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Annals of Surgery Jan 1976During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was...
During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was below 90 mm Hg upon admission in 55.6% of all patients and 37.7% of those with injuries to arteries of the extremities. The decision for operative exploration and repair of arteries of extremities was based largely on clinical grounds (shock, loss of pulse). Preoperative arteriography was needed infrequently, while operative angiography was nearly routine. Although several cases of late revascularization or traumatic thrombosis of renal artery have been reported, hypertension complicates the postoperative period, and early, aggressive approach is essential. Mortality was 10.6%, from aortic injuries. There were no deaths among patients with arterial injuries distal to inguinal ligament or thoracic outlet. The amputation rate from reconstruction failure was 1.1%, none occurring in the last 3 years of the series. The high patency rate and lack of evidence of pulmonary embolization suggest that associated venous injuries be repaired routinely. Arterial injuries represent ideal lesions (normal arterial wall with excellent run-in and run-off). Prompt treatment of shock and early, proper management of patients' mechanical disruptions will salvage many lives and most limbs.
Topics: Adolescent; Adult; Amputation, Surgical; Arteries; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Radiography; Shock, Hemorrhagic; Time Factors; Transplantation, Autologous; Veins; Wounds and Injuries
PubMed: 1247296
DOI: 10.1097/00000658-197601000-00004 -
Annals of Vascular Surgery Feb 2021The ability to salvage the mangled lower extremity is both technically challenging and time consuming. It requires the collaborative efforts among multiple surgical...
BACKGROUND
The ability to salvage the mangled lower extremity is both technically challenging and time consuming. It requires the collaborative efforts among multiple surgical specialties in addition to comprehensive post-traumatic wound follow-up. Our institution has integrated a dynamic effort among these specialists in the planning and facilitating a successful limb salvage program with creation of a mangled extremity algorithm. An integral part in this process is the vascular inflow to prepare coverage for large tissue defects lacking adequate recipient targets. Utilization of long saphenous arteriovenous (AV) loop has been cited with minimal data available using larger inflow vessels in the acute trauma setting. We performed a retrospective review and describe our early experience using our protocol with AV loop creation with free flap reconstruction to salvage traumatic leg injuries. Using the data, we sought to develop a mangled extremity protocol for trauma centers to guide mangled limb salvage.
METHODS
Since June 2016, 398 patients were admitted to our level II trauma facility with isolated traumatic wounds to the lower extremities. Thirty-one limbs were deemed mangled in which 21 received primary amputations due to multiple factors. Ten patients admitted from the trauma service with isolated mangled lower extremities injuries were identified for review. All 10 patients sustained severe crush injuries with large soft tissue defects and decreased perfusion for healing but deemed salvageable by multispecialty assessment. Mangled extremity severity scores were tabulated. Patients age ranged from 21-44 years, with 8 men and 2 women. Repeated debridements until successful sterilization of the wounds were accomplished. Ten long saphenous vein AV loops were anastomosed to the at or above knee popliteal vessels for free flap reconstruction. All patients were followed post-AV loop creation for vascular complications and wound assessments.
RESULTS
All 10 patients had sterilization of the wounds with repair of the fracture site before vascular reconstruction. Mean debridement to surgical site sterilization was 4.3 washouts (range 2-7). Successful AV loop creation with long saphenous vein was completed in 100% of patients without vascular complications nor steal events. Free flap tissue transfers directly connected to the loop were completed using 6 rectus abdominis, 3 latissimus dorsi, and 1 anterior thigh graft within 10 days of its creation. Patency rates of the AV loop was 100% with 10 successful flap transfers and 90% amputation free survival. One flap did not survive due to recurrent bacterial infection of the hardware. The 9 patients with successful procedures reached preoperative ambulatory status within 3 months after their final surgery. At 24 months follow-up, 90% amputation free survival is still maintained.
CONCLUSIONS
Although a small patient cohort, utilization of long saphenous vein AV loop is successful as a bridge to free flap transfer for isolated mangled lower extremities. Development and incorporation of our mangled extremity protocol to guide limb salvage has proven successful in our early experience. Long-term data need to be complied to assess patency of the free flap transfer and quality of life outcomes.
Topics: Adult; Amputation, Surgical; Arteriovenous Shunt, Surgical; Crush Injuries; Debridement; Female; Femoral Artery; Free Tissue Flaps; Humans; Limb Salvage; Lower Extremity; Male; Middle Aged; Popliteal Artery; Popliteal Vein; Regional Blood Flow; Retrospective Studies; Saphenous Vein; Skin Transplantation; Time Factors; Treatment Outcome; Vascular System Injuries; Young Adult
PubMed: 32800890
DOI: 10.1016/j.avsg.2020.07.056 -
Vascular Health and Risk Management Aug 2010The purpose of this study is to report the clinical and functional outcomes of patients, treated between 2004 and 2009, with high-risk popliteal vascular injuries due to...
PURPOSE
The purpose of this study is to report the clinical and functional outcomes of patients, treated between 2004 and 2009, with high-risk popliteal vascular injuries due to compound fractures about the knee.
PATIENTS AND METHODS
A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%), primary anastomosis in 20 (32.3%), and lateral repair in 3 (4.8%) patients. The patients were divided into 2 study groups: limb salvage group (group 1) and amputation group (group 2). Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage.
RESULTS
In the entire cohort of patients, 60 patients (97%) were male and 2 were female (3%); the mean age was 34.1 years (16-49 years). The overall amputation rate in this study was 37.1% (23 amputations). Significant (P < 0.05) independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions.
CONCLUSION
Expeditious recognition of vascular injury, transport to repair, and repair of associated venous injury when possible are necessary to optimize limb salvage. The importance of a high level of suspicion and low threshold for timely amputation has been emphasized when limb salvage was deemed impossible to prevent life-threatening complication. Delays in surgery, extensive soft tissue defect, compound tibia-fibula fracture, and other factors are associated with high amputation rate following popliteal artery injury.
Topics: Adolescent; Adult; Amputation, Surgical; Female; Humans; Leg; Leg Injuries; Limb Salvage; Logistic Models; Male; Middle Aged; Popliteal Artery; Popliteal Vein; Risk Factors; Wounds, Nonpenetrating; Young Adult
PubMed: 20730017
DOI: 10.2147/vhrm.s11733 -
Revista Latino-americana de Enfermagem 2018to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs).
OBJECTIVE
to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs).
METHOD
cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used.
RESULTS
the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001).
CONCLUSION
the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheterization, Peripheral; Cohort Studies; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Incidence; Male; Middle Aged; Phlebitis; Risk Factors; Veins; Young Adult
PubMed: 29791668
DOI: 10.1590/1518-8345.2377.3002 -
AJNR. American Journal of Neuroradiology Dec 2011Different and specific MR imaging patterns of lesions involving WM are widely defined in neonatal encephalopathy. The aim of this study was to describe a novel MR...
BACKGROUND AND PURPOSE
Different and specific MR imaging patterns of lesions involving WM are widely defined in neonatal encephalopathy. The aim of this study was to describe a novel MR imaging pattern of damage characterized by the abnormal prominence of DMVs in premature and full-term neonates.
MATERIALS AND METHODS
Twenty-one (11 premature and 10 full-term) neonates with MR imaging evidence of linear radially oriented fan-shaped lesions in the periventricular WM and without dural venous thrombosis were enrolled in this retrospective study. A total of 37 MR imaging examinations were performed at ages ranging from day 0 to 24 months.
RESULTS
According to the appearance of linear anomalies on T2-weighted images, we identified 2 main patterns: T2 hypointense lesions without WM cavitations and T2 hypointense lesions associated with linear cysts. The first pattern was found in 17 examinations performed between 0 and 44 days of life; the second pattern was found in another 14 examinations performed between 6 days and 4 months of life. Five examinations performed between 9 and 24 months of life showed a reduction in volume and hyperintense signal intensity of the periventricular WM on T2-weighted and FLAIR images.
CONCLUSIONS
Subtle linear WM lesions with the same anatomic distribution of DMVs may be evident in premature and full-term neonates without signs of major venous thrombosis, both in the acute and subacute phases. Their appearance and evolution suggest that transient DMV engorgement/thrombosis may be responsible for WM damage that can lead to a PVL-like pattern.
Topics: Aging, Premature; Brain Injuries; Cerebral Veins; Female; Humans; Infant, Newborn; Magnetic Resonance Angiography; Male; Medulla Oblongata; Nerve Fibers, Myelinated; Reproducibility of Results; Sensitivity and Specificity
PubMed: 21960491
DOI: 10.3174/ajnr.A2687 -
European Journal of Vascular and... Mar 2011Popliteal vein repair and ligation are the two main approaches to the treatment of the venous component of major, complex, knee injuries with vascular involvement. We...
OBJECTIVES AND DESIGN
Popliteal vein repair and ligation are the two main approaches to the treatment of the venous component of major, complex, knee injuries with vascular involvement. We have studied the incidence of pulmonary embolism following popliteal vein repair in trauma cases using computed tomography (CT) angiography and report the outcome.
MATERIAL AND METHODS
From June 2006 to December 2009, 45 patients with popliteal vein injury were operated on in our vascular unit using lateral venorrhaphy, end-to-end anastomosis, a saphenous vein interposition graft and venous patch repair. All the patients were operated on using a medial approach to the knee. On the third postoperative day, all patients underwent a colour Doppler scan of the repaired popliteal vein to study patency, and pulmonary artery CT angiography using a 64-slice multidetector CT scan unit to establish the incidence of pulmonary embolism.
RESULTS
The number of patients treated by each method were: lateral venorrhaphy 20 (44%), end-to-end anastomosis 13 (29%), saphenous vein interposition graft 9 (20%) and venous patch repair three (7%). Two patients (4%) died because of sudden cardio-respiratory arrest the day after surgery with massive bilateral pulmonary artery embolism at autopsy. Popliteal colour duplex ultrasound imaging showed seven (16%) cases of complete vein thrombosis and seven (16%) cases of partial vein thrombosis. CT angiography showed pulmonary embolism in 11 (26%) patients. From seven patients with complete thrombosis three patients, and from seven patients with incomplete thrombosis five patients showed pulmonary embolism on CT angiography. Other than two cases of early mortality, five (12%) patients developed clinical manifestations of pulmonary embolism and 11 (26%) patients had pulmonary embolism detected by CT angiography. Seven (16%) of our patients had mild-to-severe pulmonary embolism and 13 patients (29%) had proven pulmonary embolism. The total mortality rate was 7%.
CONCLUSION
A surprisingly high incidence of pulmonary embolism was observed after popliteal vein repair in civil trauma patients. Additional prophylactic methods such as using higher doses of heparin and using inferior vena cava (IVC) filters might be needed to prevent this potentially fatal complication.
Topics: Adolescent; Adult; Analysis of Variance; Anastomosis, Surgical; Chi-Square Distribution; Female; Hospital Mortality; Humans; Incidence; Iran; Knee Injuries; Ligation; Male; Middle Aged; Popliteal Vein; Pulmonary Embolism; Saphenous Vein; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Color; Vascular Grafting; Vascular Patency; Vascular Surgical Procedures; Vascular System Injuries; Venous Thrombosis; Young Adult
PubMed: 21232992
DOI: 10.1016/j.ejvs.2010.11.028 -
PloS One 2019Machine learning techniques have demonstrated superior discrimination compared to conventional statistical approaches in predicting trauma death. The objective of this...
OBJECTIVE
Machine learning techniques have demonstrated superior discrimination compared to conventional statistical approaches in predicting trauma death. The objective of this study is to evaluate whether machine learning algorithms can be used to assess risk and dynamically identify patient-specific modifiable factors critical to patient trajectory for multiple key outcomes after severe injury.
METHODS
SuperLearner, an ensemble machine-learning algorithm, was applied to prospective observational cohort data from 1494 critically-injured patients. Over 1000 agnostic predictors were used to generate prediction models from multiple candidate learners for outcomes of interest at serial time points post-injury. Model accuracy was estimated using cross-validation and area under the curve was compared to select among predictors. Clinical variables responsible for driving outcomes were estimated at each time point.
RESULTS
SuperLearner fits demonstrated excellent cross-validated prediction of death (overall AUC 0.94-0.97), multi-organ failure (overall AUC 0.84-0.90), and transfusion (overall AUC 0.87-0.9) across multiple post-injury time points, and good prediction of Acute Respiratory Distress Syndrome (overall AUC 0.84-0.89) and venous thromboembolism (overall AUC 0.73-0.83). Outcomes with inferior data quality included coagulopathic trajectory (AUC 0.48-0.88). Key clinical predictors evolved over the post-injury timecourse and included both anticipated and unexpected variables. Non-random missingness of data was identified as a predictor of multiple outcomes over time.
CONCLUSIONS
Machine learning algorithms can be used to generate dynamic prediction after injury while avoiding the risk of over- and under-fitting inherent in ad hoc statistical approaches. SuperLearner prediction after injury demonstrates promise as an adaptable means of helping clinicians integrate voluminous, evolving data on severely-injured patients into real-time, dynamic decision-making support.
Topics: Adult; Blood Transfusion; Clinical Decision-Making; Decision Support Techniques; Female; Humans; Machine Learning; Male; Middle Aged; Models, Biological; Multiple Organ Failure; Prognosis; Prospective Studies; ROC Curve; Respiratory Distress Syndrome; Risk Assessment; Time Factors; Venous Thromboembolism; Wounds and Injuries
PubMed: 30970030
DOI: 10.1371/journal.pone.0213836 -
BMC Cardiovascular Disorders Sep 2021MiR-92a-3p and oxidative stress are associated with catheter-related thrombosis (CRT). As a kind of physical intervention, resistance exercise can effectively promote...
BACKGROUND
MiR-92a-3p and oxidative stress are associated with catheter-related thrombosis (CRT). As a kind of physical intervention, resistance exercise can effectively promote blood circulation. In this study, we investigated the roles of miR-92a-3p, oxidative stress and the P38 mitogen-activated protein kinase/nuclear factor-κB (MAPK/NF-κB) pathway in CRT during resistance exercise.
METHODS
The rat CRT model was used for resistance exercise intervention. Moreover, pathological changes from the right jugular vein to the right auricle were observed under an electron microscope. In addition, reactive oxygen species (ROS) production, malondialdehyde (MDA) activity and heme oxygenase (HO-1) level in rat serum were detected via ELISA. The expression levels of miR-92A-3p and HO-1 in the vascular tissues of the rats were determined via real-time quantitative PCR. Additionally, the expression levels of HO-1, NF-κB P65, p38MAPK and IκBa in the venous tissues of the rats were analysed by Western blot analysis.
RESULTS
The pathological results showed that the thrombosis incidence rate in the CRT + RE group was lower than that in the CRT group. In the CRT group, the expression levels of ROS and MDA, which are markers related to oxidative stress in serum, significantly increased whilst the expression of HO-1 decreased. In the venous tissue, the expression of miR-92a-3p increased, the level of HO-1 decreased, the levels of p38MAPK and NF-κB p65 significantly increased but that of P-IκBa and IκBa significantly decreased. In the CRT + RE group, after administering the resistance exercise intervention, ROS production and MDA activity in serum significantly decreased, the expression level of HO-1 increased and the expression level of miR-92a-3p in the venous tissues significantly decreased and was negatively correlated with that of HO-1. The levels of p38MAPK and NF-κB p65 significantly decreased but that of P- IκBa and IκBa significantly increased.
CONCLUSION
Resistance exercise intervention downregulated miR-92a-3p expression, repaired oxidative stress injury and prevented CRT formation.
Topics: Animals; Blood Coagulation; Catheterization, Central Venous; Disease Models, Animal; Heme Oxygenase (Decyclizing); Jugular Veins; Male; MicroRNAs; NF-kappa B; Oxidative Stress; Rats, Sprague-Dawley; Resistance Training; Signal Transduction; Vascular System Injuries; Venous Thrombosis; p38 Mitogen-Activated Protein Kinases; Rats
PubMed: 34530722
DOI: 10.1186/s12872-021-02233-w -
Experimental and Clinical... Dec 2018We investigated the effects of autologous vein transplant on bile duct injury repair, through observation of the hepatic and biliary system tissue morphology changes and...
OBJECTIVES
We investigated the effects of autologous vein transplant on bile duct injury repair, through observation of the hepatic and biliary system tissue morphology changes and animal survival after bile duct injury repair.
MATERIALS AND METHODS
Rabbits were equally divided into groups. Group A had cholecystectomy and common bile duct resection (length of 0.5 cm), transplant of an autologous vein (length of 0.5 cm), and stent implant. Group B had cholecystectomy and common bile duct resection (length of 1.0 cm), transplant of an autologous vein (length of 1.0 cm), and stent implant. The third group (group C) had cholecystectomy only.
RESULTS
Two rabbits died in group A and group B; all experimental animals from group C survived. Regarding liver biochemical indexes at preoperative week 1, at postoperative month 1, and at postoperative month 3, we found no significant differences (paired t test, P > .05). Liver biochemical indexes between groups were also not significantly different (P > .05). At month 3, postoperative liver pathology of experimental animals showed no significant changes and no cholestasis; biliary epithelial cells were seen in the transplant vascular.
CONCLUSIONS
We conclude that autologous vein graft can effectively repair bile duct injury for a short coloboma.
Topics: Animals; Autografts; Cholecystectomy; Common Bile Duct; Disease Models, Animal; Male; Prosthesis Implantation; Rabbits; Stents; Time Factors; Veins; Wounds and Injuries
PubMed: 29025383
DOI: 10.6002/ect.2016.0309 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2009Peripheral vascular injuries are frequently encountered in lethal and nonlethal trauma. Although significant improvements in treatment have been achieved, such injuries...
BACKGROUND
Peripheral vascular injuries are frequently encountered in lethal and nonlethal trauma. Although significant improvements in treatment have been achieved, such injuries are still important causes of mortality.
METHODS
In this study, the records of 6769 autopsies performed between 1996 and 2006 at the Council of Forensic Medicine Bursa Group Chairmanship Morgue Department were evaluated retrospectively.
RESULTS
The 63 cases (0.9%) who were determined to have died due to vascular injury were included in this study. Fifty-seven cases (90.5%) were men (mean age: 36 years); 58.7% of the injuries were due to stab wounds. The femoral artery and vein were the most frequently injured vessels. The origin was a homicide in 85.7% of the cases. In 25% of the cases, blood alcohol levels were between 44 and 256 mg/dL.
CONCLUSION
The availability of experienced surgical teams and effective prehospital emergency care are vital for decreasing the mortality due to extremity vascular injuries. In the autopsy of a patient who died primarily due to extremity vascular injury, the injured vessel, numbers of injuries and of lethal injuries, and locations and sides of the injuries shed light on the possible presence of intention.
Topics: Adult; Autopsy; Blood Vessels; Extremities; Female; Femoral Artery; Femoral Vein; Humans; Male; Mortality; Retrospective Studies; Wounds, Stab
PubMed: 19669965
DOI: No ID Found