-
Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2016The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury...
BACKGROUND
The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma.
METHODS
Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability.
RESULTS
Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days).
CONCLUSION
In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.
Topics: Adolescent; Adult; Aneurysm, False; Arteries; Blood Vessel Prosthesis Implantation; Embolization, Therapeutic; Emergency Treatment; Endovascular Procedures; Female; Humans; Length of Stay; Male; Middle Aged; Outcome Assessment, Health Care; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Turkey; Vascular System Injuries; Wounds, Nonpenetrating; Wounds, Penetrating; Young Adult
PubMed: 28074458
DOI: 10.5505/tjtes.2016.92645 -
Journal of Vascular Surgery Oct 2008Percutaneous catheterization is a frequently-used technique to gain access to the central venous circulation. Inadvertent arterial puncture is often without consequence,... (Review)
Review
BACKGROUND
Percutaneous catheterization is a frequently-used technique to gain access to the central venous circulation. Inadvertent arterial puncture is often without consequence, but can lead to devastating complications if it goes unrecognized and a large-bore dilator or catheter is inserted. The present study reviews our experience with these complications and the literature to determine the safest way to manage catheter-related cervicothoracic arterial injury (CRCAI).
METHODS
We retrospectively identified all cases of iatrogenic carotid or subclavian injury following central venous catheterization at three large institutions in Montreal. We reviewed the French and English literature published from 1980 to 2006, in PubMed, and selected studies with the following criteria: arterial misplacement of a large-caliber cannula (>/=7F), adult patients (>18 years old), description of the method for managing arterial trauma, reference population (denominator) to estimate the success rate of the therapeutic option chosen. A consensus panel of vascular surgeons, anesthetists and intensivists reviewed this information and proposed a treatment algorithm.
RESULTS
Thirteen patients were treated for CRCAI in participating institutions. Five of them underwent immediate catheter removal and compression, and all had severe complications resulting in major stroke and death in one patient, with the other four undergoing further intervention for a false aneurysm or massive bleeding. The remaining eight patients were treated by immediate open repair (six) or through an endovascular approach (two) for subclavian artery trauma without complications. Five articles met all our inclusion criteria, for a total of 30 patients with iatrogenic arterial cannulation: 17 were treated by immediate catheter removal and direct external pressure; eight (47%) had major complications requiring further interventions; and two died. The remaining 13 patients submitted to immediate surgical exploration, catheter removal and artery repair under direct vision, without any complications (47% vs 0%, P = .004).
CONCLUSION
During central venous placement, prevention of arterial puncture and cannulation is essential to minimize serious sequelae. If arterial trauma with a large-caliber catheter occurs, prompt surgical or endovascular treatment seems to be the safest approach. The pull/pressure technique is associated with a significant risk of hematoma, airway obstruction, stroke, and false aneurysm. Endovascular treatment appears to be safe for the management of arterial injuries that are difficult to expose surgically, such as those below or behind the clavicle. After arterial repair, prompt neurological evaluation should be performed, even if it requires postponing elective intervention. Imaging is suggested to exclude arterial complications, especially if arterial trauma site was not examined and repaired.
Topics: Aged; Aged, 80 and over; Algorithms; Arteries; Catheterization, Central Venous; Female; Humans; Male; Middle Aged; Neck; Retrospective Studies; Thorax; Wounds and Injuries
PubMed: 18703308
DOI: 10.1016/j.jvs.2008.04.046 -
Angiologia 1974
Topics: Arteries; Blood Vessel Prosthesis; Humans; Wounds and Injuries
PubMed: 4440917
DOI: No ID Found -
The Surgical Clinics of North America Aug 1988Abdominal vascular injuries remain rare in centers that primarily treat victims of blunt trauma, but when penetrating wounds of the abdomen are commonly treated, the... (Review)
Review
Abdominal vascular injuries remain rare in centers that primarily treat victims of blunt trauma, but when penetrating wounds of the abdomen are commonly treated, the incidence of abdominal vascular injuries is surprisingly high. With suitable management, many of these patients survive.
Topics: Abdominal Injuries; Aorta, Abdominal; Arteries; Hemorrhage; Hepatic Veins; Humans; Iliac Artery; Mesenteric Arteries; Mesenteric Veins; Portal Vein; Renal Artery; Shock; Veins; Vena Cava, Inferior; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 3046003
DOI: 10.1016/s0039-6109(16)44583-4 -
Annals of Surgery Mar 1971
Topics: Angiography; Arteries; Blood Vessel Prosthesis; Debridement; Fasciotomy; Heparin; Humans; Postoperative Complications; Suture Techniques; Therapeutic Irrigation; Wounds and Injuries; Wounds, Gunshot
PubMed: 4927238
DOI: 10.1097/00000658-197103000-00011 -
The Journal of Trauma and Acute Care... Aug 2016The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless,...
BACKGROUND
The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care.
METHODS
Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to the ME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 to 1988.
RESULTS
Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. Most of the injuries in both groups were managed with primary repair (45% vs. 46%; p = 0.89). A similar proportion of injuries in each group was managed with anticoagulation alone (14% vs. 10%; p = 0.40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between the groups (bivariate comparison): mortality (ME, 15% vs. PE, 14%; p = 0.76), amputation following subclavian or axillary artery injury (ME, 5% vs. PE, 4%; p = 0.58), and posttreatment stroke following carotid injury (ME, 2% vs. PE, 6%; p = 0.57).
CONCLUSIONS
Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries.
LEVEL OF EVIDENCE
Therapeutic study, level V.
Topics: Adult; Axillary Artery; Blood Vessel Prosthesis Implantation; Brachiocephalic Trunk; Carotid Artery Injuries; Female; Humans; Injury Severity Score; Ligation; Male; Registries; Stents; Subclavian Artery; Tennessee; Thoracic Injuries; Trauma Centers; Treatment Outcome; Vascular System Injuries; Wounds, Penetrating
PubMed: 27192470
DOI: 10.1097/TA.0000000000001103 -
The Journal of Trauma Nov 1980There has been little attention paid to the persistence of the pulse following complete forearm arterial transection, and we found no report that has established the...
There has been little attention paid to the persistence of the pulse following complete forearm arterial transection, and we found no report that has established the etiology or frequency of this phenomenon. Eighteen patients with documented complete radial or ulnar artery transections were evaluated. Nine of the 18 patients had persistently palpable pulse distal to the transections. Seven of the pulses were due to retrograde flow and two were due to transmission from the proximal arterial stump or large collaterals. The Allen test was accurate in demonstrating arterial occlusion in each case. Digital compression of the intact artery eliminated the pulse in those cases due to retrograde flow. Documentation of flow direction and collateral vessels was performed with the Doppler directional velocity meter. The fallibility of the peripheral pulse following complete arterial injury is stressed. The Allen test, digital compression of the intact artery, and Doppler studies should be performed on patients with suspected arterial injuries. The exploration of all wounds in the region of major arteries from which profuse bleeding has occurred is recommended.
Topics: Arteries; Blood Flow Velocity; Collateral Circulation; Doppler Effect; False Negative Reactions; Forearm; Humans; Palpation; Pulse; Regional Blood Flow; Wounds, Penetrating
PubMed: 7431451
DOI: 10.1097/00005373-198011000-00007 -
Vascular and Endovascular Surgery May 2020Infrapopliteal arterial pseudoaneurysms (IAP) following blunt trauma with associated orthopedic injuries are uncommon, often present in a delayed fashion, and encompass... (Review)
Review
OBJECTIVES
Infrapopliteal arterial pseudoaneurysms (IAP) following blunt trauma with associated orthopedic injuries are uncommon, often present in a delayed fashion, and encompass a diagnostic and therapeutic dilemma. Herein, we present a series of IAPs that were diagnosed following blunt trauma and their management.
METHODS
Case series consisting of 3 patients and a review of the international literature.
RESULTS
Our case series included 3 patients presenting with IAPs following blunt trauma with associated orthopedic injuries. They were all identified in a delayed manner (>3 weeks) after the orthopedic injuries were treated. All patients presented with pain and a pulsatile mass while one concurrently had neurologic deficits. The pseudoaneurysms were diagnosed by duplex ultrasound and confirmed by angiography to be originating from the tibioperoneal trunk, anterior tibial, and posterior tibial arteries respectively. Two patients were treated with surgical excision. Of these, one required an arterial bypass procedure while the other underwent direct ligation only. The third patient was treated by endovascular coiling. A literature review from 1950 to the present found 51 reported cases of IAP resulting from blunt trauma. Ninety percent of trauma-related infrapopliteal injuries occurred in men with a mean delay in diagnosis of 5.6 months (median 1.8 months) after injury. Since 1950, management has shifted from primarily ligation to incorporating minimally invasive endovascular techniques when appropriate.
CONCLUSIONS
Infrapopliteal artery pseudoaneurysms are rare following blunt skeletal trauma. A delay in diagnosis often occurs and can result in major morbidity and extensive surgical intervention. We recommend a high index of suspicion and a thorough vascular examination in patients with lower extremity skeletal trauma to help identify and treat these injuries early and effectively.
Topics: Accidents, Traffic; Adult; Aneurysm, False; Delayed Diagnosis; Embolization, Therapeutic; Humans; Ligation; Male; Middle Aged; Popliteal Artery; Predictive Value of Tests; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries; Wounds, Nonpenetrating
PubMed: 32079503
DOI: 10.1177/1538574420907184 -
The Journal of Bone and Joint Surgery.... Jun 1956
Topics: Arteries; Humans; Orthopedic Procedures; Orthopedics; Vascular System Injuries; Wounds and Injuries
PubMed: 13319421
DOI: No ID Found -
The Journal of Trauma May 1971
Topics: Animals; Arteries; Dogs; Femoral Artery; Hindlimb; Radiography; Thrombosis; Wounds, Gunshot
PubMed: 5091697
DOI: No ID Found