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Hospital Medicine (London, England :... Sep 2002Urban violence, collision of high-speed vehicles, acts of terrorism and military conflict continue to present difficult arterial injuries. The immediate threat of... (Review)
Review
Urban violence, collision of high-speed vehicles, acts of terrorism and military conflict continue to present difficult arterial injuries. The immediate threat of exsanguination, combined often with multiple trauma, and the challenge of limb salvage makes speedy effective management essential to improve the outcome for victims, who are frequently young adults.
Topics: Abdominal Injuries; Arm Injuries; Arteries; Humans; Leg Injuries; Thoracic Injuries; Vascular Surgical Procedures; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 12357860
DOI: 10.12968/hosp.2002.63.9.1953 -
Annals of Emergency Medicine Apr 2018
Review
Topics: Ankle Brachial Index; Arteries; Extremities; Humans; Physical Examination; Ultrasonography; Vascular System Injuries; Wounds, Penetrating
PubMed: 28967515
DOI: 10.1016/j.annemergmed.2017.08.001 -
Journal of Vascular Surgery Jun 2001We sought to analyze the results of lower limb arterial injury (LLAI) management in a busy metropolitan vascular unit and to identify risk factors associated with limb... (Review)
Review
PURPOSE
We sought to analyze the results of lower limb arterial injury (LLAI) management in a busy metropolitan vascular unit and to identify risk factors associated with limb loss.
PATIENTS AND METHODS
Between 1987 and 1997, prospectively collected data on 550 patients with 641 lower limb arterial injuries were analyzed.
RESULTS
The mechanism of LLAI was gunshot wounds in 46.1%, blunt in 19%, stabbing in 11.8%, and shotgun in 9.1%. The most frequently injured vessel was the superficial femoral artery (37.2%), followed by the popliteal (30.7%), crural (11%), common femoral (8.7%), and deep femoral (5.3%) arteries. In 3.4% of cases, there was a combined injury on either side of the knee (ipsilaterally). Associated injuries included bony injury in 35.1% of cases, nerve injury in 7.6%, and remote affecting the head, chest, or abdomen in 3.6%. Surgery was carried out on 96.2% of cases with a limb salvage rate of 83.8% and a survival of 98.5%. In spite of a rising trend in LLAI, our total and delayed amputation rates remained stable. On stepwise logistic regression analysis, significant (P <.01) independent risk factors for amputation were occluded graft (odds ratio [OR] 16.7), combined above- and below-knee injury (OR 4.4), tense compartment (OR 4.2), arterial transsection (OR 2.8), and associated compound fracture (OR 2.7).
CONCLUSION
LLAI carries a high amputation rate. Stab injuries are the least likely to lead to amputations, whereas high-velocity firearm injuries are the most likely to do so. The most significant independent risk factor for limb loss was failed revascularization.
Topics: Adolescent; Adult; Aged; Amputation, Surgical; Angiography; Arteries; Child; Child, Preschool; Female; Femoral Artery; Humans; Incidence; Injury Severity Score; Leg Injuries; Logistic Models; Male; Middle Aged; Multivariate Analysis; Popliteal Artery; Probability; Risk Factors; South Africa; Treatment Outcome; Wounds, Gunshot; Wounds, Nonpenetrating; Wounds, Stab
PubMed: 11389420
DOI: 10.1067/mva.2001.113982 -
The Surgical Clinics of North America Aug 1988Arterial injuries below the adductor hiatus in the lower extremity result in amputation more often than do injuries in any other site. The major deterrents to limb... (Review)
Review
Arterial injuries below the adductor hiatus in the lower extremity result in amputation more often than do injuries in any other site. The major deterrents to limb salvage are delay in diagnosis and revascularization and extensive adjacent bone and soft-tissue trauma. Rapid diagnosis and repair are needed for all popliteal artery injuries and for infrapopliteal injuries that compromise distal flow. The optimal management of asymptomatic injuries of single shank arteries with normal flow in uninjured parallel vessels is not defined.
Topics: Amputation, Surgical; Debridement; Fibula; Humans; Hypertension; Leg Injuries; Popliteal Artery; Popliteal Vein; Postoperative Care; Regional Blood Flow; Tibia; Vasodilation; Wounds, Penetrating
PubMed: 3046006
DOI: 10.1016/s0039-6109(16)44586-x -
Perspectives in Vascular Surgery and... Jun 2006The recognition of blunt vascular injury has increased in recent years due to an improved understanding of blunt mechanical forces, mechanisms of injury, and awareness... (Review)
Review
The recognition of blunt vascular injury has increased in recent years due to an improved understanding of blunt mechanical forces, mechanisms of injury, and awareness that such injuries are often occult. This has been aided by improved quality and expanded availability of noninvasive studies. As a result, outcomes following blunt vascular injury have improved. Compared to penetrating vascular injury and other vascular disease processes, blunt vascular injury has unique features that make it useful to consider as a distinct clinical entity. Manifestations of blunt vascular injury may develop in a delayed fashion and present with more subtle findings, such as a pulse deficit or diminished ankle-brachial pressure index. The objective of this review is to present a brief historical perspective on blunt vascular injury as well as an appraisal of current diagnostic and treatment strategies. Blunt vascular injury will be discussed in distinct anatomic regions, including cervical and upper and lower extremity and evidence-based management strategies developed.
Topics: Angiography; Angioplasty; Anticoagulants; Arteries; Carotid Artery Injuries; Evidence-Based Medicine; Extremities; History, 20th Century; Humans; Magnetic Resonance Angiography; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures; Wounds, Nonpenetrating
PubMed: 17060237
DOI: 10.1177/1531003506293450 -
Radiologic Clinics of North America Mar 2004Acute arterial emergencies can arise from direct traumatic injury to the artery or be spontaneous. This article emphasizes the various presentations of arterial... (Comparative Study)
Comparative Study Review
Acute arterial emergencies can arise from direct traumatic injury to the artery or be spontaneous. This article emphasizes the various presentations of arterial emergencies. These include acute arterial occlusions; excessive bleeding; and hematoma formation caused by penetrating arterial wall injuries, pseudoaneurysms, and arteriovenous fistulas. The broad category of arterial occlusions includes traumatic lacerations, embolizations, and arterial dissections. Modern ultrasound equipment is a rapid and convenient imaging approach in many of these clinical scenarios. In combination with MR angiography and CT angiography, these noninvasive tests can diagnose the presence of most arterial injuries, and be used to measure their impact.
Topics: Aortic Dissection; Aneurysm, False; Arteries; Arteriovenous Fistula; Carotid Artery Injuries; Female; Hematoma; Humans; Male; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Stroke; Ultrasonography, Doppler, Color; Vascular Diseases; Wounds and Injuries
PubMed: 15136023
DOI: 10.1016/j.rcl.2004.01.007 -
The Australian and New Zealand Journal... Feb 1986A 5 year retrospective review of blunt arterial injuries at the Royal Brisbane Hospital revealed that delay in diagnosis had catastrophic effects on limb survival. Only...
A 5 year retrospective review of blunt arterial injuries at the Royal Brisbane Hospital revealed that delay in diagnosis had catastrophic effects on limb survival. Only 17 of 23 patients with arterial injury were diagnosed at the time of admission. No record of symptoms of limb ischaemia was made in 13 patients and no signs recorded in five. Eight limbs required amputation. Improved results should follow more accurate diagnosis at the time of admission.
Topics: Adolescent; Adult; Amputation, Surgical; Arm; Arm Injuries; Arteries; Female; Humans; Ischemia; Leg; Leg Injuries; Male; Reoperation; Retrospective Studies; Wounds, Nonpenetrating
PubMed: 3460548
DOI: 10.1111/j.1445-2197.1986.tb01871.x -
The Australian and New Zealand Journal... Jan 1997The present study was performed to identify the factors associated with amputation in patients with blunt injuries to the lower limb associated with arterial injury. The...
BACKGROUND
The present study was performed to identify the factors associated with amputation in patients with blunt injuries to the lower limb associated with arterial injury. The ability of a scoring system to predict the outcome was tested.
METHODS
There were 122 lower limb arterial injuries in 119 patients treated at the Royal Adelaide Hospital in the years 1962-1994. Prognostic factors considered were the site of the injury, the severity of the soft-tissue injury and shock, the presence of associated injuries and a description of the bone or joint injury. The mangled extremity severity score (MESS) was calculated retrospectively for each patient.
RESULTS
The outcome was primary amputation in 27 patients, delayed amputation in 36 patients and limb salvage in 59 patients. The seven deaths were all due to associated injuries. Factors associated with amputation were the severity of shock and soft-tissue injury (P < 0.01), and tibial artery injury compared with more proximal injury (P < 0.001). Factors that did not affect outcome included delay before repair, method of fracture fixation, or performance of fasciotomy. Amputation was performed in 48/71 (68%) patients with Gustilo type-IIIC fractures of the tibia. Applying the MESS to our patients resulted in a positive predictive value (PPV) of 71%, a negative predictive value (NPV) of 84% and an overall accuracy of prediction of 75%.
CONCLUSIONS
The major factor determining outcome was the severity of the soft-tissue injury. Progressive necrosis and infection was a major cause of late amputation. The MESS is not sufficiently precise to allow the decision regarding amputation to be made at the initial operation.
Topics: Accidents, Occupational; Accidents, Traffic; Adolescent; Aged; Amputation, Surgical; Aorta; Child; Child, Preschool; Female; Femoral Artery; Fractures, Bone; Humans; Iliac Artery; Male; Middle Aged; Popliteal Artery; Prognosis; Retrospective Studies; Shock; Soft Tissue Injuries; Tibial Arteries; Trauma Severity Indices; Wounds, Nonpenetrating
PubMed: 9033372
DOI: 10.1111/j.1445-2197.1997.tb01889.x -
Annals of Surgery Dec 1947
Topics: Arteries; Humans; Vascular System Injuries
PubMed: 17859042
DOI: 10.1097/00000658-194712000-00003 -
The Journal of Bone and Joint Surgery.... Nov 2000We have analysed the results of repair of traumatic lesions of the musculocutaneous nerve in 85 patients, which were graded by Seddon's modification of the Medical...
We have analysed the results of repair of traumatic lesions of the musculocutaneous nerve in 85 patients, which were graded by Seddon's modification of the Medical Research Council system into three types of injury: open 'tidy', open 'untidy' and closed 'traction'. They were also correlated with associated arterial injury. There were 57 good, 17 fair and 11 poor results. The type of injury was the most important factor in determining the result; 12 of 13 open-tidy lesions gave good results compared with 30 of 48 closed-traction lesions. The results were better when the nerves were repaired within 14 days of injury and when grafts were less than 10 cm long. They were worse in the presence of associated arterial or bony injury.
Topics: Adolescent; Adult; Arteries; Chi-Square Distribution; Child; Child, Preschool; Forearm; Humans; Injury Severity Score; Middle Aged; Multiple Trauma; Musculocutaneous Nerve; Nerve Regeneration; Prospective Studies; Range of Motion, Articular; Reoperation; Replantation; Suture Techniques; Time Factors; Treatment Outcome; Wounds and Injuries
PubMed: 11132274
DOI: 10.1302/0301-620x.82b8.10791