Vascular Trauma Research Articles

Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds.

In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.

Surgical Management of Vascular Trauma; A Systematic Review

Vascular trauma is a significant public health concern, and there have been numerous incidents globally in recent years. Peripheral vascular injuries, including axillobrachial and upper extremity branches, as well as femoropopliteal and lower limb branches, account for 40% to 75% of all vascular injuries. Our systemic review aimed to examine surgical management strategies for vascular trauma. Data sources included PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were 7 articles. Surveys and analyses of national databases were the most widely used methods (n=7 studies). The search identified 777 studies, 7 were eligible for inclusion in the analysis. Further understanding of vascular trauma, and treatment protocols may help improve evaluation and management in the future. Our research covered a range of treatment options; the proportion of vascular injuries treated without surgery or utilizing endovascular techniques has increased. Individuals who receive medications intravenously, especially drug users, often present late in the course of their diseases and are notoriously difficult to treat. Despite the challenges in control, it is crucial to remain vigilant for vascular problems that might be fatal. Patient education and awareness may lead to the early detection and treatment of these diseases, which have high morbidity and mortality rates. Revascularization is necessary for limb salvage in patients with severe vascular damage. Simultaneous orthopedic injuries pose significant challenges and increase the risk of limb amputation. Multiple fractures and a MESS score of 6 indicate limited potential for limb salvage.

Brazilian guidelines on diagnosis and management of traumatic vascular injuries.

Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.

Factors Predicting the Outcome of Musculoskeletal Injuries Associated with Vascular Trauma at a Tertiary Care Trauma Centre in South India

Introduction: Vascular injuries are uncommon in civilian settings and present after blunt and or penetrating trauma. These injuries require timely intervention to prevent loss of limb or life. The impact of vascular injuries is well described in the Western population; however, there is a lack of evidence of factors predicting the outcomes of vascular injuries associated with musculoskeletal trauma in the Indian population. Methods: The retrospective data of consecutive trauma patients presenting to our emergency/outpatient department were collected over 5 years from January 2014 to December 2019 from our electronic medical records. After clinical assessment and/or radiological findings, patients were considered for either nonoperative management or vascular repair. Orthopedic intervention preceded vascular repair to attain skeletal stabilization and to protect vascular repair. Outcomes were measured in terms of baseline demographic variables, clinical determinants, pattern of injury, type of management, limb salvage, and primary or secondary amputations and mortality. Results: There were a total of 109 (92%) males and 3 (8%) females with an age range from 11 to 71 years (median = 35.5). The majority of the injuries were in the 30–50 years age group (n = 50, 50%). Limb salvageability was attained in 81 (72.3%) patients. Twenty patients (17.9%) underwent primary amputations and 11 (9.8%) patients required secondary amputations. Blunt trauma, lower limb involvement, multiple fractures, the Mangled Extremity Severity Score (MESS), and popliteal artery injury were significant predictors of limb salvageability. Stepwise multiple regression analysis identified multiple fractures (P = 0.011) and MESS (P = 0.000) as ultimate predictors of limb outcome. Conclusion: Revascularization is critical to the success of limb salvage in patients with traumatic vascular injury. Concomitant orthopedic injuries pose significant challenges and are associated with a high risk of limb loss. Multiple fractures and MESS score ≥6 prognosticates poor limb salvageability.

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter.

Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.

Temporary arterial shunting following a complete transection of femoral artery in a resource-limited setting

The aim of a surgeon managing vascular trauma in an extremity is to save the life, limb, and function of the patient. The use of temporary intravascular shunting has been shown to be a successful damage control strategy in patients who present with hemodynamic instability. We present the first reported case of a penetrating arterial injury of the lower limb causing a large defect that was successfully treated with temporary intravascular shunting before definitive repair in the country of Liberia. In a low-resource setting such as ours, the surgeon often opts to amputate limbs with vascular injuries that are not believed to be candidates for primary repair. Using a pediatric feeding tube with good postoperative results, we demonstrated that temporary arterial shunting in damage control situations before definitive repair was not only feasible but also cost-effective and ultimately resulted in the preservation of the patient’s limb.

General surgical unit experience of traumatic vascular injuries in an Australian regional hospital

Background: Vascular trauma is a significant burden to the regional community due to the associated high morbidity and mortality from the complications of the injuries. This may be due to the complexity of the injuries and the issues with initial management at the regional hospitals. Vascular injury management training should improve the outcome of initial surgical management by the general surgical team in regional centres. The study aims to describe the epidemiology and management of vascular injury in regional hospitals in Queensland, Australia.Methods: A retrospective descriptive analysis was performed using the data of patients with traumatic vascular injuries between January 2017 and July 2021 presented to Hervey Bay hospital in Queensland, Australia.Results: Fifty-nine patients with vascular injuries were reviewed. The reported number of penetrating and blunt trauma cases were 43 (72.9%) and 16 (27.1%) respectively, and 42 (71.2%) were males. Most mechanisms of injury were cuts (n=32, 54.2%), followed by falls (n=16, 27.1%) and stabs (n=11, 18.7%). Fifty-one (86.4%) were initially surgically managed regionally, with 21 (35.6%) requiring transfer to a tertiary trauma centre. Outcomes of the incidents resulted in one (1.7%) patient requiring amputation, three (5.1%) needing a fasciotomy and the mortality of two (3.4%) patients.Conclusions: Vascular trauma causes a significant burden to Australian regional hospitals. Identifying injury patterns and common causes for vascular injury will help in early identification and prompt management. Vascular trauma management training should improve the quality of care from the general surgeons in the regional centres.

Experience of the trauma operative treatment of the lower extremities main vessels in the work injuries

Objective. The structure of combined osseous–vascular work injury of the lower extremities was studied, and the results of its operative treatment analyzed retrospectively.
 Materials and methods. The data concerning 147 patients with combined osseous–vascular work trauma of the lower extremities were analyzed. All the patients managed were from 19 to 48 yrs old, and their average age constituted 30.2 yrs old. The mine trauma with injuries of femoral and/or the shin bones and a. poplitea prevailed – in 129 (87.8%) and 116 (78.9%) observations, accordingly. There were performed 92 two–staged interventions in a common operative team with traumatologists.
 Results. Positive result of operative treatment was noted in 73 (79.3%) patients. The time span between the trauma moment and the operation beginning in this group of the patients have constituted from 2 to 5 h, while the degree of an acute arterial ischemia in accordance to V. S. Savelyev (1973) were signed as IIa–IIb. The operation duration have constituted from 3 to 4 h. All the patients have had a combined shock Degree II. The preoperative blood loss volume has been ranged from 1 to 2.5 l. The a. poplitea injury have had prevailed and occurred in 43 (58.9%) patients. In 6 (6.5%) patients after reconstructive intervention the extremity amputation was performed.
 Conclusion. Mostly favorable result was obtained in the injured persons, who were delivered early (upto 2 h) to specialized stationaries with conduction of preoperative antishock therapy.

Civilian vascular trauma, treatment and outcome at a level 1-trauma centre

BackgroundOutcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce.MethodsA retrospective study on all adults admitted to a North-European level 1-trauma centre 2009–2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan–Meier) estimated.ResultsOf 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13–1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury.ConclusionsTraumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality.Trial registration: Retrospectively registered.

Concomitant Orthopedic Injury is the Strongest Predictor of Amputation in Extremity Vascular Trauma

Although the risk of extremity amputation related to an isolated vascular injury is low, it increases significantly with concomitant orthopedic injury. Our study aims to evaluate and quantify the impact of risk factors associated with trauma-related extremity amputation in patients with vascular injury. We sought to determine whether there are other potential predictors of amputation. A retrospective review of patients with extremity vascular injury presenting to a single level 1 academic trauma center between January 1, 2007, and December 31, 2018, was performed. All patients diagnosed with major vascular injury to the upper or lower extremity were included. Data on patient demographics, medical comorbidities, anatomic location of vascular injury, and the presence of soft tissue or orthopedic injury were collected. The main outcome measure was major amputation of the affected extremity. Major amputation included below-the-knee amputation, above-the-knee amputation, as well as any amputation of the upper extremity at or proximal to the wrist. We identified 250 extremities with major vascular injury in 234 patients. Of these, 216 (86.4%) were male and 34 (13.6%) female. The mean age was 32.2years (range 18-79years) and mean follow-up was 6.9 (standard deviation: 3.3) years. Just over half of injuries, 130 (52.0%) involved the lower extremity. Forty extremities (29 lower and 11 upper), or 16.0%, of total injured extremities, required major amputation during the follow-up period. Concomitant orthopedic injury was present in 106 of 250 (42%) injured extremities. Using univariable logistic regression models, variables with a significant association with major amputation included older age, higher body mass index, blunt mechanism of injury, concomitant orthopedic injury, soft tissue injury, and nerve injury, and the need for fasciotomy (P<0.05). In multivariable analyses, blunt mechanism of injury (odds ratio [OR] (confidence ratio {CI}): 6.51 (2.29, 18.46), P<0.001) and concomitant orthopedic injury (OR [CI]: 7.23 [2.22, 23.55], P=0.001) remained significant predictors of amputation. Concomitant orthopedic injury and blunt mechanism in the setting of vascular injury are associated with a higher likelihood of amputation in patients with extremity vascular injury. Further development of a vascular extremity injury protocol may be needed to enhance limb salvage. Findings may guide patient discussion regarding limb-salvage decision-making.

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.

Six-year outcomes of a phase II study of human-tissue engineered blood vessels for peripheral arterial bypass

ObjectiveThe human acellular vessel (HAV) was evaluated for surgical bypass in a phase II study. The primary results at 24 months after implantation have been reported, and the patients will be evaluated for ≤10 years. MethodsIn the present report, we have described the 6-year results of a prospective, open-label, single-treatment arm, multicenter study. Patients with advanced peripheral artery disease (PAD) requiring above-the-knee femoropopliteal bypass surgery without available autologous graft options had undergone implantation with the HAV, a bioengineered human tissue replacement blood vessel. The patients who completed the 24-month primary portion of the study will be evaluated for ≤10 years after implantation. The present mid-term analysis was performed at the 6-year milestone (72 months) for patients followed up for 24 to 72 months. ResultsHAVs were implanted in 20 patients at three sites in Poland. Seven patients had discontinued the study before completing the 2-year portion of the study: four after graft occlusion had occurred and three who had died of causes deemed unrelated to the conduit, with the HAV reported as functional at their last visit. The primary results at 24 months showed primary, primary assisted, and secondary patency rates of 58%, 58%, and 74%, respectively. One vessel had developed a pseudoaneurysm deemed possibly iatrogenic; no other signs of structural failure were reported. No rejections or infections of the HAV occurred, and no patient had required amputation of the implanted limb. Of the 20 patients, 13 had completed the primary portion of the study; however, 1 patient had died shortly after 24 months. Of the remaining 12 patients, 3 died of causes unrelated to the HAV. One patient had required thrombectomy twice, with secondary patency achieved. No other interventions were recorded between 24 and 72 months. At 72 months, five patients had a patent HAV, including four patients with primary patency. For the entire study population from day 1 to month 72, the overall primary, primary assisted, and secondary patency rate estimated using Kaplan-Meier analysis was 44%, 45%, and 60% respectively, with censoring for death. No patient had experienced rejection or infection of the HAV, and no patient had required amputation of the implanted limb. ConclusionsThe infection-resistant, off-the-shelf HAV could provide a durable alternative conduit in the arterial circuit setting to restore the lower extremity blood supply in patients with PAD, with remodeling into the recipient’s own vessel over time. The HAV is currently being evaluated in seven clinical trials to treat PAD, vascular trauma, and as a hemodialysis access conduit.

Quiescent Bilateral Internal Carotid Artery Dissection Following Strangulation

Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events. Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause. Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.

Resuscitative Endovascular Balloon Occlusion of the Aorta is Associatedwith Increased Risk of Extremity Compartment Syndrome.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a temporizing procedure to control intra-abdominal or pelvic bleeding. Theoretically, occlusion of the aorta and the resulting ischemia-reperfusion of the lower extremities may increase the risk of extremity compartment syndrome (CS). To date, no study has addressed systematically the incidence and risk factors of CS following REBOA intervention. The purpose of this study was to address this knowledge gap. Adult trauma patients from the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016-2019) were included. Patients who received REBOA within 4h of admission were compared to patients without REBOA after propensity score matching for demographics, vital signs on admission, comorbidities, injury severity of different body regions, pelvic and lower extremity fractures, vascular trauma to the lower extremities, fixation for fractures, angioembolization (AE) for pelvis, preperitoneal pelvic packing (PPP), laparotomy, and venous thromboembolism (VTE) prophylaxis. The primary outcomes were rates of lower extremity CS and fasciotomy and acute kidney injury (AKI). Secondary outcomes included mortality. There were 534 patients who received REBOA matched with 1043 patients without REBOA. Overall, patients in the REBOA group had significantly higher rates of CS than no REBOA patients [5.4% vs 1.1%, p < 0.001, OR: 5.39]. The risk of CS remained significantly higher in the subgroups of patients with or without pelvic or lower extremity fractures, as well as in the subgroup of patients with associated extremity vascular injury [11.2% vs 1.5%, p < 0.001, OR: 8.12].The fasciotomy and AKI rates were significantly higher in the REBOA group (5.8% vs 1.2%, p < 0.001 and 12.9% vs 7.4%, p< 0.001 respectively). REBOA use is associated with a higher risk of lower extremity CS, fasciotomy and AKI, especially in patients with associated lower extremity vascular injuries. These complications should be taken into account when considering REBOA use, and close observation for this complication should always be part of the routine monitoring.

Delayed revascularization of extremities following vascular injuries: Challenges and outcome

PurposeIn developing countries delayed presentation following major vascular injury is common due to limited vascular trauma units; delay in diagnosis and time lost in transit which pose a major challenge for limb salvage. Aim of this study was to assess limb survival and complications after delayed revascularization of extremity following major vascular injury. Method20 patients, (19 males and 1 female, mean age 31.55 years) with major extremity vascular injury who presented >8 h after vascular trauma were included in this study. All patients had road traffic accidents as the cause of extremity injury. These patients were operated by primary vascular repairs, thrombectomy and/or interposition vein graft along with fixation of concomitant skeletal trauma. ResultsThe commonest vessel injured was popliteal artery. The mean time of limb revascularization was 30.8 h. Limb salvage rate was 95% and there was no perioperative mortality. 9 patients developed postoperative complications including sloughing of leg muscles (4), foot drop (3) pseudo aneurysm (1) and reperfusion injury (1). At 6 months follow-up all the patients were able to walk with full weight bearing and there was no chronic ischemia, pain or sinuses. ConclusionLimb salvage can be achieved with good results in patients with delayed revascularization in selected cases. However; delayed revascularization leads to long and protracted postoperative course with high chances of vascular and neurological complications.

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.

Derivaciones arteriales temporales en los programas de entrenamiento para los cirujanos generales.

The skills development to address vascular trauma by general surgeons is important in hospitals in countries with a lack of vascular surgeons, so we agree the implementation of training programs in vascular surgery basic techniques for general surgeons. In Peru, through an exploratory survey, 43 public hospitals have at least one vascular surgeon, of which 20 are located in Metropolitan Lima, and 14 of the 26 regions of Peru have at least one public institution with vascular surgery capabilities. We recommend the incorporation of the transient arterial shunt technique as an alternative to vascular anastomosis due to its security and feasibility for general surgeons training programs.

Pediatric cerebrovascular trauma: Incidence, management, and outcomes

BackgroundPediatric cerebrovascular trauma (CVT) is rare. There is an increasing use of endovascular management in vascular trauma. We studied the incidence, management, and outcomes of CVT in the pediatric population using the NTDB (National Trauma Data Bank). MethodsThe NTDB was queried for CVT in patients less than 18 years of age over a recent three-year period (2017–2019). Demographics, injury mechanism, type and location, Glasgow Coma Score (GCS), length of stay (LOS), surgical approach (open vs endovascular), and morbidity/mortality were evaluated. Statistical analysis included χ2 and student's t-tests or Fisher's exact tests where appropriate. ResultsOf 386,918 pediatric trauma cases, 1536 (0.4%) suffered 1821 CVT. Blunt trauma accounted for 69.3%. Patients were predominantly male (65.4%) and white (57.5%), with an mean age of 14 years. There were 998 (55%) carotid artery injuries, including 846 common/internal carotid and 145 external carotid. Other vessel injuries included 141 (11%) intracranial carotid, 571 (31%) vertebral artery and 252 (14%) jugular vein. Mean number of vessels injured was 1.2. Motor vehicle trauma was most common (49.3%) followed by firearm injury (21%). The mean GCS was 11, and mean total LOS was 11.3 days. Majority of interventions were performed in an open fashion (65.7%), whereas 29.7% were performed endovascularly. Stroke rate was 3.1%. Patients with multiple vascular injuries had an overall mortality of 29% (p<0.0001). ConclusionWhile not accorded as much importance as blunt injury, penetrating CVT comprises of 30% of injuries. Nearly 1/3rd of all cases needing surgical intervention were managed with endovascular techniques. Level of evidenceIII.

Outcome of Patients Presenting 6 to 12 Hours after Isolated Vascular Trauma in a Tertiary Care Hospital of Pakistan

Outcome of Patients Presenting 6 to 12 Hours after Isolated Vascular Trauma in a Tertiary Care Hospital of Pakistan

Predictors for limb amputation in war vascular trauma: A 20-years retrospective analysis from the Colombian armed conflict

BackgroundThe Latin American military vascular trauma is virtually unknown. The aim of this study was to describe severe war vascular trauma during the last 20 years of the Colombian armed conflict, and to identify predictors of limb amputation. MethodsRetrospective analysis of a follow-up cohort from 1999 to 2019 of patients with associated severe vascular injuries (ISS >15) in the Colombian armed conflict treated at the Hospital Militar Central. ResultsOut of 5948 patients, 243 had military vascular trauma with 430 vascular injuries. The most frequent trauma mechanisms were gunshot wounds (n = 153; 63%). The most common injured vessels were femoral. 24 (10%) patients required amputations. Mortality was 4.1%. Amputation was associated with arteriovenous lesions (RR 4.82, p = 0.025), compartment syndrome (RR 4.2, p = 0.007), arteriovenous femoropopliteal injuries (RR 3.5, p = 0.0026), multiple arterial injuries (RR 3.35, p = 0.0218), associated fractures (RR 3.1, p = 0.0032). ConclusionsConcomitant arteriovenous injuries in popliteal and femoropopliteal lesions, multiple arterial lesions, bone fractures, and compartment syndrome are associated with amputation in severe vascular injury.