Vascular System Injuries Research Articles

Assault rifle injuries in civilians: ballistics of wound patterns, assessment and initial management.

Wounds from assault rifles and their commercial offspring have been encountered with increasing frequency in civilian practice. Our aim is to summarize wound ballistics related to the main injury patterns that can also affect management strategies. An online search of the PubMed was conducted for research and review articles published after 2000 in English, using the MeSH terms "gunshot wounds", "mass casualty incidents", "war-related injuries", "soft tissue injuries", "vascular system injuries", "colon injuries", "wound infection", "antibiotic prophylaxis", "debridement", "hemorrhage", "penetrating head injuries", "pneumothorax" and additional free-text terms. Other academic databases were also searched for relevant articles and book chapters. Consensus regarding recognition of high energy wounds from assault rifle projectiles is largely based on war experience. Studies of such wounds inflicted by expanding projectiles suggest that their wounding effects significantly increase tissue damage and adverse outcomes following injury, as a result of the temporary cavity and bullet fragmentation. The use of assault rifles in mass shootings has prompted utilization of tourniquet for control of life-threatening hemorrhage, also derived from military experience, while limited evidence indicates that tension pneumothorax rather than extremity wounds is the leading cause of potentially preventable death in these incidents. Wound ballistics provides a system for evaluation of injuries from assault rifles and risk analysis of shooting incidents. Lessons learned from armed conflicts can improve the management of victims, with due consideration given to characteristics of civilian injuries. Further research is required to define the impact on survival by key life-saving procedures in the prehospital setting, in order to prioritize these interventions.

An Epidemiologic Overview of Traumatic Vascular Injures in Emergency Department; a Retrospective Cross-Sectional Study.

Introduction:Vascular system injuries (VSIs) are one of the main causes of preventable mortality and morbidity of trauma patients. This study aimed to evaluate baseline characteristics, presenting signs, managements, and outcomes of patients presenting to emergency department (ED) with traumatic VSIs. Methods:This retrospective cross-sectional study was conducted on patients with traumatic VSIs admitted to the ED of a referral tertiary trauma center, during one year. Using a pre-prepared checklist, demographics, pre-hospital care, type of VSIs, injury severity score (ISS), anatomical location of trauma, associated injuries, method of surgery, complications, and outcome were collected from patients’ profiles and reported. Results:One hundred and twelve patients with the mean age of 33.5 ± 14.7 (range = 8 - 80) years were studied (90.2% male). Most of the patients were categorized as mild or moderate in terms of their ISS. 90 (80.4%) patients had at least one soft sign and 99 (88.4%) patients had at least one hard sign. Isolated arterial injury was diagnosed in 90 (80.4%) patients, isolated venous injuries in 12 (10.7%) cases, and combined arteriovenous injuries in 10 (8.7%) patients. The most common associated injury was tendon rupture (63.4%) and nerve injuries were present in 60.7% of patients. 1 (0.9%) patient died, 6 (5.4%) patients went through amputation, and 3 (2.7%) patients were discharged against medical advice. The rest of the patients were discharged in perfect health. There was a significant correlation between trauma type (p = 0.001), upper and lower extremity trauma (p < 0.001), presence of distal ischemia and lack of pulse (p = 0.041), penetrating injury close to a major vessel (p = 0.006), type of injured vessels and arteries (p<0.001), injury to nerve (p = 0.011) and tendon (p = 0.007), presence of open fracture (p = 0.005), multiple trauma (p < 0.001), method of surgery (p < 0.001), and number of postoperative complications (p< 0.001) with poor outcome.Conclusion:The findings showed that the majority of the studied patients were young males, most of whom were discharged in perfect situation. Those who presented with higher ISS, or were affected by blunt trauma or injury to lower limb arteries had worse outcome than the others.

Chronic real-time particulate matter exposure causes rat pulmonary arteriole hyperresponsiveness and remodeling: The role of ETBR-ERK1/2 signaling

Exposure to air pollution is associated with the incidence of respiratory diseases. The present study evaluated the pulmonary vascular system injury by chronic real-time particulate matter (PM10) exposure and investigated the underlying mechanisms. Rats were exposed to PM10 or filtered air for 2 to 4 months using a whole body exposure system, and intraperitoneally injected with the MEK1/2 inhibitor U0126. Right heart catheterization and myography were performed to detect lung function and pulmonary vascular reactivity, respectively. Western blotting, qRT-PCR, enzyme-linked immunosorbent assay and histological analyses were used to detect the effects and mechanisms by which PM10 exposure-induced pulmonary vascular dysfunction. Functional experiment results showed that PM10 exposure increased the pulmonary artery pressure of rats and caused endothelin B receptor (ETBR)-mediated pulmonary arteriole hyperreactivity. U0126 significantly rescued these pathological changes. PM10 exposure upregulated the contractile ETBR of pulmonary arteriolar smooth muscle, and damaged pulmonary artery endothelial cells to induce the release of more endothelin 1 (ET-1). The upregulated ETBR bound to increased ET-1 induced pulmonary arteriolar hyperresponsiveness and remodeling. U0126 inhibited the PM10 exposure-induced upregulation of ETBR in pulmonary arteriole, ETBR-mediated pulmonary arterial hyperresponsiveness and vascular remodeling. In conclusion, chronic real-time particulate matter exposure can activate the ERK1/2 signaling, thereby inducing the upregulation of contractile ETBR in pulmonary arteriole, which may be involved in pulmonary arteriole hyperresponsiveness and remodeling in rats. These findings provide new mechanistic evidence of PM10 exposure-induced respiratory diseases, and a new possible target for treatment.

Management of war-related vascular injuries: A civilian surgeon experience in the treatment of war casualties at a secondary care hospital

Background: This study presents the management of patients with war-related injuries and early results of vascular injuries treated at a secondary care hospital neighboring to civil war. Methods: Between December 2013-December 2014 ninety-six war-related injury patients evaluated by a single vascular surgeon and participating disciplines according to components of injury in polytrauma patients. Thirty-six patients who underwent vascular surgery were retrospectively registered to the study. Demographics, treatment and early results of patients reviewed. Results: Mean age was 26.69±11.80 (7-66) years and 91.66% (33/36) were males. Injuries were caused by shrapnel wound due to bombing 61.11% (22/36), stab wound 8.33% (3/36), gunshot wound 30.55 % (11/36). The number of patients with polytrauma was 29, seven patients had isolated vascular injury. Among 42 arterial and 31 venous injuries primary suture repair, autologous vein graft interposition and prosthetic graft interposition performed to 20.54% (15), 28.76% (21), 19.17% (14) respectively. Amputation and all-cause mortality were %8.3 (3/36), 13.8% (5/36) respectively. Conclusions: Vascular injury with concomitant trauma is the main issue of war-related injuries. Surgeons should be cautious about patients who were initially deemed not to need surgery for vascular injury and then were found to need it. Repetitive physical examination is very important in case of any suspicion, especially in limited conditions for diagnostic tools like CT angiography. A rapid, careful multidisciplinary evaluation of experienced surgeons for the diagnosis and the treatment priorities in war-related injury patients may lead to increase life and limb salvage rates with a better quality of life. Keywords: vascular system injuries, war-related injuries, mortality, amputation, multiple trauma.

The impact of arterial injury level on blood supply of distal limb in lower limb trauma

Objective To explore the impact of arterial injury on distal limb blood supply in lower limb trauma. Methods Retrospective analysis of 93 patients with different levels of lower limb arterial injury admitted to our hospital from June 2014 to August 2017. There were 84 males and 9 females aged 43.54±9.90 years (ranging 25-65 years). Revascularization was performed through open reduction. Patients were divided into three groups according to their arterial injury locations. Proximal vessels were along the superficial femoral artery, from its beginning to the point where it was divided into the descending genicular artery and direct periosteal branches. Intermediate vessels were from the dividing point on the superficial femoral artery to the popliteal artery before it was divided into the medial inferior genicular artery. Distal vessels were from the dividing point on the popliteal artery to the distal end of the peroneal artery. The duration from injury to revascularization in the three groups were 13.67±5.99 h, 11.15±4.43 h, and 11.92±5.48 h, respectively. There was no significant difference between groups (F=1.564, P=0.215). ISS in the three groups were 13.00±3.74, 12.77±3.81, and 11.50±3.99, respectively. There was no significant difference between groups (F=1.445, P=0.241). The following items were compared among the three groups, postoperative creatine kinase, arterial blood lactate and limb compartment cut. Results Creatine kinase of the intermediate vascular group was 8 743.15±6 968.48 u/L, proximal vascular group 1 467.67±1 810.27 u/L, distal vascular group 2 893.51±1 304.56 u/L. The data of intermediate vascular group were higher than those of proximal and distal vascular groups with significant difference among the groups (F=22.587, P=0.000). The lactate of the intermediate vascular group was 3.20±1.51 mmol/L, proximal vascular group 1.63±0.46 mmol/L, distal vascular group 1.85±0.69 mmol/L with significant difference among the groups (F=20.612, P=0.000). The compartment cut of the intermediate vascular group was incised in 24, but not in 15. The proximal vascular group was not incised in 18, while 15 was incised and 21 not incised in distal vascular group. The rates of compartment cut were 61.5%, 0 and 41.7%, respectively with significant differences (χ2=19.156, P=0.000). Conclusion In lower limb injuries, the intermediate vascular (from the superficial femoral artery after it is divided into the descending genicular artery and direct periosteal branches to the popliteal artery before it is divided into the medial inferior genicular artery) injury leads to the most severe distal limb ischemia. Key words: Vascular system injuries; Wounds and injuries; Vascular grafting

Cerebral infarction caused by accidental incarceration of aneurysm-adjacent branches with temporary clips

Objective To explore the potential reasons of cerebral infarction caused by accidental incarceration of aneurysm-adjacent branches with temporary clips, and to give guidance to the appropriate application of temporary clips. Methods A retrospective analysis was conducted on the clinical data of 10 patients with accidental incarceration of branches of parent artery or aneurysm-adjacent perforator vessels who were admitted to Department of Neurosurgery of Fuzhou General Hospital from January 2004 to December 2016. Under microscopes, we observed the definite lesions of branches and perforator vessels during the procedures, features of temporary clips and the intraoperative procedure, and postoperative cerebral infarction with varying degrees in corresponding territories. Two cases of posterior communicating artery aneurysm and 2 cases of carotid bifurcation aneurysm were found on the extracranial superior mesenteric artery adventitia with varying degrees of atherosclerosis, misclipping occurred at the anterior pre-choroidal artery, recurrent artery of Heubner and lenticulostraiate artery. For 4 cases of anterior communicating artery aneurysms and 2 cases of middle cerebral artery aneurysm, mis-clipping was found at A1 or A2 and M1 segments adjacent to perforation. Results Among the 10 patients, CT review 2-4 days post surgery demonstrated cerebral infarction with varying degrees adjacent to the aneurysm branches, perforating branch of blood supply. Disturbance of consciousness occurred in 2 cases. Compared with preoperative state, short-term significant decrease in strength of limb muscles was observed in 5 cases, incomplete motor aphasia in 1 and asymptomatic cerebral infarction in 2. At follow-up ranging from 4 months to 3 years, 2 cases reported dementia and 2 cases had permanent hemiplegia, out of which 3 were disabling and needed long-term care. Conclusions Cerebral infarction caused by accidental incarceration of branches or perforator vessels with temporary clips could be related not only to the incarceration duration, age and vascular sclerosis, but also to the over-contraction of small blood vessels and the closing force of a temporary clip. Therefore, caution should be warranted regarding those factors in the use of temporary clips. Key words: Intracranial aneurysm; Vascular system injuries; Therapeutic occlusion; Brain infarction

Hemangioma y Linfangioma Mixto Congénito Gigante

Los linfangiomas son malformaciones hamartomatosas congénitas y en algunas ocasiones adquiridas que afectan la piel y el tejido subcutáneo, surgen cuando de forma localizada o generalizada se produce un cúmulo de conductos o quistes linfáticos. Los linfangiomas representan el 6% de los tumores benignos pueden aparecer en cualquier parte del cuerpo, el 75% se localizan en el cuello, la cabeza o las axilas. El 40-65% están presentes al nacimiento. El tratamiento ideal del linfangioma depende del grado de infiltración, el tipo de tumor y la experiencia con el tratamiento. Se presenta caso clínico de recién nacido femenina, hija de madre de 21 años de edad, primigesta con embarazo de 34 1/7 semanas de gestación por FUM y sin antecedentes de relevancia, procedente de la aldea Monte la Virgen, Las Flores, Lempira. Nace en el Hospital Juan Manuel Gálvez, vía cesárea por fase latente prolongada. En la exploración física con múltiples masas de consistencia blanda con transiluminación positiva en cuello y tórax; extremidades asimétricas a expensas de neoformaciones de color rojo-violáceas en las superficies en asociación con hemangiomas. Se observa en piel lesiones eritematosas violáceas y tumorales tubero-cavernosas difusas múltiples, especialmente en extremidades superiores, tronco anterior derecho, extremidades inferiores y región vulvar. Se manejó en sala con Piperacilina/ Tazobactam, Amikacina, Fluconazol, Inmunoglobulina, Propanolol, Prednisona y vincristina. La paciente falleció a los 8 días de vida. Palabras clave Linfangioma, lesiones del sistema vascular, recién nacido

Efficacy of endovascular interventional minimally invasive techniques in treatment of acute brachial artery injury

Objective To evaluate the efficacy of endovascular interventional minimally invasive techniques in treatment of acute brachial artery injury. Methods A retrospective case series study was designed to analyzed data of 16 cases (11 males and 5 females) sustaining acute brachial artery injury treated from March 2011 to August 2016. Mean age was 47.9 years (range, 27-66 years). Left upper extremity vascular injury occurred in 7 cases and right upper extremity vascular injury occurred in 9. There were 13 cases of arterial intima injury and 3 of arterial pseudoaneurysm. All patients underwent endovascular therapy including stent implantation and balloon dilatation. Angiography was used to evaluate the repair of brachial artery and the operation time was recorded. Improvements of distal limb arterial pulse and limb ischemic symptoms were observed, and the patients who were followed up with stent lumen stenosis more than 50% received endovascular treatment again. Results The procedures was successful in all patients, with operation time of 30-75 minutes (mean, 45 minutes). After the insertion of a stent, recovered brachial artery blood flow and disappeared pseudoaneurysm were observed on angiography, without occurrence of stent stenosis or contrast extravasation. Symptoms of local pain and numbness were alleviated, and blood supply of the distal brachial artery was improved after operation. All patients were followed up for 3-36 months(mean, 16.7 months). The false aneurysm did not recur. Two cases of stent stenosis more than 50% had a second balloon dilation procedure and the blood flow returned to normal. Stent patency was found in 14 cases with stent stenosis of less than 50%. During the follow-up period, no ischemic necrosis, displacement of the stent or stent fracture were found. Conclusion For acute brachial artery injury, endovascular management exhibits higher technical success rate and good clinical outcome with a low incidence of complications. Key words: Brachial artery; Stents; Vascular system injuries

Clinical characteristics of latent artery injury in orthopaedics and the efficiency of intra-arterial therapy

Objective To observe clinical characteristics of orthopaedic patients with latent artery injury and evaluate the efficiency of intra-arterial therapy. Methods Data of 13 orthopaedic patients with latent vascular injury who were enrolled in our hospital from June 2010 to October 2014 were retrospectively analyzed. There were 9 males and 12 females with an average age of 45.6 years(19-75 years). The affected arteries included superior gluteal artery (4 cases), obturator artery (2 cases), subclavian artery (2 cases), femoral profound artery (2 cases), femoral artery (1 case), popliteal artery (1 case) and brachial artery (1 case). According to the classification of systematic arterial injuries by Zhang Yingze, there were 6 cases of Type B and 7 cases of Type C. All patients were comfirmed by angiography with an average time of 16 hours (2-70 h) from primary injuries, and had undergone intra-arterial therapy with covered stent, spring coil and gelfoam. The functioning of arteries evaluated by ultrasound, CTA or DSA and the complication were recorded. Results Bleeding was successful controlled in 5 cases with covered stent, 5 cases with spring coil and 3 cases with spring coil and gelfoam. 7 cases with shock were improved immediately. 5 cases suffering lacunar infection were cured after repeated debridement. 1 case with popliteal artery rupture had amputation due to the long warm ischemia time. 1 case had gluteus muscular necrosis and secondary MODS, but recovered after treatment. All patients were followed up for 3-24 months with an average period of 7.3 months. No displacement of the stent, vascular occlusion and leakage were found. Conclusions Because latent artery injuries at an early stage are characterized by closure, delay and untypicality, they are often missed. Angiography is the gold standard for diagnosis. Intra-arterial therapy is an effective intervention for patients with latent non-major arterial injuries of Type B and C, and there are less recurrences and complications. Key words: Vascular system injuries; Endovascular procedures; Angiography

Tumor-associated cutaneous vascular disorders

Tumor-associated cutaneous vascular disorders include paraneoplastic vascular disorders and vascular disorders directly caused by skin neoplasms. This review summarizes the incidence, possible pathogenesis, classification and clinical features of tumor-associated cutaneous vascular disorders, which may help to understand the relationship between different cutaneous vascular disorders and tumors. In diagnostic and therapeutic process of cutaneous vascular diseases, timely screening of associated tumors is strongly recommended for chronic and persistent vascular lesions with poor response to routine therapy against vasculitis, and for patients, especially elderly patients, with systemic signs such as weight loss, fever and anemia. The prognosis of these diseases mostly depends on the type of associated tumors, and early etiological treatment is necessary. Key words: Neoplasms; Vascular system injuries; Vasculitis; Paraneoplastic

Targeting Cardiovascular Disease With Novel SIRT1 Pathways

Sirtuin (the mammalian homolog of silent information regulation 2 of yeast Saccharomyces cerevisiae) 1 (SIRT1), a NAD-dependent histone deacetylase, has emerged as a critical regulator in response to oxidative stress. Through antagonism of oxidative stress-induced cell injury and through the maintenance of metabolic homeostasis in the body, SIRT1 can block vascular system injury. SIRT1 targets multiple cellular proteins, such as peroxisome proliferator-activated receptor-γ and its coactivator-1α, forkhead transcriptional factors, AMP-activated protein kinase, NF-κB and protein tyrosine phosphatase to modulate intricate cellular pathways of multiple diseases. In the cardiovascular system, activation of SIRT1 can not only protect against oxidative stress at the cellular level, but can also offer increased survival at the systemic level to limit coronary heart disease and cerebrovascular disease. Future knowledge regarding SIRT1 and its novel pathways will open new directions for the treatment of cardiovascular disease as well as offer the potential to limit disability from several related disorders.

Endothelial function within adolescents with cardiovascular risk

Cardiovascular diseases represent the major medical and social problem. The main idea of this article was to estimate the earliest markers of vascular system injury. Endothelial function among teenagers with arterial hypertension and dyslipidemia were studied by ultrasound method, and von Willebrand factor was determined in blood. Endothelial function was changed in 46.9% of persons. Various characters of disturbances of endothelial functions were revealed. VLADIMIR STROGIY1, TATIANA WOITOVICH1, MARINA BORISIONOK2, NATALIA ZIMNICKAYA1, GALINA ZINEWICH1