Peripheral Vascular Trauma Research Articles

Association of rurality with short-term outcomes of peripheral vascular trauma

BackgroundPeripheral vascular trauma is a major contributing factor to long-term disability and mortality among patients with traumatic injuries. However, an analysis focusing on individuals at a high risk of experiencing limb loss due to rural and urban peripheral vascular trauma is lacking. MethodThis was a retrospective analysis of the 2016 to 2020 Nationwide Readmissions Database. Patients (≥18 years) undergoing open or endovascular procedures after admission for peripheral vascular trauma were identified using the 2016 to 2020 Nationwide Readmissions Database. Patients from rural regions were considered Rural, whereas the remainder comprised Urban. The primary outcome of the study was primary amputation. Multivariable regression models were developed to evaluate rurality with outcomes of interest. ResultsOf 29,083 patients, 4,486 (15.6%) were Rural. Rural were older (41 [28–59] vs 37 [27–54] years, P < .001), with a similar distribution of female sex (23.0 vs 21.3%, P = .09) and transfers from other facilities (2.8 vs 2.5%, P = .34). After adjustment, Rural status was not associated with the odds of mortality (P = .82), with urban as reference. Rural status was, however, associated with greater odds of limb amputation (adjusted odds ratio 1.85, 95% confidence interval 1.47–2.32) and reduced index hospitalization cost by $7,100 (95% confidence interval $3,500–10,800). Additionally, compared to patients from urban locations, rurality was associated with similar odds of non-home discharge and 30-day readmission. Over the study period, the marginal effect of rurality on the risk-adjusted rates of amputation significantly increased (P < .001). ConclusionPatients who undergo peripheral vascular trauma management in rural areas appear to increasingly exhibit a higher likelihood of amputation, with lower incremental costs and a lower risk of 30-day readmission. These findings underscore disparities in access to optimal trauma vascular care as well as limited resources in rural regions.

Pediatric Peripheral Vascular Trauma: Incidence and Outcomes.

Peripheral vascular trauma (PVT) is rare in children, with an incidence estimated below 1%. We studied pediatric PVT and risk factors for major amputation by accessing the 2019 National Trauma Data Bank (NTDB). Demographics, injury type and location, trauma center capability, injury severity score (ISS), length of stay (LOS), and major amputation rates were evaluated. Statistical analysis included chi-square testing for categorical variables and t-tests for continuous variables. Of 130,554 pediatric trauma patients, 1196 (.9%) had 1460 upper extremity (UE) and lower extremity (LE) PVT. Patients were predominantly male (n = 933, 78%) with a mean age of 14 years. Most patients suffered penetrating injury (n = 744, 62.2%). The most common vessels injuries were radial (n = 198, 13.6%) and femoral (n = 196, 13.4%). Major amputation occurred in 2.6% of patients (n = 31). Patients who suffered blunt injury (OR, 3.3; 95% CI, 1.5-7.5; P = .004) and lower limb PVT (OR, 11.1; 95% CI, 3.3-37.9, P = .0001) had higher odds of amputation.

MESS Scale in Peripheral Vascular Trauma of the Lower Extremities: Experience at the High Specialty Regional Hospital Dr Gustavo A Rovirosa Perez

MESS Scale in Peripheral Vascular Trauma of the Lower Extremities: Experience at the High Specialty Regional Hospital Dr Gustavo A Rovirosa Perez

Early Recognition and Effective Intervention in Peripheral Vascular Trauma

Early Recognition and Effective Intervention in Peripheral Vascular Trauma

Peripheral vascular trauma - basic management, diagnosis and treatment.

Peripheral vascular injuries occur in 1-3% of all traumas in civilian settings. The management of these injuries is often based on experience derived from war medicine where these injuries are more common. The goal of this article is to summarize basic guidelines for the diagnosis and treatment of vascular injuries. Western Trauma Association (WTA) and Eastern Association for the Surgery of Trauma (EAST) both have their own guidelines for vascular trauma management. Vascular injuries occur both in penetrating and blunt traumas. Complete vessel disruption occurs more frequently in penetrating traumas. In the case of blunt trauma, intimal defects are more common, resulting in dissection, false aneurysm, or intramural hematoma. The limb is mostly endangered due to ischemia, reperfusion injury and the compartment syndrome. Prompt diagnosis and treatment are paramount. Vascular trauma management is part of the ATLS protocol and life-over-limb principle. The primary goal is to stop the massive external bleeding. Clinical examination and CT angiography are the most helpful for the diagnosis. Surgical revision is indicated when hard signs are present. This can be a damage control surgery with the primary goal to stop the bleeding as quickly as possible. A shunt can be used for temporary reperfusion of the limb. Definitive treatment can take the form of a simple suture, patches or graft interposition; both prosthetic and autologous grafts are used. Sufficient debridement and fasciotomy are important steps in the therapy. In some cases, endovascular treatment can be used. Over the last century, the treatment strategy changed dramatically. Data from recent military conflicts show a decrease in amputation rates, and limb salvage has become a standard.

A Deep Learning-based Model to Predict Limb Amputation in Peripheral Vascular Trauma

The objective of this study is to develop an accurate neural network (NN)-based approach to predict limb amputation in patients who sustain blunt traumatic peripheral vascular injury. The 2019 National Trauma Data Bank (NTDB) was queried for International Classification of Disease, Tenth Edition (ICD-10) codes corresponding to blunt peripheral vascular trauma. A total of 15,438 patients were used to train a NN, of which 335 received a traumatic amputation. The neural network was trained using the following input variables: age, sex, Injury Severity Scale (ISS), presenting Glasgow Coma Scale (GCS), packed red blood cells (RBCs) used in the first 4 hours of presentation, heart rate, and presenting systolic blood pressure (SBP). The primary outcome of our study was the area under the receiver-operator characteristics curve (AUC) of our NN with secondary outcomes including the normalized importance ratio of variables used to train the NN. The NN accurately predicted amputation in patients who sustained blunt peripheral vascular injury with an AUC of 0.78. There were no significant differences in age between the amputation and limb salvage cohorts. There was a higher prevalence of males in the amputation cohort in addition to a higher ISS, lower GCS, increased amount of packed RBCs in the first 4 hours of presentation, and a lower presenting SBP. Our NN found ISS followed by blood transfusion requirements to be most predictive of traumatic amputation. A NN-based approach can accurately predict. Additionally, presenting ISS and transfusion requirements within the first 4 hours were found to have the highest predictive value. Furthermore, NN can be utilized as an innovative predictive adjunct in the management of critical trauma.

Pediatric Peripheral Vascular Trauma: Incidence and Outcomes

Journal of the American College of Surgeons 236(5):p S85-S86, May 2023. | DOI: 10.1097/01.XCS.0000933024.97901.23

Cadet Agustín Melgar and military peripheral vascular trauma approach during Chapultepec's Battle

Cadet Agustín Melgar and military peripheral vascular trauma approach during Chapultepec's Battle

Vascular Surgery Role in Vascular Trauma: 11-Year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center

Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. The degree however that vascular surgery (VS) is involved in vascular trauma care is not well established. We hypothesize that VS consultation is required in a high portion of complex lower extremity vascular trauma. A single-center retrospective review of all consecutive patients who sustained traumatic arterial injury of the lower extremity requiring open operative repair at a level-1 trauma center (from February 2009 to May 2020) was performed. Patients who underwent surgical repair were stratified by the service that performed the operation (VS versus trauma surgery [TS]). Secondary outcomes assessed included location of arterial injury, type of repair, and clinical outcomes. A total of 111 patients underwent operative repair of lower extremity arterial injury (mean age 34.5±15.5years, 89% male). The most common vessels requiring intervention were the superficial femoral artery (n=42, 38%), popliteal artery (n=35, 31.5%), and tibial vessels (n=19, 17.1%). The most common intervention required in patients was an autologous bypass (n=85, 76.5%), followed by ligation (n=9, 8.1%) and primary repair (n=6, 5.4%). Most interventions overall required VS involvement (n=95, 86%). VS performed a higher proportion of autologous graft procedures compared to TS (n=79, 92.9% vs. n=6, 7.1%). VS case load overall was likewise predominantly autologous grafts (n=79/95, 83.2%). TS operated on a higher proportion of injuries to the tibial vessels (44% vs. 13%, P=0.01), whereas VS intervened more frequently on popliteal injuries (36% vs. 6%, P=0.02). With regard to the method of arterial repair, TS was more likely to perform ligation (38% vs. 3 %, P<0.001) or primary repair (13% vs. 3%, P=0.04) compared to VS. However, VS was more likely to perform repair with autologous graft (83% vs. 38%, P<0.001). There were no significant differences in rates of mortality, limb loss, transfusions requirement, fasciotomy, deep venous thrombosis, hematoma formation, or length of stay between groups. Although, surgical site infections were more common in the TS group (38% vs. 15%, P=0.04). Vascular surgeons play a large role in managing complex lower extremity vascular trauma. In particular, VS remains integral for the management of more difficult injuries (e.g., popliteal injuries) and is more likely to provide more complex repairs (e.g., autologous grafts).

Epidemiology and Outcomes of Peripheral and Non-Aortocaval Vascular Trauma in Scotland 2011 – 2018

This population based study aimed to examine the demographics, mechanisms, and outcomes of patients in Scotland suffering peripheral and non-aortocaval vascular trauma between 2011 and 2018. A retrospective observational study was conducted using prospectively collected data derived from the Scottish Trauma Audit Group (STAG) from 1 January 2011 to 31 December 2018. Peripheral and non-aortocaval vascular trauma patients were identified using Abbreviated Injury Severity (AIS) codes. Demographics, mechanisms, types of injury, severity, and outcomes were analysed. Of 30 831 patients admitted with trauma to Scottish hospitals, 569 (1.8%) patients suffered a vascular injury during the eight year study period with 275 (0.9%) patients sustaining a peripheral or non-aortocaval vascular injury. There were 221 (80%) men and 54 (20%) women with a median (range) age of 39 (14 - 88) years. Blunt trauma was responsible for 179 (65%) injuries, of which road traffic accidents were the most common mechanism. A further 67 (24%) injuries were due to penetrating trauma, of which assault was the most common cause. The most common injury was to abdominal arteries (e.g., hepatic, renal, splenic [n= 83]) with an associated mortality rate of 17%. The median (range) Injury Severity Score (ISS) was 16 (4 - 75). Sixteen (6%) patients died in the Emergency Department (ED). Two hundred and twenty-seven (83%) patients were taken to theatre during their admission with a 30 day peri-operative mortality rate of 10%, compared with an overall mortality rate of 16%. Injuries to an abdominal vein (e.g., portal, renal, splenic, superior mesenteric) had the highest number of associated deaths, with 11 (32%) of 34 cases resulting in a fatality. There is a low incidence of vascular trauma in Scotland. Blunt force was responsible for more vascular injuries than penetrating trauma. Patients with peripheral and non-aortocaval vascular injuries are likely to be severely injured and suffer a high mortality rate.

Exosomal ncRNAs: The pivotal players in diabetic wound healing.

Diabetes is the most prevalent metabolic disease in the world today. In addition to elevated blood glucose, it also causes serious complications, which has a significant effect on the quality of life of patients. Diabetic trauma is one of complications as a result of the interaction of diabetic neuropathy, peripheral vascular disease, infection, trauma, and other factors. Diabetic trauma usually leads to poor healing of the trauma and even to severe foot ulcers, wound gangrene, and even amputation, causing serious psychological, physical, and financial burdens to diabetic patients. Non-coding RNAs (ncRNAs) carried by exosomes have been demonstrated to be relevant to the development and treatment of diabetes and its complications. Exosomes act as vehicle, which contain nucleic acids such as mRNA and microRNA (miRNA), and play a role in the intercellular communication and the exchange of substances between cells. Because exosomes are derived from cells, there are several advantages over synthetic nanoparticle including good biocompatibility and low immunogenicity. Exosomal ncRNAs could serve as markers for the clinical diagnosis of diabetes and could also be employed to accelerate diabetic wound healing via the regulation of the immune response and modulation of cell function. ncRNAs in exosomes can be employed to promote diabetic wound healing by regulating inflammation and accelerating re-vascularization, re-epithelialization, and extracellular matrix remodeling. Herein, exosomes in terms of ncRNA (miRNA, lncRNA, and circRNA) to accelerate diabetic wounds healing were summarized, and we discussed the challenge of the loading strategy of ncRNA into exosomes.

Non‐articulated hybrid glass and carbon‐reinforced shank tube for bio‐medical applications

AbstractGlobally, the most prevalent reasons of lower extremity amputation are diabetes, peripheral vascular disease, trauma, tumors and congenital abnormalities. Though modern lower limb prosthetic devices are available in the market, affordability for amputees in developing and underdeveloped nations is a concern, so it is required to make it more accessible with more economical options. This research is an initiative to develop a composite shank tube by filament winding technique as an alternative to conventional metallic tubes for prosthetic components. The composite materials used for this study included glass fiber/epoxy and hybrid fiber (glass + carbon)/epoxy. The composite tubes were manually fabricated and were subjected to axial compression test to estimate the loading bearing and energy absorption capacities. The composite's material properties were determined as per ASTM standards. The obtained properties and experimental data were used to carry out simulations for the composite tubes with ANSYS® 2021 software package under quasistatic loading conditions. Based on the research that was done, the overall performance of Hybrid Fiber tube in terms of peak loads and energy absorption indexes looks good, and there is a high possibility that they could be used as a load‐bearing part in a lower limb prosthetic system.

Peripheral Vascular Trauma among Vascular Surgery Cases Operated in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Peripheral vascular trauma can result in limb or life-threatening injuries. Early surgical intervention leads to a better outcome. Diagnosis is made clinically, by non-invasive and invasive imaging modalities. Our aim in this study is to find out the prevalence of peripheral vascular trauma among vascular surgery cases operated in a tertiary care centre of Nepal. This is a descriptive cross-sectional study of peripheral vascular injuries that underwent operative management in a tertiary care hospital of Nepal from January 2018 to May 2020. Ethical approval was taken from the Institutional Review Committee of Kathmandu University School of Medical Sciences (Registration Number 79/20). Convenience sampling technique was used. Data for the study was retrieved from operation records of the patients along with their treatment summaries and entered and analyzed in the Statistical Package for Social Sciences version 20.0. All cases with complete records were included. Conservatively managed cases and cases that underwent primary amputation were not included in the study. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 624 vascular surgery patients, 40 (6.41%) (4.48-8.33 at 95% Confidence Interval) patients had presented with peripheral vascular trauma during the study period. There were 26 (65%) cases where the upper limb was involved. The prevalence of vascular surgery for peripheral vascular trauma among vascular surgeries operated in our study was similar to other studies done in similar settings. Vascular injury needs urgent intervention and appropriate management will result in a high chance of limb salvage and survival.

Vascular Surgery Role in Vascular Trauma: An 11-year Analysis of Peripheral Vascular Trauma Management at a Level 1 Trauma Center

Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. However, the degree to which vascular surgery (VS) is involved in vascular trauma care is not well-established. We hypothesize that VS consultation is required in a high portion of complex lower extremity vascular trauma.

Pediatric peripheral vascular injuries and associated orthopedic considerations

Pediatric peripheral vascular trauma is a rare but highly morbid injury in children and is frequently associated with concomitant orthopedic injuries. These children require multidisciplinary care by pediatric, vascular, and orthopedic surgery. In this review, we describe elements of the complex care required for children with peripheral vascular trauma.

The influence of primary and subsequent limb amputation on the overall rate of limb amputation in Saskatchewan, Canada, 2006\u20132019: a population-based study

BackgroundUnderstanding trends in limb amputation (LA) can provide insight into the prevention and optimization of health care delivery. We examine the influence of primary (first report) and subsequent (multiple reports) limb amputation on the overall (all reports) rate of limb amputation in Saskatchewan considering amputation level.MethodsHospital discharged data associated with LA from 2006 to 2019 and population estimates in Saskatchewan were used. LA cases were grouped based on overall, primary, and subsequent LA and further divided by level into major (through/above the ankle/wrist) and minor (below the ankle/wrist). Incidence rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial were used to analyze the trends. In addition, the top three amputation predisposing factors (APF) were described by LA groups.ResultsThe rate of overall LA and primary LA remained stable (AAPC − 0.9 [95% CI − 3.9 to 2.3]) and (AAPC −1.9 [95% CI −4.2 to 0.4]) respectively, while the rate of subsequent LA increased 3.2% (AAPC 3.2 [95% CI 3.1 to 9.9]) over the 14-year study period. The rate of overall major LA declined 4.6% (AAPC − 4.6 [95% CI −7.3 to −1.7]) and was largely driven by the 5.9% decline in the rate of primary major LA (AAPC − 5.9 [95% CI − 11.3 to –0.2]). Subsequent major LA remained stable over the study period (AAPC −0.4 [95% CI − 6.8 to 6.5]). In contrast, the overall rate of minor LA increased 2.0% (AAPC 2.0 [95% CI 1.0 to 2.9]) over the study period which was largely driven by a 9.6% increase in the rate of subsequent minor LA (AAPC 9.6 [95% CI 4.9 to 14.4]). Primary minor LA rates remained stable over the study period (AAPC 0.6 [95% CI − 0.2 to 1.5]). The study cohorts were 1.3-fold greater risk of minor LA than major LA. Diabetes mellitus (DM) was the leading APF representing 72.8% of the cohort followed by peripheral vascular disease (PVD) and trauma with 17.1 and 10.1% respectively. Most (86.7%) of subsequent LA were performed on people with DM.ConclusionsOverall LA rates remained stable over the study period with declining rates of major LA countered by rising rates of minor LA. Minor LA exceeded major LA with the largest rate increase identified in subsequent minor LA. Diabetes was the greatest APF for all LA groups. This rising rate of more frequent and repeated minor LA may reflect changing intervention strategies implemented to maintain limb function. The importance of long-term surveillance to understand rates of major and minor LA considering primary and subsequent intervention is an important step to evaluate and initiate prevention and limb loss management programs.

Operative Management and Outcomes of Peripheral Vascular Trauma in Pediatric and Adolescent Population

Introduction: Unique characteristics of vascular injuries in children such as pronounced vascular spasm and lack of tissue support over small, thin-walled vessel make vascular repair challenging. This retrospective study was done to evaluate the management and outcome of pediatric and adolescent peripheral vascular trauma. Methodology: Fifteen patients with peripheral vascular trauma who met the inclusion criteria during the study period (August 2019-July 2020) were included. Data were analyzed retrospectively. Results: Majority, 12(80%) of patients suffered blunt trauma. Primary repair in 13(86.66%) patients was the most common surgical technique employed. All the patients had associated long bone fracture dealt with internal fixation. Four (26.66%) cases had median nerve injury which was amenable to direct repair. Associated venous injury in 5 (33.33%) was also repaired. No mortality, re-operations, or amputation was noted. Conclusion: Excellent limb salvage rate was achieved. Initial revascularization without delay should be the norm. Associated neurological involvement determines postoperative functional outcome. Clinical evaluation with Doppler assessment saves time and crucial in vascular injuries prone to spasm.

HYPOCHLOROUS ION BASED DRESSING: THROWBACK TO THE SURGEONS’ CHOICE

1.1 BACKGROUND : As per Robbin's pathology(Robbins &amp; Cotran Pathologic Basis of Disease - 10th Edition, n.d.) "an ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inamed necrotic tissue." In an era of modern-day fast track surgery and premier practices of medicine, management of wound remains an archaic, almost omnipresent challenge to a health care provider mediating the need for solutions. The hunt for an optimum dressing agent has been everlasting, one of which is our point of discussion in this study. The addition of Chlorine(Cl2) to Water(H2O) gives rise to Hypochlorous ion, a weak acid that has been used traditionally as disinfectant, sterilizer and beaches. These properties can be utilised for wound disinfection and swifter wound healing. 1.2 AIMS AND OBJECTIVES: Ÿ To study the efcacy of Hypochlorous ion-based dressing over traditional normal saline based dressing . Ÿ To study the effects factoring in various associated comorbidities in patients such as Diabetes Mellitus, Peripheral Vascular Disease, Trauma and Pressure Ulcer. 1.3 METHODOLOGY: A comparative study was conducted in a tertiary care facility in India that included 101 patients who were distributed randomly utilizing computerised algorithms into study and control group. The control group received daily normal saline dressing whereas the study group underwent daily hypochlorous ion-based dressing. The subjects were analysed after 4 weeks and evaluated for decrease in wound surface area and improvement of wound quality and tabulated for analysis. 1.4 CONCLUSION: Hypochlorous ion based daily dressing shows signicant reduction in wound surface area as well as signicantly better and faster improvement in the quality of wound in patients of Traumatic, Diabetic and Pressure Ulcer whereas the results in patients suffering from Peripheral Vascular Disease were equivocal.

Damage control of peripheral vascular trauma - Don't be afraid of axillary or popliteal fosses.

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review.

This study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 18% and 29% respectively. On the other hand, 20% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma ( p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury ( p = 0.001). The MESS has a significant correlation to both age groups I and II ( p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.