Risk Factor For Vascular Injury Research Articles

Open injuries and obesity as emerging risk factors for vascular injury in knee dislocations: A retrospective study

PurposeKnee dislocations (KDs) are rare in orthopaedic trauma but can have devastating effects. Failing to diagnose a concomitant vascular injury can lead to amputation. Different methods are used for the diagnosis of a vascular injury and the best approach is under debate.This study aims to examine the risk factor(s) of vascular injury in patients with KDs, examine variables that differ between obese patients and non-obese patients with KDs, and analyse the modalities used to identify vascular injuries in the KD population. MethodsThe electronic patient medical record system at a major trauma centre was retrospectively reviewed to identify knee dislocations from 2015 to 2022. These were stratified based on age, gender, BMI, mechanism of injury, vascular injury, non-vascular complications, and laterality. Co-variates were inputted into a univariable regression analysis, followed by a multivariable regression analysis to identify risk factors of vascular injury in patients with knee dislocations. Co-variates were also compared between obese and non-obese patients using two-tailed t-tests for continuous variables and chi-squared test for categorical variables. ResultsForty patients were identified with a KD, with twenty-eight males and twelve females. The average age was 42.9 years, seventeen patients had a BMI of thirty or over, and eleven patients (27.5%) had a vascular injury. Open injuries (OR: 2.21; 95% CI: 1.19–11.30; p = 0.038) and obesity (OR: 2.66; 95% CI: 1.45–18.69; p = 0.027) are risk factors for vascular injury in patients with knee dislocation. Compared to non-obese patients, obese patients had a higher rate of open injury (p = 0.028), vascular injury (p = 0.017), low-energy injuries (p = 0.014), non-vascular complications (p = 0.017), and amputation (p = 0.036). ConclusionOpen injuries and obesity are risk factors for vascular injury in patients with KD. Compared to non-obese patients, obese patients have low-energy injuries and an increased rate of non-vascular complications, meaning that clinicians could err on the side of caution when investigating vascular injury.Level of evidence: IV.

Experience in mixed vascular dementia in the genetic bank of the School of Medicine, University of Buenos Aires, Argentina

AbstractBackgroundAlzheimer’s disease (AD) is the most common form of dementia. The sporadic forms represent 95% whereas 5% assumes to the familiar forms. Among the genetic factors of Alzheimer’s disease is genotype for APOE variant e4 which is associated to a major risk of suffering the illness. There is a mixed vascular component, that is to say vascular dementia and Alzheimer’s disease which might be related to the same gene APOE‐e4 in homozygous or heterozygous. To analyze the influence of APOE genotype and the mixed vascular component in the development of AD and the allelic and genotypic distribution of APOE in our population is our aim.MethodIn the genetic bank of dementias of the School of Medicine (of the) University of Buenos Aires we have selectively studied those patients with vascular commitment and Alzheimer’s disease. It was noted the association of risk between this gene and Alzheimer’s disease in our population, as well as is possible it’s association with the mixed component of the patients with dementia. Population under study: 1) AD Patients : The clinical diagnosis was made according to the NICDS‐ADRDA criteria. (n = 49, 20 men and 29 women). 2) >60 years Controls : subjects with no history of neurological diseases (n = 31.8 men and 23 women). 3) Population Controls : (n = 70, 24 men and 46 women).ResultA significant association between APOE‐ ε4 allele, mixed vascular component and AD was found. Even higher than the ApoE‐4 component of AD. About the influence of the genotype in the AD of delayed beginning aour results was: controles vs. AD, OR: 3,70 (1,43 ‐ 1,57), p<0,01 / controles>60 years vs. AD, OR: 4,32 (1,47 ‐ 12,43), p<0,02. And we found the relation between Apo ‐ e Genotype in Mixed Dementia and AD was AD vs controles, OR = 4,1, RR = 1,6, p<0,0001 / DM vs controles, OR = 10,3, RR = 4,1, p<0,0005ConclusionOur results suggests that it may correspond to an increased risk of outbreak of the physiopathology of AD in patients with vascular injury and / or cerebral hypoxia. The APOE‐4 would be a risk factor for vascular injury remaining unprotected brain, resulting in mixed demetia.

Radiation and Diabetic Retinopathy: A Dark Synergy

Exacerbation of the vascular pathology in radiation retinopathy as a result of pre-existing diabetes has been recognized for many years, as reflected by clinical reports and a few early experimental studies. However, the underlying pathogenetic mechanisms for the synergistic interaction of radiation retinopathy (RR) and diabetic retinopathy (DR) have not been compared and evaluated for insight on this phenomenon. The present work draws attention to the roles of reactive oxygen species (ROS) and reactive nitrogen species (RNS) as common mediators of both conditions and sources of ongoing cellular injury in the radiation-induced bystander effect (RIBE) and the senescence-associated secretory phenotype (SASP). Chronic hyperglycemia-mediated oxidative stress and depleted antioxidant defense in diabetes, together with impaired DNA damage sensing and repair mechanisms, were identified as the primary elements contributing to the increased severity of RR in diabetic patients. We conclude that apart from strategic genetic mutations affecting the DNA damage response (DDR), diabetes represents the most significant common risk factor for vascular injury as a side effect of radiotherapy.

Incidence and Management of Vascular Injuries after Invasive Cardiac Catheterization in Children

Background: Vascular injuries after cardiac catheterization are well documented in adult population. The incidence of vascular injuries after pediatric cardiac catheterization is not as well defined. With the advent of therapeutic cardiac catheterization in pediatric patients, the incidence of vascular complications is likely to increase. Purpose: The aim of the study was to determine the incidence and management of vascular injuries associated with pediatric cardiac catheterization as an initial experience of in a newly established pediatric center. Methods: This retrospective and observational study was conducted on 268 children with congenital heart disease who have undergone cardiac catheterization either as diagnostic procedure or a therapeutic intervention between March 2018 and August 2019. Patient records were reviewed to obtain demographic, procedural, and treatment data. Patients were analyzed for the incidence and the type of vascular injury seen and treatment given for the same. The type of vascular injury was divided in to major and minor based on severity of the injury. Results: Diagnostic cardiac catheterization was performed in 77 patients and interventions in 191 patients. A total of 62 (23.1%) patients developed some vascular injury out of which 60 (22.3%) cases had minor complication and 2 (0.7%) had major a complication. The most common type of vascular complication seen in our study was transient loss of femoral pulse. Conclusions: Vascular injury is common in children undergoing cardiac catheterization, majority of which are minor complications and can be managed conservatively. They are seen more commonly during therapeutic cardiac catheterization. Further studies with larger sample size are needed to identify the risk factors for vascular injury.

Major Vascular Injury During Gynecologic Surgery

Vascular injury is a rare but potentially fatal complication of gynecologic surgery. Reported risk factors for vascular injury during abdominal surgery include obesity, adhesions, vascular aberrations, and surgery at low-volume surgical centers. Oncologic procedures pose inherent additional risk of injury related to operating in proximity to major vascular structures or tumor involving the pelvic sidewall. Here we review major vascular injuries that may occur during hysterectomy and other types of gynecologic surgeries, with a focus on risk factors, prevention, recognition, and intraoperative management. All pelvic vasculature is at risk. Efforts to prevent injury include gentle and directional opening of avascular planes, cautious dissection of tumor and adherent lymph nodes from vascular structures, prophylactic ligation when indicated, and careful placement of initial and subsequent laparoscopic trocars. Recognition and control of injury must be immediate. Venous injuries manifest as nonpulsatile but potentially torrential hemorrhage, whereas an arterial injury typically presents with pulsatile bleeding from an obvious source. Repair of a major vascular injury is accomplished with pressure with or without hemostatic agents, suturing, clipping, or cautery depending on the clinical situation. (J GYNECOL SURG 37:200)

Vascular injury during laparoscopic gynaecological surgery: a methodological approach for prevention and management

Key content Major vascular injuries occur in up to one in 200 laparoscopies, most commonly during Veress needle insertion or primary trocar entry; laparoscopic surgeons should rehearse actions to be taken in case of injury. Vascular injury during laparoscopy is associated with significant morbidity and up to 23% mortality. Risk factors include previous surgery, intra‐abdominal pathology, low/high body mass index and complex surgeries. Techniques to manage vascular injury include aggressive fluid resuscitation, hyperbaric pressure, blood transfusion, manual pressure, considering conversion to an open midline laparotomy and the involvement of a vascular or general surgeon. Standardised assessment and management protocols should be rehearsed and available in all units. Learning objectives To be aware of the incidence of laparoscopic vascular injury and the potential complications that can occur. To recognise key risk factors for vascular injury and ways to prevent injury occurring. To rehearse drills on systematic emergency management of laparoscopic bleeding to standardise care; this is ideally suited to the realms of multidisciplinary simulation scenario‐based training, to improve a team’s response to a vascular injury. Ethical issues Are women who are at increased risk of vascular injuries appropriately counselled regarding complications and consequences, and are they given the options for alternative management?

Posterior Sternoclavicular Dislocation: Do We Need "Cardiothoracic Backup"? Insights From a National Sample.

To describe the incidence of and risk factors for vascular injury associated with P-SCD. We used data from the HCUP-NIS from 2015 to 2016 and defined a cohort of patients with sternoclavicular dislocation (SCD) using ICD-10-CM diagnosis codes. We further isolated a subset with P-SCD. We describe the incidence of thoracic vascular injury, demographics, and injury severity score in this cohort. Of an estimated 550 patients who had SCD, 140 (25%) were identified as having a P-SCD. No vascular injuries occurred in the P-SCD cohort. Among all patients with SCD, <2% of patients had a vascular injury, all of whom had an injury severity score ≥15, independent of the vascular injury itself. Among patients with an isolated P-SCD injury (55), overall length of stay was 1.8 days and total charges averaged $29,724.45. There was no mortality among patients with isolated P-SCD. Here, we report no vascular injuries in the largest known series of P-SCD. Among all patients with SCD, vascular injury was rare, occurring only in severely polytraumatized patients. The recommendation for routine involvement of cardiothoracic surgeons in all cases of P-SCD should be re-examined. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Strategies for the prevention and control of bleeding due to vascular injury in thoracoscopic lung surgery

The technique of thoracoscopic lung surgery has gradually matured. Nowadays, thoracoscope is recommended as the most preferred approach for surgical treatment of early stage non-small cell lung cancer in different guidelines. However, there are still some cases of accidential major bleeding due to vascular injury during thoracoscopic lung surgery. The wall of the hilum vessels is relatively thin. These vessels often involve a great portion of the cardiac output blood flow. Once the injury happened, the emergent condition may be life-threatening due to massive blood loss. Therefore, this became an important factor which hindered the development of thoracoscopic lung surgery. In this review, details of the vascular injury in thoracoscopic lung surgery were summarized, including the incidence of vascular injury, commonly injured sites and reasons of the injuries. Among all the cases of thoracoscopic major pulmonary resection, 2.9% to 9.2% may suffer from vascular injury during the operation. The most commonly injuried sites are pulmonary artery and the branches, and this is also the most critical situation during thoracoscopic lung surgery. Hilum adhesion is the most important risk factor for vascular injury. On the one hand, the suction-compressing angiorrhaphy technique was developed for bleeding control and angioplasty. On the other hand, the strategies like pre-control of the pulmonary, cut the bronchus in advance, and fire the bronchus and pulmonary artery together may decrease the incidence of vascular injury in patients with risk factors.

Relationship Between Femur and Femoral Arteries for Identifying Risk Factors for Vascular Injury.

BackgroundThis study aimed to identify risk factors for vascular injury in proximal femoral fracture through identifying frequency and distances between femur and femoral arteries with computed tomography angiography and 3-dimensional reconstruction.Material/MethodsIn a series of 400 participants, based on measurement results regarding the distribution of femoral arteries in the medial femur, the femoral portion covering that part was divided into levels A–E. The center region, margin region, and risky area in the medial femur were defined. The frequency of femoral arteries and interested shortest distance between the outer femur and superficial, deep, and perforating femoral arteries (SFAs, DFAs, and PFAs) in the center region, margin region, and risky area at each level were recorded.ResultsThere were 173 males and 227 females (average age: 63.61±19.18 years) in this study. The starting point and end point for femoral arteries in the medial femur were from 22.55±4.23% to 54.56±8.39% of the whole femur. The femoral arteries in the medial femur mainly were distributed at levels B (88.2%), C (65.9%), and D (40.6%). The femoral arteries in center regions in the risky area, most of which were DFAs and PFAs, were mainly concentrated at levels B (26.93%) and C (11.81%).ConclusionsThe mid-shaft level was the most risky level, and the DFAs and PFAs were easier to injure than the SFAs when performing internal fixation of proximal femoral fracture. We recommended that great attention be paid to drill and screw insertion around the mid-shaft level for prevention of iatrogenic vascular injury.

Carotid body tumor: a 25-year experience.

Carotid body tumor is an uncommon hypervascular benign tumor in the head and neck region. It usually presents as a slow growing mass at the carotid bifurcation. Because of the high rate of neurovascular complications, resection of this tumor is considered challenging for otolaryngologists. Between 1988 and 2013, 40 carotid body tumors from 38 patients were diagnosed and underwent resection at Siriraj Hospital (25 female and 13 male patients). Their age ranged from 15 to 59years. Seven patients had bilateral tumors simultaneously whereas six cases had familial history of carotid body tumor. Carotid angiography was performed in 29 cases; other additional diagnostic studies included CT scan, MRI, and MRA to detect the widening of carotid bifurcation, its extension, and multifocal tumors. All diagnosed tumors were successfully removed. However, internal carotid artery and carotid bifurcation were injured in 11 cases (27.5%). Shamblin class III and previous biopsy history were considered risk factors for vascular injury. Postoperative cranial nerves deficit was found in 20% of the cases and CNS complication occurred in two patients (5%). There was no surgical mortality. Additionally, upon the mean follow-up period of 36months, no recurrence or malignant transformation was detected in this study. Multidisciplinary approach, early tumor detection, meticulous preoperative evaluation, and modern vascular surgical technique are the key success factors for tumor removal.

Serum Uric Acid: An Independent Risk Factor for Vascular Injury

Hyperuricemia (serum uric acid levels >8mg/dl) has been associated with hypertension for a long time.1 At some point it was felt that elevated uric acid levels were the result of decreased kidney function, but recent clinical and experimental data have shown a direct correlation between high uric acid levels and progression of vascular injury, leading to increased cardiovascular morbidity and mortality, hypertension, and accelerated loss of kidney function. 2 The mechanism of action appears to be mediated by the profound effects of uric acid in human vascular cells, which include endothelial dysfunction, vascular proliferation, and nitric oxide release from vascular cells.3•5 Moreover, as a consequence of afferent arteriolar injury by hyperuricemia, chronic tubulointerstitial changes leading to progressive loss of kidney function and worsening hypertension can occur.6 Strategies to treat asymptomatic hyperuricemia should be considered in high-risk individuals to prevent progression of cardiovascular disease and chronic kidney disease.

Management of Vascular Calcification in CKD Patients

Vascular calcification is common in patients with chronic kidney disease (CKD) and it may affect almost every artery. It is associated with a significant increase in morbidity and mortality. Therefore, the detection, prevention and treatment of vascular calcification in CKD patients are critical for the overall approach for the management of these patients. Hyperphosphatemia, especially when the blood levels of serum phosphorus are above 5.5 mg/dl, plays a major role in the development of vascular calcification. Hyperphosphatemia induces vascular calcification by both passive and active processes. By increasing calcium-phosphate product, hyperphosphatemia results in direct deposition of calcium salts in the arteries and in cardiac valves. The active process involves the uptake of phosphate by the smooth muscle cells of the arteries by a Na-P co-transporter. This increase in cell phosphate then induces phenotypic changes of these cells, rendering them into osteoblasts which in turn, begin laying calcium salts in the arterial walls. Therefore, it is critical that the blood levels of serum phosphorus be maintained below 5.5 mg/dl in CKD patients. Inflammation and the production of C-reactive protein (CRP) and interleukin 6 are also risk factors for vascular injury and vascular calcification. In a study of 254 dialysis patients with elevated blood levels of CRP (>1.0 mg/l) and 258 patients with CRP levels equal to or less than 1.0 mg/l, it was found that higher levels of CRP are significantly associated with the presence of both atheromatous and medial calcification of the aorta and hand arteries. Also, it was reported that a significant association between CRP levels and cardiac valves calcification in patients undergoing continuous ambulatory peritoneal dialysis. The reasons for the elevation in CRP in dialysis patients are not clear, but certainly, is more evident in those with obvious inflammatory processes. Therefore, any inflammation that is detected should be treated appropriately.

Mechanistic role of cytochrome P450 monooxygenases in oxidized low-density lipoprotein-induced vascular injury: therapy through LOX-1 receptor antagonism?

Oxidized low-density lipoprotein (oxLDL) is an important risk factor for vascular injury. Its role on coronary vasoconstriction remains speculative. Endothelial monooxygenases (cytochrome P450s [CYPs]) are regulators of vascular tonus through production of epoxy fatty acids. We investigated the effects of oxLDL on CYP monooxygenases in human arterial coronary endothelial cells and explanted healthy and atherosclerotic aortae. We found oxLDL to induce radical oxygen species production via the action of NADPH oxidase NOX4. Intracellular radical oxygen species production prompted reduced protein expression of the transcriptional regulator nuclear factor 1 (NF-1). We identified novel DNA binding sites for NF-1 in promoter regions of CYPs. DNA binding of NF-1 was confirmed by electromobility shift assays. OxLDL repressed DNA binding of NF-1 and diminished transcript level of CYP genes targeted by this factor. The production of endothelial-derived hyperpolarization factor, a key regulator of vascular tonus, was also reduced. Repression of CYP monooxygenases was reversed, and production of endothelial-derived hyperpolarization factor was normalized after treatment of endothelium with the lectin-like oxLDL receptor antagonist kappa-carrageenan or blocking of LOX-1 with a specific antibody. This suggests a mechanistic role of CYP monooxygenases in oxLDL-induced vascular injury. Therapy of endothelial dysfunction through LOX-1 receptor antagonism will be an interesting avenue to explore. The full text of this article is available online at http://www.circresaha.org.