Post-traumatic Vascular Injury Research Articles

The Role of 320 Slice CT Angiography in Predicting Vascular Trauma.

To determine the accuracy of multidetector CT angiography (MDCT angiography) as initial diagnostic technique in depicting and characterizing post traumatic vascular injuries, looking for additional injuries and confirming the findings with intervention and follow-up. Descriptive analytical study. Department of Radiology, Shifa International Hospital, Islamabad, from June 2010 to October 2013. Patients who underwent MDCT angiography for clinically suspected post traumatic vascular injury were included. All MDCT angiographies were performed on 320 slice CT (Aquilion OneTM) and were reviewed by two independent consultant radiologists. The sites of injury were intracranial, neck and maxillofacial, chest, abdomen and extremities. The presence and characteristics of vascular injuries were confirmed by post-operative findings or digital subtraction angiography (DSA). Sensitivity and specificity was calculated. The age of the patients ranged from 7 to 90 years with 94% (48) males and 6% (3) females. Blunt trauma was commoner than penetrating trauma. The site of injury in majority was extremities. Majority of patients had post-traumatic pseudoaneurysm formation followed by arterial occlusion, thrombosis, active extravasation, spasm, arteriovenous malformation and combination injuries. Twenty-one (41%) patients were reported as having vascular injury and confirmed by surgery or DSA. Fifteen (29.5%) patients were reported as normal and had no intervention on follow-up. The sensitivity and specificity of MDCT angiography was found as 100% and 88%, NPV of 100%, PPV of 94% and accuracy of 96%. MDCT angiography can be reliably used as an initial diagnostic technique for the evaluation and characterization of post-traumatic vascular injuries.

Value of multislice computed tomography angiography (MCTA) in neglected post traumatic vascular injuries of the extremities

ObjectivesTo evaluate the role of MCTA in detecting neglected vascular injuries in the extremities. Study designThis study included nineteen patients with previous trauma history, with clinically suspected vascular lesion. CTA was done for every patient and followed by surgical treatment. ResultsOut of the nineteen patients included, eighteen patients were accurately diagnosed by MCTA to have vascular lesions (94.7%), pseudoaneurysm in 10 (55.6%) patients, stenosis in 4 (22.2%) patients, AVF in 2 (11.1%) patients, and occlusion of an arterial segment in 2 (11.1%) patients. One patient (5%) had metallic artifact that alters image interpretation The accuracy of CTA in detecting vascular lesion in the examined patients was 94.7% with sensitivity and specificity of 94.4% and 100%, respectively. ConclusionMCT angiography is an initial accurate diagnostic method in evaluating patients with suspected neglected extremity trauma.

MODERN TECHNOLOGY IN THE SURGICAL TREATMENT OF HEAD INJURY SEQUELAE

The paper presents main types of surgically relevant posttraumatic lesions in 4136 patients with skull vault as well as skull base defects, craniofacial deformities, recurrent CSF leaks, arterio-venous fistulas, aneurysms and pseudoaneurysms etc. Classification of TBI sequelae and complications as well as its clinical course grading is presented. The use of modern neuroimaging techniques for studying pathophysiologic mechanisms and complications of TBI has been demonstrated. Special emphasis was given to minimally invasive and reconstructive surgery; computer modeling with subsequent full-copy stereolitographic laser implant setup was shown which is of great importance in cases of large and complex skull base and craniofacial deformities. Patient selection for transcranial and endonasal CSF leak closure techniques was justified. Treatment of post-traumatic vascular injuries using Serbinenko balloon-catheters as well as modern techniques such as stents, coils and embolization has been demonstrated.

Therapeutic intervention in renal arterial injuries

The efficacy of transcatheter vascular occlusion has been proven in many disease states. No doubt, its most productive application is its role in posttraumatic vascular injury. Posttraumatic hematuria refractory to conservative management demands intervention. Irrespective of the interventional technique, maximum conservation of renal parenchyma and preservation of normal renal function are mandatory in the management of renal trauma. This paper describes a 10-year experience with transcatheter embolization of posttraumatic refractory hematuria in 45 patients. The angiographic abnormalities requiring embolization are classified, indications for embolizations discussed, and consideration given to the choice of embolic material. As determined by immediate postembolization angiographic criteria and clinical outcome, the procedure was successful in 43 patients. In addition to two minor complications of unintentional nontarget vessel occlusion, there were two failures. It is concluded that transcatheter vascular occlusion in posttraumatic, intractable, renal hematuria, refractory to conservative management, should be considered. It is a safe, simple, and satisfactory alternative to surgical intervention. Should transcatheter embolization fail, conventional nephrectomy, partial nephrectomy, or segmental dearterialization may be necessary.

Abstract No. 118: How Well Can CT Predict the Presence of Arterial Injury in Patients with Pelvic Trauma?

Abstract No. 118: How Well Can CT Predict the Presence of Arterial Injury in Patients with Pelvic Trauma?

Portal venous gas subsequent to blunt abdominal trauma

The clinical significance of portal venous gas within the liver following blunt abdominal trauma has been variable. Surgery is indicated when it is found with bowel necrosis due to post-traumatic vascular injury. It has also been found with non-emergent and transient causes of pneumatosis [1–8]. In this case report there was no evidence of bowel necrosis nor of bowel transection at surgery. Of additional interest is the uncommon central location of the portal venous gas within the liver.

Therapeutic intervention in renal arterial injuries

The efficacy of transcatheter vascular occlusion has been proven in many disease states. No doubt, its most productive application is its role in posttraumatic vascular injury. Posttraumatic hematuria refractory to conservative management demands intervention. Irrespective of the interventional technique, maximum conservation of renal parenchyma and preservation of normal renal function are mandatory in the management of renal trauma. This paper describes a 10-year experience with transcatheter embolization of posttraumatic refractory hematuria in 45 patients. The angiographic abnormalities requiring embolization are classified, indications for embolizations discussed, and consideration given to the choice of embolic material. As determined by immediate postembolization angiographic criteria and clinical outcome, the procedure was successful in 43 patients. In addition to two minor complications of unintentional nontarget vessel occlusion, there were two failures. It is concluded that transcatheter vascular occlusion in posttraumatic, intractable, renal hematuria, refractory to conservative management, should be considered. It is a safe, simple, and satisfactory alternative to surgical intervention. Should transcatheter embolization fail, conventional nephrectomy, partial nephrectomy, or segmental dearterialization may be necessary.

Effect of U-50488h, a selective opioid κ receptor agonist, on vascular injury after spinal cord trauma

U-50488H, a selective opioid κ receptor agonist has been shown to be a neuroprotective agent in animal models of spinal cord injury. The mechanism of action of U-50488H is not known. Methylprednisolone, the only neuroprotective drug proven in patients with acute spinal cord injury may prevent the secondary injury after an initial trauma. Secondary vascular injury develops after experimental spinal cord trauma. In this study we examined the effects of U-50488H on post-traumatic vascular injury based on the measurement of vascular permeability, edema and neutrophil infiltration in a rat spinal cord injury model. Vascular permeability was assessed by vascular extravasation of fluorescein isothiocyanate conjugated dextran (FITC-D), a macromolecular tracer. Tissue edema was determined by percentage water content and neutrophil infiltration by myeloperoxidase (MPO) activity, a marker enzyme for neutrophils. U-50488H at doses of 5, 10, 20 and 40 mg/kg i.p. administered twice (0.5 h before and 0.5 h after trauma) reduced vascular permeability in a dose-dependent manner. More frequent dosing (10 mg/kg, 0.5 h before and 0.5, 2, 8 and 22 h after injury) reduced vascular permeability 24 h after injury. U-50488H also reduced edema formation but did not affect neutrophil infiltration. Results from this study raise the possibility that the neuroprotective effect of U-50488H involves a secondary vascular event.

Kininogen and Kinin in Experimental Spinal Cord Injury

Activation of the kallikrein-kinin system has been implicated in the pathogenesis of vasogenic brain edema and posttraumatic vascular injury. We determined the levels of kininogen and kinin in an experimental spinal cord injury model in the rat. Kininogen content in traumatized cord segments increased in a time-dependent manner. Western blot analysis showed that the kininogen in traumatized cord comigrates with 68K low-molecular-weight kininogen or T-kininogen. Trypsin treatment of the kininogen in traumatized cord released both bradykinin and T-kinin, which were separated by HPLC and quantified with a kinin radioimmunoassay. Endogenous kinin levels in the frozen spinal cord also increased up to 40-fold 2 h after injury as compared with controls. The results demonstrate an increased accumulation of kininogen and its conversion to vasoactive kinins in experimental spinal cord injury.

The multimolecular cascade of spinal cord injury. Studies on prostanoids, calcium, and proteinases.

Experimental spinal cord injury in animals induced by weight drop produces neurological deficit and paralysis. Correlation of the progressive morphological changes in the lesion by both light and electron microscopy with the biochemical alterations revealed ischemia, edema, hemorrhage, tissue necrosis, granular changes in axons, vesicular degeneration of myelin and axonal calcification. The biochemical pathology was that of degradation of axonal (neurofilaments) and myelin proteins (MBP and PLP) with increased activities of proteolytic enzymes and particularly the neutral proteinase. The level of total calcium increased progressively in the lesion to a peak at 8 hrs. and subsequently remained constant thereafter. The capacity of calcium for activating proteinases and lipases and fostering the degradation of axon and myelin proteins as well as the liberation of arachidonic acid required for the synthesis of prostanoids must be relevant. An increased production of prostanoids is indicated by elevation of thromboxane (TxB2), a stable metabolite of TXA2 at 1 hour after injury. The 6-keto-PG1(1)a was also increased but to a lesser extent. We suspect that the activation of arachidonic acid metabolism contributes to post-traumatic vascular injury and the progressive ischemia. These putative roles for calcium in proteolysis and lipolysis, inducing degradation of macromolecules and production of prostanoids which initiate edema, lysolecithin a myelinolytic factor and mitochondrial dysfunction in spinal cord injury are discussed.