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Journal of Vascular Surgery. Venous and... May 2020Popliteal vascular injuries are common and frequently associated with limb loss. Although many studies have evaluated the treatment and outcomes of popliteal artery... (Comparative Study)
Comparative Study
BACKGROUND
Popliteal vascular injuries are common and frequently associated with limb loss. Although many studies have evaluated the treatment and outcomes of popliteal artery injuries (PAI), there is little available evidence regarding popliteal venous injuries (PVI). As such, substantial debate remains regarding the benefit of repair over ligation of PVI. The objectives of this study were to compare in-hospital outcomes of repair versus ligation of isolated PVI, as well as to determine nonvascular factors associated with worse outcomes.
METHODS
Patients in the National Trauma Databank from 2007 to 2014 with at least one PVI were evaluated. First, patients with concomitant PVI and PAI were compared with patients with isolated PVI. Second, outcomes were compared between ligation and repair of isolated PVI. To limit the impact of concomitant injuries and focus on the impact of venous injury management, we defined isolated PVI as cases without concomitant PAI and with Abbreviated Injury Scale severity score of less than 3 for all body regions other than lower extremity. Patients dead on arrival and those with less than 18 years of age were excluded. The primary outcomes were in-hospital mortality, amputation, and in-hospital amputation-free survival (AFS). Secondary outcomes included lower extremity compartment syndrome, fasciotomy, acute kidney injury, pulmonary embolism, deep venous thrombosis, and inferior vena cava filter placement.
RESULTS
Overall, 1819 patients (0.03%) had a PVI and after exclusion 1213 met the criteria for initial analysis. Of those, 308 had isolated PVI, and 905 had combined PVI and PAI. Patients with combined PVI and PAI had higher rates of amputation (15.2% vs 6.8%; P < .001), fasciotomy (64.5% vs 30.8%; P < .001), compartment syndrome (14.8% vs 8.8%; P = .006), and a lower AFS (82.9% vs 91.8%; P < .001) than patients with isolated PVI. There was no difference in in-hospital mortality, amputation, or in-hospital AFS between ligation and repair of isolated PVI. On multivariable logistic regression of isolated PVI, ligation was not independently associated with in-hospital AFS, amputation, or mortality.
CONCLUSIONS
Ligation of isolated PVI was not an independent predictor of in-hospital mortality, lower extremity amputation, or in-hospital AFS. Ligation also did not result in higher rates of fasciotomy, acute kidney injury, or pulmonary embolism.
Topics: Adult; Amputation, Surgical; Databases, Factual; Female; Hospital Mortality; Humans; Ligation; Limb Salvage; Male; Middle Aged; Popliteal Vein; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States; Vascular Surgical Procedures; Vascular System Injuries; Young Adult
PubMed: 31843477
DOI: 10.1016/j.jvsv.2019.09.014 -
Annals of Vascular Surgery Feb 2018Major venous injury during open aortic reconstruction though uncommon often result in sudden and massive blood loss resulting in increased morbidity and mortality. This...
BACKGROUND
Major venous injury during open aortic reconstruction though uncommon often result in sudden and massive blood loss resulting in increased morbidity and mortality. This study details the etiology, management, and outcome of such injuries.
METHODS
A retrospective review of 945 patients (1981-2017) undergoing aortic reconstruction from 2 midsized (350 bed each) teaching hospitals was conducted. Seven hundred twenty-three patients (76.5%) underwent open abdominal aortic aneurysm (AAA) repair/iliac aneurysm repair, 222 patients (23.5%) underwent aortofemoral grafting (AFG). Patients sustaining major venous injury (sudden loss of more than 500 mL of blood) during major aortic reconstruction were studied. The number of units of packed red blood cells transfused, location of injured vessel, type of repair, postoperative morbidity, and mortality were collected in our vascular registry on a continuous basis. All patients identified with iliac vein/inferior vena cava/femoral vein injury had follow-up noninvasive venous examination of the lower extremities.
RESULTS
Eighteen major venous injuries (1.9%) occurred during aortic reconstruction in 17 patients (1 patient had 2 major venous injuries): IVC (n = 4), iliac vein (n = 10), left renal vein (n = 4, this includes a posterior retroaortic renal vein injury n = 1). Of the 18 major venous injuries, 7 occurred during open AAA repair for ruptured AAA and another 9 occurred during repair of intact AAA (P = 0.001), 2 venous injuries occurred after AFG, and 1 after primary AFG (P = 0.05). Using multivariate regression analysis, periarterial inflammation had significant association with major venous injury (P < 0.001). The presence of associated iliac aneurysm with abdominal aortic aneurysm also increased the incidence of major venous injury during AAA surgery (P = 0.05). Two patients (11.8%) died, one from uncontrolled bleeding due to tear of right common iliac vein during ruptured AAA repair and second patient from disseminated intravascular complication following repair of ruptured AAA. Intraoperative transfusion requirements were 3-28 units, (median 8 units). Three of 9 (33%) surviving patients developed iliofemoral venous thrombosis following repair of iliac/femoral vein injury.
CONCLUSIONS
Major venous injury during aortic reconstructions occurs more commonly during the repair of ruptured AAA and redo AFG. Following repair of iliac/femoral vein injury, surveillance for possible deep venous thrombosis by duplex imaging should be considered.
Topics: Aged; Aorta; Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Loss, Surgical; Blood Transfusion; Chi-Square Distribution; Female; Hospital Bed Capacity; Hospitals, Teaching; Humans; Iatrogenic Disease; Iliac Vein; Logistic Models; Male; Michigan; Multivariate Analysis; Odds Ratio; Plastic Surgery Procedures; Registries; Renal Veins; Retrospective Studies; Risk Factors; Time Factors; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures; Vascular System Injuries; Veins; Vena Cava, Inferior; Venous Thrombosis
PubMed: 28887236
DOI: 10.1016/j.avsg.2017.08.004 -
Revista Latino-americana de Enfermagem 2018to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs).
OBJECTIVE
to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs).
METHOD
cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used.
RESULTS
the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001).
CONCLUSION
the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheterization, Peripheral; Cohort Studies; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Incidence; Male; Middle Aged; Phlebitis; Risk Factors; Veins; Young Adult
PubMed: 29791668
DOI: 10.1590/1518-8345.2377.3002 -
The Journal of Trauma and Acute Care... Oct 2018Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR)...
BACKGROUND
Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR) resuscitation, for selective adult patients has demonstrated decreased mortality. We sought to investigate the application of this protocol in children.
METHODS
All DOR pediatric patients from 2009 to 2016 at a pediatric Level I trauma center were identified. Direct to OR criteria included penetrating injury, chest injuries, amputations, significant blood loss, cardiopulmonary resuscitation, and surgeon discretion. Demographics, injury patterns, interventions, and outcomes were analyzed. Observed mortality was compared with expected mortality, calculated using Trauma Injury Severity Score methodology, with two-tailed t tests, and a p value less than 0.5 was considered significant.
RESULTS
Of 2,956 total pediatric trauma activations, 82 (2.8%) patients (age range, 1 month to 17 years) received DOR resuscitation during the study period. The most common indications for DOR were penetrating injuries (62%) and chest injuries (32%). Forty-four percent had Injury Severity Score (ISS) greater than 15, 33% had Glasgow Coma Scale (GCS) score of 8 or less, and 9% were hypotensive. The most commonly injured body regions were external (66%), head (34%), chest (30%), and abdomen (27%). Sixty-seven (82%) patients required emergent procedural intervention, most commonly wound exploration/repair (35%), central venous access (22%), tube thoracostomy (19%), and laparotomy (18%). Predictors of intervention were ISS greater than 15 (odds ratio, 14; p = 0.013) and GCS < 9 (odds ratio = 8.5, p = 0.044). The survival rate to discharge for DOR patients was 84% compared with an expected survival of 79% (Trauma Injury Severity Score) (p = 0.4). The greatest improvement relative to expected mortality was seen in the subgroup with penetrating trauma (84.5% vs 74.4%; p = 0.002).
CONCLUSION
A selective policy of resuscitating the most severely injured children in the OR can decrease mortality. Patients suffering penetrating trauma with the highest ISS, and diminished GCS scores have the greatest benefit. Trauma centers with appropriate resources should evaluate implementing similar policies.
LEVEL OF EVIDENCE
Diagnostic tests or criteria, level II.
Topics: Abdominal Injuries; Adolescent; Catheterization, Central Venous; Child; Child, Preschool; Clinical Protocols; Craniocerebral Trauma; Diagnostic Techniques, Surgical; Emergency Treatment; Female; Glasgow Coma Scale; Humans; Hypotension; Infant; Injury Severity Score; Male; Operating Rooms; Resuscitation; Survival Rate; Thoracic Injuries; Thoracostomy; Triage; Wounds and Injuries; Wounds, Penetrating
PubMed: 29554039
DOI: 10.1097/TA.0000000000001908 -
Journal of Vascular Surgery Dec 2018Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such... (Comparative Study)
Comparative Study
OBJECTIVE
Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such as to the inferior vena cava (IVC) and aortic injuries remain responsible for a significant proportion of early trauma deaths in modern trauma care. The purpose of this study was to explore patterns in epidemiology and mortality after IVC and aortic injuries in the United States.
METHODS
A 13-year analysis of the National Trauma Databank (2002-2014) was performed to extract all patients who sustained IVC, abdominal aortic, or thoracic aortic injuries. Demographics, clinical data, and outcomes were extracted. Patients were analyzed according to injury mechanism.
RESULTS
A total of 25,428 patients were included in this analysis. Overall, the mean age was 39.8 ± 19.1 years, 70.3% were male, and 14.1% sustained a penetrating trauma. Although the incidence of all three injuries remained constant throughout the study period, for blunt trauma, mortality decreased over the study period (from 48.8% in 2002 to 28.7% in 2014; P < .001), in particular for thoracic aortic injuries (from 46.1% in 2002 to 23.7% in 2014; P < .001) and abdominal aortic injuries (from 58.3% in 2002 to 26.2% in 2014; P < .001). This decrease in mortality after blunt trauma was accompanied by an increase in endovascular procedures over the study period (from 1.0% in 2002 to 30.4% in 2014; P < .001), in particular for blunt thoracic aortic injuries (from 0.7% in 2002 to 41.4% in 2014; P < .001). When penetrating trauma patients were analyzed, overall there was an increase in mortality (from 43.8% in 2002 to 50.6% in 2014; P < .001), in particular after abdominal aortic injury (from 30.4% in 2002 to 66.0% in 2014; P < .001). Similar trends were observed for IVC injuries. No increase in endovascular use in penetrating trauma was identified (from 0.1% in 2002 to 3.4% in 2014; P < .001).
CONCLUSIONS
The present study demonstrates an overall decrease in mortality after blunt aortic injuries in the United States. This decrease was accompanied by an increase in the use of endovascular procedures. After penetrating trauma, however, despite contemporary advances in trauma care, mortality has increased over the study period, in particular after abdominal aortic injury. No increase in endovascular use in penetrating trauma was demonstrated.
Topics: Abdominal Injuries; Adolescent; Adult; Aged; Aged, 80 and over; Aorta, Abdominal; Aorta, Thoracic; Child; Child, Preschool; Endovascular Procedures; Female; Humans; Incidence; Infant; Male; Middle Aged; Registries; Retrospective Studies; Thoracic Injuries; Time Factors; United States; Vascular Surgical Procedures; Vascular System Injuries; Vena Cava, Inferior; Wounds, Nonpenetrating; Wounds, Penetrating; Young Adult
PubMed: 30473029
DOI: 10.1016/j.jvs.2018.04.033 -
Journal of Reconstructive Microsurgery Feb 2020The use of the venous flap for simultaneous revascularization and coverage of soft tissue defects has been documented in the literature for over 30 years. First...
BACKGROUND
The use of the venous flap for simultaneous revascularization and coverage of soft tissue defects has been documented in the literature for over 30 years. First described in 1981, Nakayama et al demonstrated that a vein and overlying skin, or a venous flap, may be transposed from one area of the body to another with complete survival of the graft. The aim of this study was to conduct a systematic review of the literature to determine predictors of venous flap survival in traumatic hand injuries.
METHODS
A literature search of PubMed, MEDLINE, and Cochrane Library was performed with emphasis on venous flap use in traumatic hand injuries. MeSH terms included: vein graft, revascularization, venous flow through flap, arterialized venous flap, bypass, replantation, amputation, avulsion, trauma, injury, amputate, finger, hand, and thumb.
RESULTS
Forty-three articles were collected that contained data on 626 free venous flaps. Most patients were males (73.9) and injured their right hand (52.3%). The forearm was the most commonly used venous flap donor site (83.6%), and most of the skin paddles were 10 to 25 cm (41.1%). Arterial inflow was used in 93.1% of the flaps. Most venous flaps (79.6%) healed without superficial tissue loss or necrosis. Ninety-two (14.7%) flaps had partial loss while 36 (5.8%) flaps did not survive.
CONCLUSION
The use of venous flaps for concomitant revascularization and soft tissue coverage of the hand permits good results with limited morbidity. The overall flap survival rate is nearly 95%. Younger patients whose flaps have arterial inflow and skin paddles of medium size (10-25 cm) have the best chance for survival.
Topics: Finger Injuries; Free Tissue Flaps; Hand Injuries; Humans; Male; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Veins
PubMed: 31454834
DOI: 10.1055/s-0039-1695053 -
BMC Cardiovascular Disorders Sep 2021MiR-92a-3p and oxidative stress are associated with catheter-related thrombosis (CRT). As a kind of physical intervention, resistance exercise can effectively promote...
BACKGROUND
MiR-92a-3p and oxidative stress are associated with catheter-related thrombosis (CRT). As a kind of physical intervention, resistance exercise can effectively promote blood circulation. In this study, we investigated the roles of miR-92a-3p, oxidative stress and the P38 mitogen-activated protein kinase/nuclear factor-κB (MAPK/NF-κB) pathway in CRT during resistance exercise.
METHODS
The rat CRT model was used for resistance exercise intervention. Moreover, pathological changes from the right jugular vein to the right auricle were observed under an electron microscope. In addition, reactive oxygen species (ROS) production, malondialdehyde (MDA) activity and heme oxygenase (HO-1) level in rat serum were detected via ELISA. The expression levels of miR-92A-3p and HO-1 in the vascular tissues of the rats were determined via real-time quantitative PCR. Additionally, the expression levels of HO-1, NF-κB P65, p38MAPK and IκBa in the venous tissues of the rats were analysed by Western blot analysis.
RESULTS
The pathological results showed that the thrombosis incidence rate in the CRT + RE group was lower than that in the CRT group. In the CRT group, the expression levels of ROS and MDA, which are markers related to oxidative stress in serum, significantly increased whilst the expression of HO-1 decreased. In the venous tissue, the expression of miR-92a-3p increased, the level of HO-1 decreased, the levels of p38MAPK and NF-κB p65 significantly increased but that of P-IκBa and IκBa significantly decreased. In the CRT + RE group, after administering the resistance exercise intervention, ROS production and MDA activity in serum significantly decreased, the expression level of HO-1 increased and the expression level of miR-92a-3p in the venous tissues significantly decreased and was negatively correlated with that of HO-1. The levels of p38MAPK and NF-κB p65 significantly decreased but that of P- IκBa and IκBa significantly increased.
CONCLUSION
Resistance exercise intervention downregulated miR-92a-3p expression, repaired oxidative stress injury and prevented CRT formation.
Topics: Animals; Blood Coagulation; Catheterization, Central Venous; Disease Models, Animal; Heme Oxygenase (Decyclizing); Jugular Veins; Male; MicroRNAs; NF-kappa B; Oxidative Stress; Rats, Sprague-Dawley; Resistance Training; Signal Transduction; Vascular System Injuries; Venous Thrombosis; p38 Mitogen-Activated Protein Kinases; Rats
PubMed: 34530722
DOI: 10.1186/s12872-021-02233-w -
Emergency Radiology Jun 2021To determine the incidence, injury type, injury associations, and management of patients with renal vein injuries following trauma. (Observational Study)
Observational Study
PURPOSE
To determine the incidence, injury type, injury associations, and management of patients with renal vein injuries following trauma.
METHODS
This is a 10-year single-center retrospective observational study of patients with renal vein injuries identified on admission abdominopelvic CT following trauma. Our institutional trauma registry and radiology information system (RIS) was used to identify patients with renal vein injuries. The medical records and imaging exams were reviewed to determine venous injury type, associated injuries, management, and outcomes.
RESULTS
Fifteen (15) patients with renal vein injuries (N = 9 right side) were identified out of 36,077 trauma evaluations, for an overall incidence of 0.042%. Eight (53.3%) were male with a mean age of 36.3 years (range 9-67 years) and a mean Injury Severity Score (ISS) of 32 (range 13-57). The most common imaging findings were pseudoaneurysm formation with or without intimal injury and intraluminal thrombus seen in 86.7% of the cohort. Twelve patients (80.0%) had other acute traumatic renal findings, most commonly an ipsilateral grade 4 or higher renal injury. Angiography was performed in 6 patients (40.0%), however no patients received renal vein specific endovascular evaluation, endovascular treatment, or surgical treatment of their renal vein injuries. Three patients were treated with long-term anticoagulation, of which one received an IVC filter. There were no known renal vein injury specific mortalities.
CONCLUSIONS
Renal vein injuries are an extremely rare entity but can be detected on admission CT. The most common injury patterns include an intimal injury with intraluminal thrombus and pseudoaneurysm in combination with an intimal injury and intraluminal thrombus. Conservative, nonoperative management was successfully employed in all cases with no renal vein specific mortalities.
Topics: Abdominal Injuries; Adolescent; Adult; Aged; Child; Humans; Injury Severity Score; Male; Middle Aged; Renal Veins; Retrospective Studies; Vascular System Injuries; Wounds, Nonpenetrating; Young Adult
PubMed: 33417111
DOI: 10.1007/s10140-020-01878-y -
Hepatobiliary & Pancreatic Diseases... Oct 2014Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The...
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
Topics: Adolescent; Adult; Aged; Biliary Fistula; Embolization, Therapeutic; Female; Hemodynamics; Hemoperitoneum; Hepatic Veins; Humans; Liver; Male; Middle Aged; Portal Vein; Radiography; Retrospective Studies; Survival Rate; Trauma Severity Indices; Treatment Outcome; Wounds, Nonpenetrating; Wounds, Penetrating; Young Adult
PubMed: 25308366
DOI: 10.1016/s1499-3872(14)60049-7 -
The Journal of Trauma and Acute Care... Mar 2020
Topics: Adult; Echocardiography, Transesophageal; Embolization, Therapeutic; Hemorrhage; Humans; Lung Injury; Male; Multiple Trauma; Thoracotomy; Vena Cava, Inferior; Wounds, Gunshot
PubMed: 31985553
DOI: 10.1097/TA.0000000000002578