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Pediatric Radiology Dec 2017Venous-related brain injury is a common form of cerebrovascular injury in children and encompasses a diverse group of cerebrovascular diagnoses. The purpose of this... (Review)
Review
Venous-related brain injury is a common form of cerebrovascular injury in children and encompasses a diverse group of cerebrovascular diagnoses. The purpose of this pictorial essay is to introduce the relevant anatomy, pathophysiology and various imaging patterns of venous-related cerebral injury in children. Unifying concepts to better understand the effects of venous hypertension in the developing brain will be emphasized. These unifying concepts will provide the imaging professional with a conceptual framework to better understand and confidently identify imaging patterns of venous-related cerebral injury.
Topics: Brain Injuries; Cerebral Veins; Child; Diagnostic Imaging; Humans; Vascular System Injuries
PubMed: 29149371
DOI: 10.1007/s00247-017-3975-x -
Seminars in Thrombosis and Hemostasis Mar 2020Trauma-induced coagulopathy (TIC) is well documented in injured children. However, many important features of pediatric hemostasis are still in development in early... (Review)
Review
Trauma-induced coagulopathy (TIC) is well documented in injured children. However, many important features of pediatric hemostasis are still in development in early childhood and may impact TIC. Certain pediatric subgroups are at a higher risk. Traumatic brain injury, which occurs with a higher rate in children, and physical child abuse are known risk factors for TIC that deserve special consideration. Resuscitation of a pediatric trauma patient follows many of the same goals as in the injured adult trauma, although some key aspects of pediatric resuscitation require ongoing investigation. Venous thromboembolism occurs with higher rates in certain high-risk groups of pediatric trauma patients, although overall it is considerably less frequent in children as compared with adults.
Topics: Adolescent; Blood Coagulation Disorders; Child; Child, Preschool; Female; Humans; Male; Wounds and Injuries
PubMed: 32160641
DOI: 10.1055/s-0040-1702203 -
Annals of Vascular Surgery Oct 2021Penetrating injuries to the inferior vena cava and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought...
BACKGROUND
Penetrating injuries to the inferior vena cava and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought to determine the relationship between iliocaval injury, VTE and mortality.
METHODS
The National Trauma Data Bank was queried for penetrating abdominal trauma from 2015-2017. Univariate analyses compared baseline characteristics and outcomes based on presence of iliocaval injury. Multivariable analyses determined the effect of iliocaval injury on VTE and mortality.
RESULTS
Of 9,974 patients with penetrating abdominal trauma, 329 had iliocaval injury (3.3%). Iliocaval injury patients were more likely to have a firearm mechanism (83% vs. 43%, P < 0.001), concurrent head (P = 0.036), spinal cord (P < 0.001), and pelvic injuries (P < 0.001), and higher total injury severity score (median 20 vs. 8.0, P < 0.001). They were more likely to undergo 24-hr hemorrhage control surgery (69% vs. 17%, P < 0.001), but less likely to receive VTE chemoprophylaxis during admission (64% vs. 68%, P = 0.04). Of patients undergoing iliocaval surgery, 64% underwent repair, 26% ligation, and 10% unknown. Iliocaval injury patients had higher rates of VTE (12% vs. 2%), 24-hr mortality (23% vs. 2.0%) and in-hospital mortality (33% vs. 3.4%) (P < 0.001 for all). VTE rates were similar following repair (14%) and ligation (17%). Iliocaval injury patients also had higher rates of cardiac complications (10.3% vs. 1.4%), acute kidney injury (8.2% vs. 1.3%), extremity compartment syndrome (4.0 vs. 0.2%), and unplanned return to OR (7.9% vs. 2.5%) (P < 0.001 for all). In multivariable analyses, iliocaval injury was independently associated with risk of VTE (OR 2.12; 95% CI, 1.29-3.48; P = 0.003), and in-hospital mortality (OR = 9.61; 95% CI, 4.96-18.64; P < 0.001).
CONCLUSION
Iliocaval injuries occur in <5% of penetrating abdominal trauma but are associated with more severe injury patterns and high mortality rates. Regardless of repair type, survivors should be considered high risk for developing VTE.
Topics: Abdominal Injuries; Adult; Databases, Factual; Female; Humans; Iliac Vein; Ligation; Male; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States; Vascular Surgical Procedures; Vascular System Injuries; Vena Cava, Inferior; Venous Thromboembolism; Wounds, Penetrating; Young Adult
PubMed: 34153491
DOI: 10.1016/j.avsg.2021.06.002 -
Khirurgiia 2022To study the possibilities and results of reconstruction of caval veins.
OBJECTIVE
To study the possibilities and results of reconstruction of caval veins.
MATERIAL AND METHODS
We analyzed the results of reconstruction of caval veins in 31 patients (19 men and 12 women) including superior vena cava (SVC) in 5 cases and inferior vena cava (IVC) in 26 cases. Penetrating wounds with vascular damage were found in 8 patients. Iatrogenic damage to IVC was observed in 19 patients (nephrectomy for kidney cancer - 2, nephrectomy for secondary kidney wrinkling - 1, echinococcectomy from retroperitoneal space - 1, adrenalectomy for adrenal tumors - 5, right-sided lumbar sympathectomy - 1, resection of abdominal aortic aneurysm - 1, resection of a large retroperitoneal tumor - 6). Iatrogenic damage to SVC occurred in 2 patients during resection of mediastinal tumor. In other 4 cases, elective surgery for mediastinal tumor (1), pancreatic head cancer (2) and liver alveococcosis (1) was accompanied by resection and replacement of caval veins.
RESULTS
All interventions for caval vein injury were performed under adequate infusion therapy. Seven (22.6%) patients died. One patient with blunt chest trauma and damage to SVC died during thoracotomy. In another patient, infrarenal IVC was intersected during mobilization of retroperitoneal hydatid cyst that required ligation for vital indications. High venous hypertension below the ligature led to eruption of sutures on the venous stump. The patient died from hypovolemia after additional IVC ligation. Other 5 patients died in early postoperative period without leaving the state of shock. These patients had damage to retrohepatic segment of IVC (1), vascular-organ (1) and iatrogenic (3) injuries. One patient died from pulmonary embolism, two patients - from venous bleeding between the 2nd and the 5th postoperative days. Patients died before reoperations. Two patients with postoperative bleeding underwent redo surgery with favorable outcomes. One patient underwent redo surgery for peritonitis with a favorable result. Thus, 7 (22.6%) patients with caval vein injury died in intraoperative and early postoperative period. Non-specific complications occurred in 4 (12.9%) patients. These events were corrected by conservative measures. Other 24 (77.4%) patients with traumatic and iatrogenic injuries of caval veins were discharged.
CONCLUSION
Caval vein injury is less common event compared to other vascular damages. Nevertheless, this complication is accompanied by severe blood loss, shock and hypovolemia. We can only assume damage to a great vessel in patients with penetrating wounds before surgery and appropriate symptoms of internal bleeding. However, final diagnosis is made during surgery. Hemostasis is a responsible and difficult surgical stage in these patients. There is usually no alternative to reconstructive surgery in these cases. However, ligation is permissible in extremely ill patients and only in infrarenal segment of IVC. Vascular suture is a more acceptable and effective option for reconstruction. However, patch repair is advisable for large defects. In our opinion, this approach is better regarding long-term patency compared to total replacement with synthetic prostheses.
Topics: Female; Humans; Hypovolemia; Iatrogenic Disease; Male; Mediastinal Neoplasms; Thoracic Injuries; Vascular System Injuries; Vena Cava, Inferior; Vena Cava, Superior; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 36223148
DOI: 10.17116/hirurgia202210135 -
The Journal of Vascular Access May 2021Iatrogenic arteriovenous fistula of major neck vessels is a rare complication but can occur after central venous catheterization. Symptoms can range from nothing to...
Iatrogenic arteriovenous fistula of major neck vessels is a rare complication but can occur after central venous catheterization. Symptoms can range from nothing to severe heart failure and management can be particularly complex. We report a case that we treated recently in our department.
Topics: Aged; Arteriovenous Fistula; Catheterization, Central Venous; Humans; Iatrogenic Disease; Jugular Veins; Ligation; Male; Subclavian Artery; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries
PubMed: 32425097
DOI: 10.1177/1129729820923920 -
The Surgical Clinics of North America Oct 2017The golden hour of trauma represents a crucial period in the management of acute injury. In an efficient trauma resuscitation, the primary survey is viewed as more than... (Review)
Review
The golden hour of trauma represents a crucial period in the management of acute injury. In an efficient trauma resuscitation, the primary survey is viewed as more than simple ABCs with multiple processes running in parallel. Resuscitation efforts should be goal oriented with defined endpoints for airway management, access, and hemodynamic parameters. In tandem with resuscitation, early identification of life-threatening injuries is critical for determining the disposition of patients when they leave the trauma bay. Salvage strategies for profoundly hypotensive or pulseless patients include retrograde balloon occlusion of the aorta and resuscitative thoracotomy, with differing populations benefiting from each.
Topics: Balloon Occlusion; Humans; Hypotension; Intubation, Intratracheal; Resuscitation; Thoracotomy; Triage; Wounds and Injuries
PubMed: 28958368
DOI: 10.1016/j.suc.2017.06.001 -
Journal of Vascular Surgery. Venous and... Sep 2019Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on... (Review)
Review
BACKGROUND
Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on quality of life. Venous disorders can be attributed to a combination of vascular compression with a high burden of activity.
OBJECTIVE
This article promotes increased awareness of these uncommon conditions specific to the athlete by summarizing pathophysiology, clinical features, investigation, and treatment protocols for use in clinical practice. Prognostic outcomes of these management regimens are also discussed, allowing for clinicians to counsel these high-functioning individuals appropriately. With the aim of providing an overview of sport-related venous pathology, a literature review was undertaken identifying articles that were independently reviewed by the authors.
RESULTS
Lower limb venous thrombosis has been identified in young, high-functioning athletes attributed to both compression-related venous trauma, associated with repetitive movements resulting in intimal damage, and blunt trauma. The diagnosis and treatment follow the same protocols as for the general population. Of note, early ambulation is advocated, with an aim to return to premorbid (noncontact) function within 6 weeks. Athletes performing high-intensity repetitive upper limb movement, such as baseball players, are predisposed to upper limb deep venous thrombosis (DVT). Diagnosis follows the same protocols as for lower extremity DVT; however, the optimal treatment strategy remains debated. Current guidelines advocate the use of anticoagulation alone. A specific subset of primary upper limb DVT is effort thrombosis, where there is compression at the level of the thoracic outlet. Thrombolysis with first rib resection is indicated in the acute setting within 14 days. In cases of complete occlusion, surgical decompression with venous reconstruction may be required. Popliteal vein entrapment syndrome is also discussed. This entity has been identified as an overuse injury associated with popliteal vein compression. Duplex ultrasound examination is indicated as a first-line investigation, with conservative noninvasive options considered as an initial management strategy. Chronic venous insufficiency or persistent symptoms may require subsequent surgical decompression.
CONCLUSIONS
Key conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
Topics: Aneurysm; Athletic Injuries; Humans; Risk Factors; Thoracic Outlet Syndrome; Treatment Outcome; Vascular System Injuries; Veins; Venous Insufficiency; Venous Thrombosis; Wounds, Nonpenetrating
PubMed: 31231058
DOI: 10.1016/j.jvsv.2019.03.012 -
Critical Care Nurse Jun 2016Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is... (Review)
Review
Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Traditional methods of detecting physiological changes include measurements of blood pressure, heart rate, urine output, serum levels of lactate, mixed venous oxygen saturation, and central venous oxygen saturation. Continuous noninvasive monitoring of tissue oxygen saturation in muscle has the potential to indicate severity of shock, detect occult hypoperfusion, guide resuscitation, and be predictive of the need for interventions to prevent multiple organ dysfunction syndrome. Tissue oxygen saturation is being used in emergency departments, trauma rooms, operating rooms, and emergency medical services. Tissue oxygen saturation technology is just as effective as mixed venous oxygen saturation, central venous oxygen saturation, serum lactate, and Stewart approach with strong ion gap, yet tissue oxygen saturation assessment is also a direct, noninvasive microcirculatory measurement of oxygen saturation.
Topics: Biomarkers; Female; Humans; Injury Severity Score; Lactic Acid; Male; Monitoring, Physiologic; Oximetry; Oxygen; Oxygen Consumption; Predictive Value of Tests; Resuscitation; Risk Assessment; Shock, Septic; Survival Rate; Wounds and Injuries
PubMed: 27252098
DOI: 10.4037/ccn2016206 -
Microsurgery May 2016A common postoperative observation after microsurgical ear replantation has been venous congestion necessitating alternate modes of decongestion, frequently in... (Review)
Review
BACKGROUND
A common postoperative observation after microsurgical ear replantation has been venous congestion necessitating alternate modes of decongestion, frequently in conjunction with blood transfusion. A comprehensive literature search was performed to assess the relationship between mode of vascular reconstruction and postoperative outcome as well as postoperative transfusion requirement after microsurgical ear replantation.
METHODS
The search was limited to cases of microsurgical ear replantation following complete amputation. Only articles published in English and indexed in PubMed were included.
RESULTS
The initial search retrieved 285 articles, which was narrowed down to 40 articles reporting on 60 cases that matched the aforementioned criteria. Reconstruction of the arterial and venous limb (Group 1) was performed in 63.3% of patients and artery-only anastomosis (Group 2) was performed in 31.7%. Among measurable outcomes, only the duration of surgery was significantly different between groups (2.6 hours longer in Group 1 than Group 2; P = 0.0042).
CONCLUSION
In light of contemporary data demonstrating successful artery-only ear replantation, replantation should not be abandoned when unable to establish venous outflow microsurgically. © 2015 Wiley Periodicals, Inc. Microsurgery 36:345-350, 2016.
Topics: Amputation, Traumatic; Arteries; Ear, External; Humans; Microsurgery; Replantation; Treatment Outcome; Veins
PubMed: 25847853
DOI: 10.1002/micr.22411 -
The Journal of Trauma and Acute Care... Aug 2014Diagnosis of vascular injury in pediatric trauma is challenging as clinical signs may be masked by physiologic compensation. We aimed to (1) investigate the prevalence... (Review)
Review
BACKGROUND
Diagnosis of vascular injury in pediatric trauma is challenging as clinical signs may be masked by physiologic compensation. We aimed to (1) investigate the prevalence of noniatrogenic pediatric venous injuries, (2) discuss options in management of traumatic venous injury, and (3) investigate mortality from venous injury in pediatric trauma. Our objective was to provide the practicing clinician with a summary of the published literature and to develop an evidence-based guide to the diagnosis and management of traumatic venous injuries in children.
METHODS
A systematic review of published literature (PubMed) describing noniatrogenic traumatic venous injury in the pediatric population (<17 years) was performed according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines. Data were retrieved systematically under the following headings: Study Design, Population Demographics (dates of recruitment, mean age, mechanism of injury), Diagnostic Approach, Vessel Injured, Management (operative technique), and Mortality.
RESULTS
Thirteen articles were included in this systematic review. In total, 508 noniatrogenic traumatic venous injuries were reported in children between the year 1957 and present day. Mechanisms of injury included blunt trauma from seat belt-related injury and fall from height or penetrating trauma from gunshot and foreign object. Injury to the inferior vena cava was most frequently reported, followed by femoral vein and internal jugular injuries. Primary repair was the most frequently reported technique for surgical repair (38%), followed by ligation (25%) and end-to-end anastomosis (15%). Mortality in pediatric trauma patients who had venous injury was reported as 0% to 67% in published series, highest in the series in which the most frequently reported injury was of the inferior vena cava.
CONCLUSION
Traumatic venous injury in the pediatric population is uncommon but may be associated with significant morbidity and mortality. Intra-abdominal venous injuries are associated with high mortality from exsanguination. Early diagnosis and intervention are therefore essential in such cases.
LEVEL OF EVIDENCE
Systematic review, level IV.
Topics: Child; Evidence-Based Medicine; Humans; Mortality; Prevalence; Veins
PubMed: 25058265
DOI: 10.1097/TA.0000000000000312