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Journal of Vascular Surgery Jun 2022The aim of the present study was to analyze and report the clinical presentation and treatment at a single center of bull horn vascular injuries (BHVIs) that had...
OBJECTIVE
The aim of the present study was to analyze and report the clinical presentation and treatment at a single center of bull horn vascular injuries (BHVIs) that had occurred during popular celebrations in the past four decades. Thus, we investigated BHVIs in a high-volume academic center in Spain.
METHODS
All the patients with a BHVI admitted between January 1980 and January 2021 were retrospectively enrolled in the present study. Data collection included demographics, injury profile, and outcomes. The primary outcome was in-hospital mortality. The hospital and intensive care unit lengths of stay, rates of reintervention, postoperative complications, and mortality were also analyzed. Data were collected from the electronic and/or digitized medical history records.
RESULTS
A total of 296 patients were included in the present analysis. The mean patient age was 33.4 years (range, 17-91 years), and 93.9% were men. Of the 296 patients, 126 (42.6%) had experienced a complication, and 57 (19.3%) had required reoperation. The overall in-hospital mortality was 5.1%. The risk factors for mortality were arterial injury (odds ratio [OR], 5.11; 95% confidence interval [CI], 1.45-23.3; P = .009), injury to the abdominal region (OR, 3.45; 95% CI, 1.11-14.54; P = .038), American Society of Anesthesiologists classification IV (OR, 3.27; 95% CI, 1.87-17.83; P = .004), and age >65 years (OR, 3.13; 95% CI, 1.38-10.04; P = .001). Statistically significant differences were found between bull horn arterial injuries and arterial plus concomitant venous injuries in the intensive care unit length of stay (4.9 ± 13.3 days vs 3.1 ± 12.6 days; P = .024), hospital length of stay (12.0 ± 8.2 days vs 10.1 ± 6.3 days; P = .007), postoperative complications (45.2% vs 30.6%; P = .002), and mortality (3.4% vs 1.9%; P = .001).
CONCLUSIONS
The morbidity and mortality from BHVIs have remained high for the past 40 years. Popular celebrations with bulls constitute an etiology of vascular trauma that can have dire consequences.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Cattle; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome; Vascular System Injuries; Young Adult
PubMed: 35063613
DOI: 10.1016/j.jvs.2022.01.009 -
Journal of Medical Case Reports Sep 2017Trauma is the main cause of morbidity and mortality in the pediatric population. Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children.... (Review)
Review
BACKGROUND
Trauma is the main cause of morbidity and mortality in the pediatric population. Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury, although uncommon (2 to 9%), is the fourth most common solid organ injury. Unlike other solid organ injuries, pancreatic trauma may be subtle and difficult to diagnose. Computed tomography currently is the imaging modality of choice. As the incidence of pancreatic injury in children sustaining blunt abdominal trauma is low, management remains a challenge.
CASE PRESENTATION
We present a 7-year-old Bahraini boy who sustained blunt trauma to his abdomen. He presented with abdominal pain and vomiting. His examination revealed abdominal distension and an epigastric bruise. Contrast-enhanced computed tomography reported grade III liver injury, grade I bilateral renal injury, a suspicion of splenic injury, and a grade III to IV pancreatic injury. He was admitted to Pediatric Intensive Care Unit and was treated conservatively. Because he was stable, he was discharged to the surgical ward at day 3. At day 18 he developed a pancreatic pseudocyst that was aspirated and recurred at day 25 when a pigtail catheter was inserted. He was kept on total parenteral nutrition through a peripherally inserted central catheter. The pigtail catheter was removed on day 36 and a low fat diet was started by day 44. He was discharged home at day 55 in good health. Out-patient follow-up and serial abdominal ultrasound showed resolution of the cyst and normalization of blood tests.
CONCLUSION
Non-operative management of pancreatic injury is effective and safe in hemodynamically stable patients with no other indication for surgery.
Topics: Abdominal Pain; Catheterization, Peripheral; Central Venous Catheters; Child; Conservative Treatment; Humans; Kidney; Length of Stay; Liver; Male; Pancreas; Pancreatic Pseudocyst; Tomography, X-Ray Computed; Treatment Outcome; Vomiting; Wounds, Nonpenetrating
PubMed: 28886723
DOI: 10.1186/s13256-017-1383-3 -
Acta Bio-medica : Atenei Parmensis Apr 2021Muscle in vein (MIV ) conduits have gradually been employed in the last 20 years as a valuable technique in bridging peripheral nerve gaps after nerve lesions who cannot...
Muscle in vein (MIV ) conduits have gradually been employed in the last 20 years as a valuable technique in bridging peripheral nerve gaps after nerve lesions who cannot undergo a direct tension-free coaptation. The advantages of this procedure comparing to the actual benchmark (autograft) is the sparing of the donor site, and the huge availability of both components (i.e. muscle and veins). Here we present a case serie of four MIV performed at our hospital from 2018 to 2019. The results we obtained in our experi-ence confirmed its effectiveness both in nerve regeneration (as sensibility recovery) and in neuropathic pain eradication. Our positive outcomes encourage its use in selected cases of residual nerve gaps up to 30 mm.
Topics: Humans; Muscles; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Veins
PubMed: 33944845
DOI: 10.23750/abm.v92iS1.9202 -
Neurocritical Care Jun 2021This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence,...
BACKGROUND
This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome.
METHODS
We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome.
RESULTS
Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI.
CONCLUSION
Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice.
Topics: Head Injuries, Penetrating; Humans; Retrospective Studies; Survivors; Tomography, X-Ray Computed; Wounds, Gunshot
PubMed: 33025542
DOI: 10.1007/s12028-020-01106-y -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2018To present the surgical experience at a tertiary academic center of treating patients with traumatic arteriovenous fistulas (AVFs) who in whom endovascular treatment was...
BACKGROUND
To present the surgical experience at a tertiary academic center of treating patients with traumatic arteriovenous fistulas (AVFs) who in whom endovascular treatment was contraindicated or in whom unsuccessful endovascular treatment had been performed.
METHODS
A total of 27 patients with traumatic AVFs who underwent surgery between September 2014 and May 2016 were included. The site of injury, timing of surgery, and the surgical methods utilized were analyzed retrospectively.
RESULTS
Arteriovenous fistulas were located in the lower extremity in 26 patients (96.29%) and in the upper extremity in one patient (3.7%). Etiological factors included gunshot injuries in 23 patients (85.18%) and penetrating injury in four patients (14.81%). AVFs in the lower extremity were between the popliteal artery and vein in 21 patients and between the femoral artery and vein in five patients. The one patient with upper-extremity AVF had a communication between the brachial artery and cephalic vein. Primary repair of the artery and vein after ligation, arterial graft interposition plus primary vein repair, and arterial and venous graft interposition were performed for surgical repair in two, five, and 20 patients, respectively. The saphenous vein was used for grafting in all cases needing grafts.
CONCLUSION
In patients enduring penetrating trauma in the close vicinity of major vascular structures, a detailed history-taking and physical examination should be performed along with auscultation. The endovascular approach may represent the initial choice of management because of its lower rate of complications, noninvasive nature, decreased in-hospital costs, and decreased loss of work productivity. However, surgery is still unavoidable option in a significant proportion of patients who are either hemodynamically unstable, contraindicated for endovascular treatment, or in whom endovascular treatment was unsuccessful.
Topics: Adolescent; Adult; Arteriovenous Fistula; Humans; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Vascular Surgical Procedures; Vascular System Injuries; Wounds, Gunshot; Young Adult
PubMed: 29786818
DOI: 10.5505/tjtes.2017.49060 -
Medicine May 2019Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime,...
BACKGROUND
Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries.
METHODS
To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes.
RESULTS
Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc).
CONCLUSION
We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.
Topics: Amputation, Surgical; Ankle Brachial Index; Blast Injuries; Blood Vessel Prosthesis; Decompression, Surgical; Emergency Medicine; Extremities; Fasciotomy; Fractures, Bone; Humans; Military Medicine; Military Personnel; Retrospective Studies; Skin Transplantation; Time Factors; Trauma Severity Indices; United States; Vascular Surgical Procedures; Vascular System Injuries
PubMed: 31045795
DOI: 10.1097/MD.0000000000015406 -
Journal of Vascular Surgery. Venous and... May 2020
Topics: Humans; Phlebography; Ultrasonography, Interventional; Vascular Diseases; Vascular Surgical Procedures; Veins
PubMed: 33371987
DOI: 10.1016/j.jvsv.2020.03.009 -
Surgery May 2017Inferior vena cava repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair....
BACKGROUND
Inferior vena cava repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair. Primary repair of the inferior vena cava avoids the use of foreign material and allows an all-autologous repair in an expeditious fashion. The purpose of this study was to demonstrate the utility of inferior vena cava repair, determine the degree of inferior vena cava stenosis, and examine clinical outcomes after primary repair.
METHODS
We conducted a single-center retrospective review of patients who underwent primary inferior vena cava repairs between January 2002 and January 2014 at a tertiary care center. Primary repair followed lateral venorrhaphy for tumor extraction or for repair of an iatrogenic inferior vena cava injury. Patient demographics, cross-sectional vena cava dimensions, and patient outcomes were tabulated.
RESULTS
In total, 47 (30 men and 17 women) patients underwent primary inferior vena cava repair (median age 58 years, range 31-83 years). Twenty-six patients (15 men and 11 women) underwent en bloc radical nephrectomy, inferior vena cava tumor thrombus extraction, and primary lateral venorrhaphy (median age 61 years, range 39-83 years). The majority, 92% of these patients, had renal cell carcinoma on final pathology, with a median follow-up period of 39 months (range 1-108 months). Twenty-one patients (15 men and 6 women) underwent primary repair for iatrogenic inferior vena cava injury (median age 54 years, range 31-82 years). The median follow-up period was 18.5 months (3-110 months). Clinic follow-up with postoperative imaging was obtained in 76.9% of those undergoing tumor thrombus extraction (n = 20) and 76.2% of those undergoing repair of an iatrogenic injury (n = 16). Overall, there was a 13% infrarenal inferior vena cava diameter loss, 17% inferior vena cava diameter loss at the level of the renal veins, and 10% suprarenal inferior vena cava diameter loss when comparing postoperative with preoperative imaging. All patients remained asymptomatic; therefore, inferior vena cava narrowing associated with primary repair was clinically insignificant.
CONCLUSION
Primary inferior vena cava repair is associated with less than 20% inferior vena cava diameter loss and does not compromise venous outflow from the extremities. Primary inferior vena cava repair is a safe and expeditious technique that provides excellent clinical outcomes and long-term patency.
Topics: Adult; Aged; Aged, 80 and over; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Vascular Patency; Vascular Surgical Procedures; Vena Cava, Inferior
PubMed: 28011005
DOI: 10.1016/j.surg.2016.11.006 -
Turkish Neurosurgery 2019To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in... (Review)
Review
AIM
To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups.
MATERIAL AND METHODS
We prospectively followed up a cohort of 34 patients with fractures over dural venous sinuses from January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compound depressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively.
RESULTS
The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospital arrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common mode of injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%). Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was five days, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery.
CONCLUSION
The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgical intervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant in neurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose including a funduscopic examination and venogram as parts of the initial trauma work-up for these patients.
Topics: Adult; Cohort Studies; Cranial Sinuses; Disease Management; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Phlebography; Prospective Studies; Skull Fracture, Depressed; Tomography, X-Ray Computed; Young Adult
PubMed: 31192444
DOI: 10.5137/1019-5149.JTN.25572-18.2 -
European Review For Medical and... Jun 2021Timely intervention is the key to the successful management of penetrating injuries to jugular veins; however, the optimal clinical management of these perforations and...
OBJECTIVE
Timely intervention is the key to the successful management of penetrating injuries to jugular veins; however, the optimal clinical management of these perforations and associated risk factors for mortality are not fully established. This study examined the trauma characteristics, vital signs, and in-hospital mortality in penetrating external and internal jugular vein injuries (PEJVI and PIJVI, respectively).
PATIENTS AND METHODS
In this National Trauma Data Bank database study on patients with penetrating jugular vein injuries (PJVIs), details pertaining to demographics, comorbidities, type of injury, mechanism and intent of injury, Injury Severity Score (ISS), vital signs, treatment, and outcome, were abstracted. Multivariate logistic regression was used to identify the risk factors of in-hospital mortality.
RESULTS
A total of 548 patients with PJVIs were included in the final analysis. Patients with PEJVI were more likely to have a self-inflicted injury (p<.001) than those with PIJVI. In both groups, hemorrhage control surgery was performed in almost 60% of the patients within 24 hrs. of the injury (p=.767). Systolic blood pressure (OR 0.99, 95% CI: 0.98-1.00, p=.043), Glasgow coma scale (OR 0.88, 95% CI: 0.81-0.95, p<.001), ISS (OR 1.10, 95% CI: 1.06-1.14, p<.001), and the firearm as a mechanism of injury (OR 2.85, 95% CI: 1.19-6.79, p=.018) were found to be independently associated with the risk of in-hospital mortality.
CONCLUSIONS
The injury severity, hemodynamic stability, comma scale, intent, and mechanism of injury differed significantly in PEJVI and PIJVI; however, the type of PJVI did not have an independent association with in-hospital mortality.
Topics: Adult; Databases, Factual; Female; Glasgow Coma Scale; Hospital Mortality; Humans; Injury Severity Score; Jugular Veins; Logistic Models; Male; Middle Aged; Risk Factors; Wounds and Injuries; Wounds, Penetrating
PubMed: 34227070
DOI: 10.26355/eurrev_202106_26144