our hospital. Thirty-one women with a mean age of 37years (17-53) and median parity of 2 (0-4) with inadequately staged ovarian malignancy underwent completion surgery. Complex ovarian mass was the most common indication for initial surgery (94%). The tumours were epithelial in 27 (87%), germ cell in 3 (10%) and sex cord stromal in 1 (3%). In view of extensive disease at presentation, 19% (6/31) were referred for neoadjuvant chemotherapy and underwent interval debulking. With regard to surgical complexity, 52% (16/31), 38% (12/31) and 10% (3/31) underwent simple, intermediate and complex surgeries, respectively. Optimal cytoreduction (R0 and R1) was performed in 25 patients (81%). Twelve (39%) had upstaging of disease. Six patients required no further adjuvant treatment following surgical restaging. Complications included bladder injury (1), iliac vessel injury (1) and surgical site infections (2). During the study period of 45months, 7 patients (23%) presented with disease recurrence. There were 2 recorded deaths. In inadequately staged ovarian malignancies, completion surgery should be considered based on the patients' performance status and disease assessment. Considering the low specificity of imaging and Ca 125, completion surgery provides information to plan adjuvant therapy, besides allowing optimal cytoreduction but delays initiation of adjuvant therapy.

Perineal sigmoidopexy utilizing transanal endoscopic microsurgery (TEM) to treat full thickness rectal prolapse: a feasibility trial in porcine and human cadaver models.

Perineal approaches for rectal prolapse repair have low complication rates but high recurrence rates, while abdominal approaches that include sigmoidopexy have lower recurrence rates but higher complication rates. To optimize both recurrence and complication rates, we developed a novel procedure that uses transanal endoscopic microsurgery (TEM) to perform a sigmoidopexy via a perineal approach. We created a rectal prolapse model in six swine and two human cadavers using a previously published technique. The rectum was mobilized and eviscerated transanally. After marking the planned point of sigmoid transection, the rectum was returned to the peritoneal cavity. A TEM proctoscope was inserted transanally alongside the rectum, and the lateral sigmoid colon walls were sutured to the sacrum. The sigmoid colon was then transected where previously planned, and a primary sigmoid anastomosis was performed. Total operative time, sigmoidopexy operative time, and suture security were measured and compared to standard rectosigmoidectomy and abdominal sigmoidopexy times. No sigmoid colon, iliac vessel, bladder, or ureteral injuries occurred. At least two sigmoidopexy sutures were secure on inspection in all animals and human cadavers, with increasing success of secure suture placement as experience increased. Operative length was similar to traditional abdominal sigmoidopexy. TEM sigmoidopexy is technically feasible. This approach has the potential to reduce the recurrence rate associated with perineal approaches alone, but further study is needed to confirm this hypothesis.

Characterization and Outcomes of Iliac Vessel Injury in the 21st Century

Iliac vessel trauma (IVT) is traditionally associated with high mortality. We evaluated a modern series of patients with IVT to assess current outcomes and endovascular therapy use. We performed a retrospective review of the National Trauma Data Bank. Patients with IVT were stratified by blunt and penetrating mechanism and arterial and venous injury. In blunt IVT, there was no significant difference in mortality between those with and without pelvic fractures (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.36-1.06). In penetrating IVT, combined arterial and venous IVT was associated with higher mortality (OR 1.70, 95% CI 1.06-2.70) compared to isolated arterial IVT. Isolated venous IVT was associated with lower mortality (OR 0.55, 95% CI 0.35-0.85) compared to isolated arterial IVT. Endovascular stenting was utilized in 11.3% of blunt IVT with pelvic fractures, 6.3% of blunt IVT without pelvic fractures, and 1.8% of penetrating IVT. Iliac Vessel Trauma has significant mortality. Endovascular intervention for IVT is applied sparingly.

Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature

Laparoscopic surgery has become increasing popular, and its use has been proven safe. However, major vascular injuries during laparoscopic procedures can have devastating effects, and there is a paucity of information regarding their intraoperative management. Here we report our experience with laparoscopic vascular injury repair and analyze the available literature on this topic. Two cases of iliac vessel injury during laparoscopic colectomy were reviewed from a single surgeon's experience with of over 1,000 major laparoscopic procedures. The details of injury, techniques used, and outcomes were analyzed. A review of the literature was also conducted via PubMed. An injury to the left common iliac artery in a 75-year-old man and an injury to the left external iliac vein in a 39-year-old man during laparoscopic sigmoid colectomy are described, with successful laparoscopic vascular repair in both. Estimated blood loss was 300 and 250 ml, respectively. Patients were discharged home on postoperative days 4 and 3 without complications. A review of the literature yielded descriptions of a total of 704 major vascular injuries, with 6 case reports of vascular injuries involving the iliac vessels and inferior vena cava with successful laparoscopic repair. Laparoscopic repair of major vasculature is feasible if sound techniques are followed. We describe a stepwise technique for dealing with intraoperative laparoscopic vascular injury.

Iliac vessel injuries: difficult injuries and difficult management problems.

Injury to the iliac vessels poses a serious and frustrating treatment dilemma for all trauma surgeons. Generally, patients present in profound shock secondary to severe hemorrhage from either iliac arterial, venous, or combined injuries. Despite improvements in our emergency medical services (EMS), rapid transport, standard training of trauma surgeons, and improved technology, the morbidity and mortality from iliac vessel injuries remain high, ranging from 25 to 40%. A systematic review of the literature, with emphasis placed on the diagnosis, treatment, and outcomes of these injuries, incorporating the author's experience. Injuries to the iliac vessel remain a daunting task, even after great advances in anatomic injury grading and damage control as well as advances in surgical techniques and critical care. Despite all the advances in treatment and appropriate management strategies, the morbidity and mortality from iliac vessel injuries remain high, demonstrating the complex challenge their treatment presents to even the modern-day trauma surgeon.

A Ten Year Review of Civilian Iliac Vessel Injuries from a Single Trauma Centre

ObjectiveTo report the surgical management and outcome of iliac vessel (IV) injuries in a civilian trauma centre with a high incidence of penetrating trauma. Design, patients and methodsA retrospective record review of patients with IV injuries treated between January 2000 and December 2009. ResultsSixty nine patients, 59 with gunshot wounds, sustained 108 iliac vessel injuries. Mean revised trauma and injury severity scores was 7.06 and 28.4, respectively. Twenty nine patients required damage control laparotomy. Common or external iliac arteries were repaired by primary repair (10), temporary shunt with delayed graft (6), interposition graft (5) or ligation if limb non-viable (3). Forty-seven patients had injuries to the common or external iliac vein, 42 were ligated. Mortality was 25% and 6 survivors required amputation. ConclusionsIn a stable patient a primary arterial repair is preferred but a temporary shunt can be a life and limb saving option in the unstable patient. Ligating the common or external iliac veins is associated with a low incidence of prolonged leg swelling.

Common Iliac Vessel Injury after Lumbar Discectomy

Injury of common iliac vein related to lumbar discectomy is a rare complication. We report a patient who sustained injury of common iliac vein during lumbar discectomy for extraforaminal lumbar herniated disc. In this case, she had hypovolemic shock due to massive bleeding, and underwent emergent interventional treatment and open laparatomy. Although the vascular injuries were successfully repaired, it could be a fatal complication. We report the clinical features and early management, emphasizing the need for rapid diagnosis, immediate intervention and treatment for favorable outcome.

Characterization and outcomes of iliac vessel injury in the 21st century: A review of the National Trauma Data Bank

Characterization and outcomes of iliac vessel injury in the 21st century: A review of the National Trauma Data Bank

Female urology: What method will you select?

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki

Aortic injury with chance fracture in a child

To present the findings in a 10-year-old male with a Chance fracture and associated aortic vascular injury and review of the literature on the subject. We reviewed the clinical and imaging findings in a patient who was in a serious motor vehicle accident, sustaining a Chance fracture of the lumbar spine and associated aortic and common iliac vessel injury. We also accomplished a literature review. Evidence of an associated aortic injury was available on the initial computed tomography (CT) study, but the findings were more exquisitely demonstrated on reconstructed studies of the lumbar spine. Our literature review indicated that aortic injury associated with Chance fracture is relatively rare and often overlooked. Abdominal aortic injury although rare, can occur with Chance fractures. With the now present sophisticated CT imaging in most Emergency Rooms it is possible to obtain exquisite reconstructed images of all organ systems including the vascular tree. The images may provide enough details so that further delineation of any given problem may not be necessary.

125: Valproic acid in small volume resuscitation modulates inflammation and lactic acidosis in swine model of hemorrhagic shock

Background: Valproic Acid (VPA) is a histone deacetylase (HDAC) inhibitor found to prolong survival of rats in hemorrhagic shock when given as pretreatment. In this study we test whether the post-hemorrhage administration of VPA with small volume resuscitation would induce histone hyperacetylation and inflammatory modulation in a lethal swine hemorrhagic shock model. Methods: Anesthetized Yorkshire swine were subjected to lethal hemorrhagic shock using standard iliac vessel injuries with uncontrolled bleed for 15 minutes (average blood loss of 40% Total Blood Volume, TBV).

Endovascular management of iliac vessel injury during revision of total hip replacement

Re-operative hip arthroplasty may be associated with life threatening vascular complications involving the iliac arteries and veins. The anatomic distortion and difficult surgical dissection in a re-operative field often contributes to iliac vascular injuries. Bleeding during removal of the acetabular component of the hip prosthesis is often the initial sign of a major intra-operative vascular injury, the external iliac artery being the most common injured vessel. Preoperative identification of patients at risk for vascular injury during revision of hip arthroplasty is currently feasible and advisable with the information provided by plain X-ray films, angiography, CT-scan and nowadays with the 3D-angio-CT. The traditional approach for intra-operative exposure, control and repair of iliac vascular injuries during re-operative hip arthroplasty has been a retroperitoneal abdomino-pelvic incision. We here present an endovascular approach for the pre-emptive percutaneous control and potential repair of vascular injuries during a second hip arthroplasty revision in a patient at high risk for recurrent bleeding following severe hemorrhage during the initial hip revision.