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The Journal of Trauma and Acute Care... Sep 2021This is a literature review on the history of venous trauma since the 1800s, especially that to the common femoral, femoral and popliteal veins, with focus on the early... (Review)
Review
ABSTRACT
This is a literature review on the history of venous trauma since the 1800s, especially that to the common femoral, femoral and popliteal veins, with focus on the early 1900s, World War I, World War II, Korean War, Vietnam War, and then civilian and military reviews (1960-2020). In the latter two groups, tables were used to summarize the following: incidence of venous repair versus ligation, management of popliteal venous injuries, patency of venous repairs when assessed <30 days from operation, patency of venous repairs when assessed >30 days from operation, clinical assessment (edema or not) after ligation versus repair, incidence of deep venous thrombosis after ligation versus repair, and incidence of pulmonary embolism after ligation versus repair.There is a lack of the following in the literature on the management of venous injuries over the past 80 years: standard definition of magnitude of venous injury in operative reports, accepted indications for venous repair, standard postoperative management, and timing and mode of early and later postoperative assessment.Multiple factors have entered into the decision on venous ligation versus repair after trauma for the past 60 years, but a surgeon's training and local management protocols have the most influence in both civilian and military centers. Ligation of venous injuries, particularly those in the lower extremities, is well tolerated in civilian trauma, although there is the usual lack of short- and long-term follow-up as noted in many of the articles reviewed.
LEVEL OF EVIDENCE
Review article, levels IV and V.
Topics: Armed Conflicts; History, 20th Century; History, 21st Century; Hospitals, Military; Humans; Military Personnel; Trauma Centers; Treatment Outcome; United States; Vascular Surgical Procedures; Veins; Wounds and Injuries
PubMed: 34137743
DOI: 10.1097/TA.0000000000003316 -
The American Surgeon Feb 1995Controversy continues over management of major venous injuries. The records of 322 patients with venous injury were reviewed. Isolated venous injury was present in 83...
Controversy continues over management of major venous injuries. The records of 322 patients with venous injury were reviewed. Isolated venous injury was present in 83 patients; 54 (65%) underwent ligation of the injured vein. Combined arterial and venous injuries were present in 239 patients; 170 (71%) patients had ligation. Injured were the inferior vena cava, iliac, femoral, popliteal, distal leg, and arm veins; all were confirmed at surgery. Arterial injuries were repaired with standard techniques; venous injuries were ligated or repaired by end-to-end or lateral phleborrhaphy. Adjunctive fasciotomy was used as clinically indicated. The patients were followed an average of 32 months. No patient with isolated venous injury developed permanent sequelae, although 29 (35%) had transient extremity edema. Transient edema developed in 86 (36%) patients with combined injury, and permanent edema occurred in 4 (2%). Edema developed regardless of vein injury ligation or repair. No extremity was lost after venous injury ligation. While repair of all venous vascular injuries is still the surgical ideal, in civilian practice permanent sequelae of venous injury ligation are rare and in patients with hemodynamic instability from blood loss, extensive local injury, associated organ injury, anesthesia requirements, or other concerns venous ligation is acceptable.
Topics: Adolescent; Adult; Aged; Arteries; Child; Edema; Extremities; Female; Femoral Vein; Follow-Up Studies; Humans; Iliac Vein; Ligation; Male; Middle Aged; Popliteal Vein; Postoperative Complications; Retrospective Studies; Veins; Vena Cava, Inferior; Wounds and Injuries
PubMed: 7856974
DOI: No ID Found -
Perspectives in Vascular Surgery and... Jun 2011Historically, epidemiology, diagnosis, and management of venous trauma have not been well understood. Venous injuries often have subtle presentations, unclear... (Review)
Review
Historically, epidemiology, diagnosis, and management of venous trauma have not been well understood. Venous injuries often have subtle presentations, unclear consequences, and debatable treatment options. Many venous injuries are asymptomatic and are diagnosed only during surgical exploration for other injuries. The obvious venous injury is the one found during surgical exploration of an arterial trauma. Isolated venous injuries are difficult to diagnose and often only discovered if massive swelling or life-threatening hemorrhage occurs. Once discovered, the question is how to treat: ligation or repair. The answer is the prudent use of both methods. For patients at the brink of hemodynamic collapse, ligation is the best choice. For stable patients, an effort should be made to reestablish venous outflow. Definitive repair in unstable patients should not attempted, instead temporary solutions should be used that will allow the patient to leave the operating room quickly and began correction of hypothermia, acidosis, and coagulopathy.
Topics: Afghan Campaign 2001-; Endovascular Procedures; Hemodynamics; Humans; Iatrogenic Disease; Incidence; Iraq War, 2003-2011; Ligation; Military Medicine; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries; Veins
PubMed: 21810800
DOI: 10.1177/1531003511408336 -
Emergency Radiology Jun 2016Thoracic venous injuries are predominantly attributed to traumatic and iatrogenic causes. Gunshot wounds and knife stabbings make up the vast majority of penetrating... (Review)
Review
Thoracic venous injuries are predominantly attributed to traumatic and iatrogenic causes. Gunshot wounds and knife stabbings make up the vast majority of penetrating trauma whereas motor vehicle collisions are the leading cause of blunt trauma to the chest. Iatrogenic injuries, mostly from central venous catheter complications are being described in growing detail. Although these injuries are rare, they pose a diagnostic challenge as their clinical presentation does not substantially differ from that of arterial injury. Furthermore, the highly lethal nature of some of these injuries provides limited literature for review and probably underestimates their true incidence. The widespread use of multi-detector computed tomography (MDCT) has increased the detection rate of these lesions in hemodynamically stable patients that survive the initial traumatic event. In this article, we will discuss and illustrate various causes of injury to each vein and their supporting CT findings while briefly discussing management. The available literature will be reviewed for penetrating, blunt, and iatrogenic injuries to the vena cava, innominate, subclavian, axillary, azygos, and pulmonary veins.
Topics: Adult; Humans; Male; Motorcycles; Thoracic Injuries; Tomography, X-Ray Computed; Veins; Vena Cava, Inferior
PubMed: 26965007
DOI: 10.1007/s10140-016-1386-1 -
Perspectives in Vascular Surgery and... Jun 2006The management of venous trauma continues to be debated. Historically, ligation of injured veins is the most common modality of surgical treatment. In the past... (Review)
Review
The management of venous trauma continues to be debated. Historically, ligation of injured veins is the most common modality of surgical treatment. In the past half-century, additional techniques have been used, including primary repair, interposition graft, and occasionally endovascular techniques. Venous repair, whether in the acute or chronic setting, is believed to prevent or ameliorate the complications of pain, edema, and phlegmasia. Venous repair in civilian trauma and in wartime is commonplace; however, overall treatment strategies remain largely unchanged since the Vietnam War.
Topics: Afghanistan; Angiography; History, 20th Century; Hospitals, Military; Humans; Iraq; Phlebography; Practice Guidelines as Topic; Registries; Trauma Centers; Treatment Outcome; United States; Vascular Surgical Procedures; Veins; Vietnam Conflict; Warfare; Wounds and Injuries
PubMed: 17060235
DOI: 10.1177/1531003506293452 -
Current Opinion in General Surgery 1994Over the past 20 years, the predominant trend in the care of the civilian trauma patient has been toward less invasive therapy. Splenic injuries that are now being... (Review)
Review
Over the past 20 years, the predominant trend in the care of the civilian trauma patient has been toward less invasive therapy. Splenic injuries that are now being identified with computed tomography scan or ultrasound are managed without laparotomy. Similarly, in caring for the patient with potential vascular injury of the extremity, the trend has been toward less invasive means of diagnosis and therapy. Defining which patients need angiography and how to use duplex scanning and pressure indices are still evolving issues.
Topics: Aneurysm, False; Arteries; Diagnostic Imaging; Humans; Multiple Trauma; Veins; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 7583998
DOI: No ID Found -
Injury Jan 2012AAST-OIS grade V complex hepatic injuries are often fatal as a result of exsanguination. We report a patient presenting in extremis with a penetrating injury to the... (Review)
Review
AAST-OIS grade V complex hepatic injuries are often fatal as a result of exsanguination. We report a patient presenting in extremis with a penetrating injury to the right kidney, liver, middle hepatic vein, diaphragm, and lung. A combination of intrahepatic balloon tamponade and hepatic venous stenting was used to control exsanguinating haemorrhage, the first time this combination has been reported. Rapid assessment and treatment and a team approach, together with the innovative application of haemostatic techniques, allowed a multidisciplinary team to salvage this patient.
Topics: Adult; Balloon Occlusion; Diaphragm; Hepatic Veins; Humans; Kidney; Liver; Male; Stents; Treatment Outcome; Wounds, Stab
PubMed: 21917256
DOI: 10.1016/j.injury.2011.08.028 -
Surgery Jan 1993
Topics: Humans; Politics; Vascular Diseases; Veins; Wounds and Injuries
PubMed: 8417479
DOI: No ID Found -
The Journal of Trauma Aug 1982Survivors of innominate and other major cardiovascular injuries are being seen with increasing frequency. Penetrating injuries more frequently involve the distal...
Survivors of innominate and other major cardiovascular injuries are being seen with increasing frequency. Penetrating injuries more frequently involve the distal innominate artery and innominate veins. Associated subclavian and carotid artery injuries are more frequent following penetrating trauma. Blunt trauma typically involves the proximal innominate artery. A variety of operative exposures is useful but the selection of incision frequently depends upon the presence or absence of associated mediastinal injuries. Partial or complete median sternotomy in combination with various cervical and thoracic extensions is advised. Successful management of innominate artery injury can be performed without the aid of cardiopulmonary bypass or arterial shunts.
Topics: Blood Vessel Prosthesis; Brachiocephalic Trunk; Brachiocephalic Veins; Cardiopulmonary Bypass; Humans; Methods; Radiography; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 7050402
DOI: 10.1097/00005373-198208000-00001 -
The Surgical Clinics of North America Aug 1988There has been considerable interest in the management of injured extremity veins since the American experience during the Vietnam War. Fortunately, there are an... (Review)
Review
There has been considerable interest in the management of injured extremity veins since the American experience during the Vietnam War. Fortunately, there are an increasing number of reports from civilian experience in the United States that add valuable information. Although the controversy continues, it appears that there is merit in repair of many injured lower-extremity veins, particularly the popliteal vein when it is a single return conduit, assuming that the patient's general condition will permit, in an attempt to prevent acute venous hypertension initially and chronic venous hypertension subsequently. Figure 1 identifies the recovery potential that exists even if the initial venous repair fails. In contrast to thrombosis in the arterial system, recanalization is the rule in venous thrombosis. Patent valves can exist above and below the rather localized area of thrombosis. It appears that recanalization will prevent the problems of chronic venous insufficiency. It is obvious that many patients do well for years; however, the sequelae of acute venous hypertension may be more demonstrable after 10 or 15 years. There has not been similar evidence supporting a more aggressive approach in general in upper-extremity veins. However, it should be appreciated that a return pathway must remain patent, as noted in replantation of extremities. Obviously, there are differences in military and civilian wounds, with the former usually having more extensive soft-tissue destruction and obliteration of collateral veins and lymphatic channels. Unfortunately, many civilian gunshot wounds are being seen in the United States that are similar to the military type. We must not forget the lessons of the past, and we must continue to analyze our experience in the management of injured veins under a variety of conditions.
Topics: Blood Vessel Prosthesis; Femoral Vein; Humans; Leg Injuries; Registries; United States; Veins
PubMed: 3046007
DOI: 10.1016/s0039-6109(16)44587-1