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British Journal of Sports Medicine Sep 1991A case is reported of acquired venous aneurysms in the superficial forearm veins of an oarsman. The aetiology, presentation and complications are discussed.
A case is reported of acquired venous aneurysms in the superficial forearm veins of an oarsman. The aetiology, presentation and complications are discussed.
Topics: Adult; Aneurysm; Athletic Injuries; Cumulative Trauma Disorders; Forearm; Humans; Male; Physical Education and Training; Veins
PubMed: 1777783
DOI: 10.1136/bjsm.25.3.149 -
Journal of the National Medical... Apr 1995Lacerations of the inferior vena cava are associated with a high mortality and may be difficult to repair. The majority of injuries are due to penetrating trauma. Rapid... (Review)
Review
Lacerations of the inferior vena cava are associated with a high mortality and may be difficult to repair. The majority of injuries are due to penetrating trauma. Rapid transportation to definitive surgical care with effective resuscitation may improve mortality. Surgical management includes adequate treatment of hypovolemic shock due to blood loss. Placement of intravenous infusion sites below the level of the diaphragm may be effective. Operative control of the inferior vena cava can be accomplished by directed digital compression followed by a proximal and distal control. Injuries of the inferior vena cava above the level of the renal veins are associated with an increased mortality. Retrohepatic and subdiaphragmatic injuries are highly lethal. This article discusses appropriate surgical approaches for repair of the inferior vena cava above and below the diaphragm.
Topics: Emergency Medical Services; Humans; Rupture; Vena Cava, Inferior
PubMed: 7752285
DOI: No ID Found -
Journal of Vascular Surgery Apr 2010The purpose of this study is to document the incidence of vascular complications during anterior lumbar interbody fusion (ALIF) in 212 consecutive patients treated at...
OBJECTIVE
The purpose of this study is to document the incidence of vascular complications during anterior lumbar interbody fusion (ALIF) in 212 consecutive patients treated at the Scripps Clinic and determine what factors adversely affected outcome.
METHODS
We reviewed the prospectively maintained database of all ALIF procedures performed at Scripps Clinic between August 2004 and June 2009. All procedures were performed by a spine surgeon in conjunction with a vascular surgeon who performed the exposure portion of the operation, and protected the vessels from injury during the instrumentation phase of the operation.
RESULTS
Two hundred twelve ALIF operations were identified. The mean age of the patients was 53.8 years, and 120 (56.6%) were female. The mean body mass index (BMI) was 29.6 (range, 18.1 to 47.8). Twenty-two (10.4%) operations were performed at the L4-5 disc space, 149 (70.3%) at L5-S1, and 41 (19.3%) involved L4-L5 with L5-S1. The mean estimated blood loss (EBL) was 143 milliliters. There was a significant direct correlation between increasing BMI and EBL (P = .018). Thirteen (6.1%) vascular injuries occurred of which five were major (38.5%). One major arterial injury (0.5%) occurred and required arterial thrombectomy and stent placement. Four of the major vascular injuries were venous in nature and required a multi-suture repair. The remaining eight injuries (61.5%) were venous, the majority of which required a suture repair. There were no mortalities. There was an increase risk of vascular injury when both L4-L5 and L5-S1 were exposed (P = .003) and with the male gender (P = .013). Calcification of the aorto-iliac system did not exert an effect on EBL or vascular injury. In four cases, the surgeon was unable to expose the appropriate disc levels.
CONCLUSIONS
Anterior exposure of the spine for ALIF can be performed safely with a team approach that includes a vascular surgeon. Preoperative evaluation by a vascular surgeon is advisable. Patients with increased BMI and bi-level exposures should be approached with caution.
Topics: Adult; Aged; Aged, 80 and over; Arteries; Blood Loss, Surgical; Body Mass Index; California; Databases as Topic; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Spinal Fusion; Suture Techniques; Treatment Outcome; Vascular Surgical Procedures; Veins; Wounds and Injuries; Young Adult
PubMed: 20347691
DOI: 10.1016/j.jvs.2009.11.039 -
Penetrating femoropopliteal injury during modern warfare: experience of the Balad Vascular Registry.Journal of Vascular Surgery Jun 2008Wounding patterns, methods of repair, and outcomes from femoropopliteal injury have been documented in recent civilian literature. In Operation Iraqi Freedom, as in past...
OBJECTIVE
Wounding patterns, methods of repair, and outcomes from femoropopliteal injury have been documented in recent civilian literature. In Operation Iraqi Freedom, as in past conflicts, these injuries continue to be a therapeutic challenge. Therefore, the objective of the current study is to document the pattern of femoropopliteal injuries, methods of repair, and early outcomes during the current military campaign in Iraq.
METHODS
From September 1, 2004, to April 30, 2007, all vascular injuries arriving at the Air Force Theater Hospital (the central echelon III medical facility in Iraq; equivalent to a civilian level I trauma center), Balad Air Base, Iraq were prospectively entered into a registry. From this, injuries involving the lower extremities were reviewed.
RESULTS
During the 32-month study period, 9289 battle-related casualties were assessed. Of these, 488 (5.3%) were diagnosed with 513 vascular injuries, and 142 casualties sustained 145 injuries in the femoropopliteal domain. Femoral level injury was present in 100, and popliteal level injury occurred in 45. Injuries consisted of 59 isolated arterial, 11 isolated venous, and 75 combined. Fifty-eight casualties were evacuated from forward locations. Temporary arterial shunts were placed in 43, of which 40 (93%) were patent on arrival at our facility. Our group used shunts for early reperfusion before orthopedic fixation, during mass casualty care, or autogenous vein harvest in 11 cases. Arterial repair was accomplished with autogenous vein in 118 (88%), primary means in nine (7%), or ligation in seven (5%). Venous injury was repaired in 62 (72%). Associated fracture was present in 55 (38%), and nerve injury was noted in 19 (13%). Early limb loss due to femoropopliteal penetrating injury occurred in 10 (6.9%). Early mortality was 3.5% (n = 5).
CONCLUSIONS
Femoropopliteal vascular injury remains a significant reality in modern warfare. Femoral injuries appear more prevalent than those in the popliteal region. Early results of in-theater repair are comparable with contemporary civilian reports and are improved from the Vietnam era. Rapid evacuation and damage control maneuvers such as temporary shunting and early fasciotomy assist timely definitive repair and appear effective.
Topics: Amputation, Surgical; Blood Vessels; Femoral Artery; Femoral Vein; Hospitals, Military; Humans; Iraq; Iraq War, 2003-2011; Ligation; Limb Salvage; Military Personnel; Popliteal Artery; Popliteal Vein; Registries; Reoperation; Retrospective Studies; Treatment Outcome; United States; Vascular Surgical Procedures; Veins; Wounds, Penetrating
PubMed: 18407450
DOI: 10.1016/j.jvs.2008.01.052 -
Journal of Addictive Diseases Oct 2010Injection users are at risk for vascular injuries resulting in chronic venous disease (CVD). The authors examined walking mobility in relation to CVD for 713 individuals...
Injection users are at risk for vascular injuries resulting in chronic venous disease (CVD). The authors examined walking mobility in relation to CVD for 713 individuals in methadone treatment. The authors used a cross-sectional, comparative design that was stratified on age, sex, ethnicity, and drug use. CVD was present in 92.3% of participants. The structural equation model supported the causal link between leg injection and CVD (.40, P<.001). The worse the mobility, the greater was the CVD classification (-.21, P<.001). CVD had an indirect effect on mobility through pain. CVD and pain need to be considered when assessing mobility in illicit drug users.
Topics: Adult; Aged; Chronic Disease; Cross-Sectional Studies; Female; Humans; Illicit Drugs; Leg Injuries; Male; Methadone; Middle Aged; Mobility Limitation; Models, Statistical; Pain; Pain Measurement; Substance Abuse, Intravenous; Vascular System Injuries; Veins; Walking
PubMed: 20924885
DOI: 10.1080/10550887.2010.509275 -
Journal of the American College of... Aug 1993The aim of this study was to look at the prevalence of coronary atherosclerosis, its severity and site of involvement in patients < 35 years old who died from noncardiac... (Comparative Study)
Comparative Study Review
OBJECTIVES
The aim of this study was to look at the prevalence of coronary atherosclerosis, its severity and site of involvement in patients < 35 years old who died from noncardiac trauma.
BACKGROUND
Autopsies performed on casualties of the Korean War revealed coronary artery involvement in 77.3% of the hearts studied, and data after the Vietnam War noted the presence of atherosclerosis in 45% of casualties with severe disease in 5%, suggesting a decline in the prevalence of coronary atherosclerosis in young men.
METHODS
One hundred eleven victims of noncardiac trauma (86.4% white with a mean age of 26 +/- 6 years) underwent pathologic examination of their coronary arteries to estimate the presence and severity of coronary atherosclerosis grossly, microscopically and through computerized planimetry. Identified segments of the coronary arteries were sectioned at 3-mm intervals, stained with special stains and after microscopic examination transferred to videotape and digitized to allow estimation of the percent compromise in the lumen area by atherosclerotic plaque.
RESULTS
Signs of coronary atherosclerosis were seen in 78.3% of the total study group, with > 50% narrowing in 20.7% and > 75% narrowing in 9%. No demographic or anatomic features separated the groups with less or more severe involvement of their coronary arteries. Proximal involvement was more common except in the right coronary artery, which was as frequently involved distally.
CONCLUSIONS
The overall prevalence of coronary atherosclerosis in a young, predominantly male study group was comparable with that noted after the Korean War. Left main or significant two- and three-vessel involvement was noted in 20% of the group studied and emphasizes the need for aggressive risk factor modification in this group.
Topics: Adolescent; Adult; Autopsy; Body Mass Index; Coronary Artery Disease; Coronary Vessels; Female; Humans; Image Processing, Computer-Assisted; Male; Prevalence; Risk Factors; Tennessee; Wounds and Injuries
PubMed: 8335815
DOI: 10.1016/0735-1097(93)90050-b -
International Heart Journal Nov 2021Catheter ablation is a treatment modality which has been increasingly used for cardiac arrhythmias. However, it is not complication-free, and cardiac perforation is one...
Catheter ablation is a treatment modality which has been increasingly used for cardiac arrhythmias. However, it is not complication-free, and cardiac perforation is one of its most life-threatening complications. As surgery is usually not the first-line treatment for this emergent episode, there were only very few sporadic surgical reports in the literature. This systemic review primarily aims to collect different surgical approaches for catheter-induced cardiac perforation to help surgeons manage this kind of uncommon and critical patients. Of the 452 initially screened articles, 22 studies (38 patients) were included in the systemic review. Of all the included patients, 84% (32/38) were found to have pericardial effusion acutely following catheter-related procedures, and 16% (6/38) experienced delayed-onset episodes. Regarding the surgical procedures, four patients underwent removal of clots only, eight patients underwent suture repair of the left ventricle (LV), nine patients underwent suture repair of the right ventricle (RV), five patients underwent suture repair of the LA, and four patients underwent sutureless repair of the LV and pulmonary vein (LV 1, RV 1, pulmonary vein 1). In addition to repair of perforation sites, the concomitant combined procedures included repair of intercostal vessels (complication of pericardiocentesis) for one patient, cryoablation for two patients, and maze procedure for one patient. For cardiac perforation following catheter ablation or electrophysiology study, although the majority of the patients are treated with pericardiocentesis and medical management at first, cardiovascular surgeons have to prepare to take over if the bleeding is persistent or if the cardiac tamponade is not relieved.
Topics: Catheter Ablation; Electrophysiologic Techniques, Cardiac; Heart Injuries; Humans; Pulmonary Veins; Sutures
PubMed: 34789643
DOI: 10.1536/ihj.21-201 -
Molecular Medicine (Cambridge, Mass.) Dec 2019HMGB1 is a mediator of systemic inflammation in sepsis and trauma, and a promising biomarker in many diseases. There is currently no standard operating procedure for... (Comparative Study)
Comparative Study
BACKGROUND
HMGB1 is a mediator of systemic inflammation in sepsis and trauma, and a promising biomarker in many diseases. There is currently no standard operating procedure for pre-analytical handling of HMGB1 samples, despite that pre-analytical conditions account for a substantial part of the overall error rate in laboratory testing. We hypothesized that the considerable variations in reported HMGB1 concentrations and kinetics in trauma patients could be partly explained by differences in pre-analytical conditions and choice of sample material.
METHODS
Trauma patients (n = 21) admitted to a Norwegian Level I trauma center were prospectively included. Blood was drawn in KEDTA coated tubes and serum tubes. The effects of delayed centrifugation were evaluated in samples stored at room temperature for 15 min, 3, 6, 12, and 24 h respectively. Plasma samples subjected to long-term storage in - 80 °C and to repeated freeze/thaw cycles were compared with previously analyzed samples. HMGB1 concentrations in simultaneously acquired arterial and venous samples were also compared. HMGB1 was assessed by standard ELISA technique, additionally we investigated the suitability of western blot in both serum and plasma samples.
RESULTS
Arterial HMGB1 concentrations were consistently lower than venous concentrations in simultaneously obtained samples (arterial = 0.60 x venous; 95% CI 0.30-0.90). Concentrations in plasma and serum showed a strong linear correlation, however wide limits of agreement. Storage of blood samples at room temperature prior to centrifugation resulted in an exponential increase in plasma concentrations after ≈6 h. HMGB1 concentrations were fairly stable in centrifuged plasma samples subjected to long-term storage and freeze/thaw cycles. We were not able to detect HMGB1 in either serum or plasma from our trauma patients using western blotting.
CONCLUSIONS
Arterial and venous HMGB1 concentrations cannot be directly compared, and concentration values in plasma and serum must be compared with caution due to wide limits of agreement. Although HMGB1 levels in clinical samples from trauma patients are fairly stable, strict adherence to a pre-analytical protocol is advisable in order to protect sample integrity. Surprisingly, we were unable to detect HMGB1 utilizing standard western blot analysis.
Topics: Adolescent; Adult; Aged; Arteries; Biomarkers; Blood Specimen Collection; Female; Freezing; HMGB1 Protein; Humans; Male; Middle Aged; Prospective Studies; Temperature; Time Factors; Veins; Wounds and Injuries; Young Adult
PubMed: 31892315
DOI: 10.1186/s10020-019-0131-0 -
Plastic and Reconstructive Surgery Jul 2024Although the zone-of-injury concept is widely accepted, no histologic studies of vessel wall changes causing the phenomenon have been reported. In this prospective...
BACKGROUND
Although the zone-of-injury concept is widely accepted, no histologic studies of vessel wall changes causing the phenomenon have been reported. In this prospective study, the vascular response to high-energy lower extremity trauma was investigated to evaluate the validity of the zone-of-injury concept.
METHODS
The histologic appearance of arterial and venous walls in the zone of injury was studied in 19 patients (median age, 46 years; interquartile range, 29.5 to 62.5 years) who underwent osteosynthesis and free flap reconstruction after high-energy lower extremity open fracture. Vascular samples were harvested from the injured extremity, and control samples were harvested from the free flap donor site. Histologic and morphometric characteristics of the vessels were analyzed microscopically and using digital pathology QuPath software.
RESULTS
Vascular samples were harvested on postinjury days 1 through 11. Intimal thickness was more than 3 times greater in arteries harvested from the zone of injury than in control samples ( P < 0.01), and the intima/media ratio was 2-fold that in control samples ( P = 0.01). Arterial intimal fibrosis was more evident in vessels harvested from the zone of injury ( P < 0.01), but medial fibrosis and medial thickness did not differ significantly between groups. Venous intimal thickening ( P < 0.01) and the intima/media ratio ( P = 0.02) were greater in samples from the zone of injury. Fibrosis-related changes did not differ between groups ( P = 0.45).
CONCLUSIONS
These findings support the validity of the zone-of-injury concept by providing a novel histologic basis for this phenomenon. Intimal thickening and arterial intimal fibrosis are prominent histologic features of vessels affected by major lower extremity trauma.
Topics: Humans; Prospective Studies; Middle Aged; Adult; Male; Female; Fractures, Open; Leg Injuries; Lower Extremity; Arteries; Veins; Free Tissue Flaps; Tunica Intima; Fracture Fixation, Internal
PubMed: 37561997
DOI: 10.1097/PRS.0000000000010980 -
Phlebology Jun 2019
Topics: Humans; Lower Extremity; Venous Thromboembolism; Wounds and Injuries
PubMed: 30354874
DOI: 10.1177/0268355518809226