-
International Journal of Legal Medicine May 2017The objectives of this study were to compare arterial and venous contrast medium extravasation in severe pelvic injury detected by ante- and post-mortem multi-detector...
OBJECTIVES
The objectives of this study were to compare arterial and venous contrast medium extravasation in severe pelvic injury detected by ante- and post-mortem multi-detector CT (MDCT) and determine whether vascular injury is associated with certain types of pelvic fracture.
METHODS
We retrospectively included two different cohorts of blunt pelvic trauma with contrast medium extravasation shown by MDCT. The first group comprised 49 polytrauma patients; the second included 45 dead bodies undergoing multi-phase post-mortem CT-angiography (MPMCTA). Two radiologists jointly reviewed each examination concerning type, site of bleeding and pattern of underlying pelvic ring fracture.
RESULTS
All 49 polytrauma patients demonstrated arterial bleeding, immediately undergoing subsequent angiography; 42 (85%) had pelvic fractures, but no venous bleeding was disclosed. MPMCTA of 45 bodies revealed arterial (n = 33, 73%) and venous (n = 35, 78%) bleeding and pelvic fractures (n = 41, 91%). Pelvic fracture locations were significantly correlated with ten arterial and six venous bleeding sites in dead bodies, with five arterial bleeding sites in polytrauma patients. In dead bodies, arterial haemorrhage was significantly correlated with the severity of pelvic fracture according to Tile classification (p = 0.01), unlike venous bleeding (p = 0.34).
CONCLUSIONS
In severe pelvic injury, certain acute bleeding sites were significantly correlated with underlying pelvic fracture locations. MPMCTA revealed more venous lesions than MDCT in polytrauma patients. Future investigations should evaluate the proportional contribution of venous bleeding to overall pelvic haemorrhage as well as its clinical significance.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Arteries; Contrast Media; Female; Fractures, Bone; Hemorrhage; Humans; Male; Middle Aged; Multidetector Computed Tomography; Pelvic Bones; Phlebography; Retrospective Studies; Veins; Young Adult
PubMed: 27891547
DOI: 10.1007/s00414-016-1503-4 -
Journal of Vascular Surgery Jan 2018The incidence of morbidity and mortality for iliac vascular injuries in the literature are likely overestimated owing to associated injuries. Data for isolated iliac... (Comparative Study)
Comparative Study
OBJECTIVE
The incidence of morbidity and mortality for iliac vascular injuries in the literature are likely overestimated owing to associated injuries. Data for isolated iliac vascular injuries are very limited. No large studies have reported the incidence of morbidity for repair versus ligation of isolated iliac vein injuries.
METHODS
Patients in the National Trauma Data Bank (NTDB; 2007-2012) with at least one iliac vascular injury were analyzed. Isolated iliac vessels were defined as cases with Abbreviated Injury Scale severity score of greater than 3 for extraabdominal injuries and an Organ Injury Scale grade of greater than 3 for intraabdominal injuries.
RESULTS
Overall, 6262 iliac vascular injuries (2809 penetrating, 3453 blunt) were identified in 271,076 patients with abdominal trauma (2.3%). There were 3379 patients (1841 penetrating, 1538 blunt) with isolated iliac vascular injuries (1.2%) and 557 patients (514 penetrating, 43 blunt) with combined iliac artery and vein injuries (0.2%). The 30-day mortality rate was 16.5% for isolated iliac vein injury, 19.3% for isolated iliac artery injury, and 48.7% for combined isolated iliac artery and vein injury. The 30-day mortality rate was 23.4% for isolated iliac vascular injuries compared with 39.0% for nonisolated iliac vascular injuries (P < .001). Patients with isolated iliac vein injuries had morbidity rates of deep venous thrombosis (repair, 14.6%; ligation, 14.1%; P = .875), pulmonary embolism (repair, 1.8%; ligation, 0.5%; P = .38), fasciotomy (repair, 9.3%; ligation, 14.6%; P = .094), amputation (repair, 1.8%; ligation, 2.6%; P = .738), acute kidney injury (repair, 5.8%; ligation, 4.7%; P = .627). Multivariate logistic regression demonstrated that ligation of isolated iliac vein injuries had an odds ratio of 2.2 for mortality compared with repair (95% confidence interval, 1.08-4.66).
CONCLUSIONS
Isolated iliac vascular injuries are associated with a high incidence of mortality, especially for combined venous and arterial injury, but mortality is significantly lower than in patients with nonisolated iliac vascular injuries. In patients with isolated iliac vein injuries, mortality was higher in patients who underwent ligation compared with repair; however, the rates of deep venous thrombosis, pulmonary embolism, fasciotomy, amputation, and acute kidney injury were not different between the treatment groups. These data lend credence to the assessment that repair of iliac vein injuries is preferable to ligation whenever feasible.
Topics: Abdominal Injuries; Adolescent; Adult; Aged; Feasibility Studies; Female; Humans; Iliac Artery; Iliac Vein; Incidence; Ligation; Male; Middle Aged; Postoperative Complications; Trauma Severity Indices; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries; Young Adult
PubMed: 29268917
DOI: 10.1016/j.jvs.2017.07.107 -
European Journal of Vascular and... Sep 2017
Topics: Arteriovenous Fistula; Computed Tomography Angiography; Femoral Artery; Femoral Vein; Humans; Male; Middle Aged; Phlebography; Time Factors; Vascular System Injuries; Wounds, Stab
PubMed: 28554729
DOI: 10.1016/j.ejvs.2017.04.021 -
The American Journal of Emergency... Oct 2012The objective of this study is to assess if venous blood gas (VBG) results (pH and base excess [BE]) are numerically similar to arterial blood gas (ABG) in acutely ill...
OBJECTIVE
The objective of this study is to assess if venous blood gas (VBG) results (pH and base excess [BE]) are numerically similar to arterial blood gas (ABG) in acutely ill trauma patients.
METHODS
We prospectively correlated paired ABG and VBG results (pH and BE) in adult trauma patients when ABG was clinically indicated. A priori consensus threshold of clinical equivalence was set at ± less than 0.05 pH units and ± less than 2 BE units. We hypothesized that ABG results could be predicted by VBG results using a regression equation, derived from 173 patients, and validated on 173 separate patients.
RESULTS
We analyzed 346 patients and found mean arterial pH of 7.39 and mean venous pH of 7.35 in the derivation set. Seventy-two percent of the paired sample pH values fell within the predefined consensus equivalence threshold of ± less than 0.05 pH units, whereas the 95% limits of agreement (LOAs) were twice as wide, at -0.10 to 0.11 pH units. Mean arterial BE was -2.2 and venous BE was -1.9. Eighty percent of the paired BE values fell within the predefined ± less than 2 BE units, whereas the 95% LOA were again more than twice as wide, at -4.4 to 3.9 BE units. Correlations between ABG and VBG were strong, at r(2) = 0.70 for pH and 0.75 for BE.
CONCLUSION
Although VBG results do correlate well with ABG results, only 72% to 80% of paired samples are clinically equivalent, and the 95% LOAs are unacceptably wide. Therefore, ABG samples should be obtained in acutely ill trauma patients if accurate acid-base status is required.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alkalosis; Arteries; Blood Gas Analysis; Female; Humans; Hydrogen-Ion Concentration; Injury Severity Score; Male; Middle Aged; Prospective Studies; Trauma Centers; Veins; Wounds and Injuries; Young Adult
PubMed: 22169587
DOI: 10.1016/j.ajem.2011.09.027 -
Journal of Visceral Surgery Dec 2015In an emergency, a general surgeon may be faced with the need to treat arterial trauma of the extremities when specialized vascular surgery is not available in their... (Review)
Review
In an emergency, a general surgeon may be faced with the need to treat arterial trauma of the extremities when specialized vascular surgery is not available in their hospital setting, either because an arterial lesion was not diagnosed during pre-admission triage, or because of iatrogenic arterial injury. The need for urgent control of hemorrhage and limb ischemia may contra-indicate immediate transfer to a hospital with a specialized vascular surgery service. For a non-specialized surgeon, hemostasis and revascularization rely largely on damage control techniques and the use of temporary vascular shunts (TVS). Insertion of a TVS is indicated for vascular injuries involving the proximal portion of extremity vessels, while hemorrhage from distal arterial injuries can be treated with simple arterial ligature. Proximal and distal control of the injured vessel must be obtained, followed by proximal and distal Fogarty catheter thrombectomy and lavage with heparinized saline. The diameter of the TVS should be closely approximated to that of the artery; use of an oversized TVS may result in intimal tears. Systematic performance of decompressive fasciotomy is recommended in order to prevent compartment syndrome. In the immediate postoperative period, the need for systematic use of anticoagulant or anti-aggregant medications has not been demonstrated. The patient should be transferred to a specialized center for vascular surgery as soon as possible. The interval before definitive revascularization depends on the overall condition of the patient. The long-term limb conservation results after placement of a TVS are identical to those obtained when initial revascularization is performed.
Topics: Arm Injuries; Arteries; Blood Vessel Prosthesis Implantation; Compartment Syndromes; Emergency Treatment; Equipment Design; General Surgery; Hemostasis; Humans; Leg Injuries; Suture Techniques; Treatment Outcome; Vascular System Injuries; Veins
PubMed: 26456452
DOI: 10.1016/j.jviscsurg.2015.09.005 -
Journal of Vascular Surgery May 2004Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in...
PURPOSE
Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins.
METHODS
Clinical data and outcome in all patients with iatrogenic venous injuries during abdominal and pelvic operations between 1985 and 2002 were reviewed.
RESULTS
Forty patients (21 men, 19 women; mean age, 51 years [range, 27-87 years]) sustained 44 venous injuries. Injuries occurred during general (30%), colorectal (23%), orthopedic (20%), gynecologic (15%), and other (12%) operations. Factors leading to injury included oncologic resection (65%), difficult anatomic exposure (63%), previous operation (48%), recurrent tumor (28%), and radiation therapy (20%). All patients had substantial bleeding (mean, 3985 mL; range, 500-20,000 mL). Injuries were located in the inferior vena cava (n = 6), portal vein (n = 7), renal vein (n = 1), and iliac vein (n = 30). Repair was performed with venorrhaphy (64%), end-to-end anastomosis (14%), interposition graft (20%), and vessel ligation (2%). Seven patients (18%) died of injury-related causes, including multisystem organ failure (n = 4), uncontrollable bleeding (n = 2), and pulmonary embolism (n = 1). Thirteen patients (32.5%) had major injury-related complications, including repeat exploration because of bleeding (n = 6), multisystem organ failure (n = 6), and venous thrombosis (n = 4). In two patients (5%) unilateral lower extremity edema developed, with no evidence of thrombosis. There was no late graft or venous thrombosis. Variables associated with increased risk for death were massive bleeding, acidosis, hypotension, and hypothermia (P <.05).
CONCLUSION
Operative injuries of abdominal and pelvic veins occur in patients undergoing oncologic resection and those with difficult anatomic exposure, owing to previous operation, recurrent tumor, or radiation therapy. Massive blood loss, acidosis, hypotension, and hypothermia are associated with increased risk for death. Repair of venous injuries offers durable results with low incidence of graft or venous thrombosis.
Topics: Abdomen; Blood Loss, Surgical; Female; Humans; Iatrogenic Disease; Iliac Vein; Intraoperative Complications; Male; Middle Aged; Pelvis; Portal Vein; Renal Veins; Risk Factors; Veins; Vena Cava, Inferior
PubMed: 15111840
DOI: 10.1016/j.jvs.2003.11.040 -
Annals of the Royal College of Surgeons... May 2017INTRODUCTION This audit of traumatic diaphram injury (TDI) from a busy South African trauma service reviews the spectrum of disease and highlights current approaches to...
INTRODUCTION This audit of traumatic diaphram injury (TDI) from a busy South African trauma service reviews the spectrum of disease and highlights current approaches to these injuries. METHODS The Pietermaritzburg Metropolitan Trauma Service (PMTS) has maintained an Electronic Surgical Registry (ESR) and a Hybrid Electronic Medical Record (HEMR) system since January 1 2012. RESULTS A total of 105 TDIs were identified and repaired during the study period. The mean patient age was 30 years (range 15-68 years - SD 9.7). The majority (92.4%) of patients were male (97/105). Penetrating trauma was the leading mechanism of injury (94%). 75 patients sustained a TDI from a stab wound, and the remaining 24 injuries resulted from gunshot wounds. Multiple associated injuries and high morbidity was seen with right diaphragm injury, blunt trauma, gunshot wounds and chronic diaphragmatic hernias. CONCLUSIONS TDI is a fairly uncommon injury with a local incidence of 1.6%. It presents in a spectrum from the obvious to the occult. Multiple associated injuries and high morbidity occur following blunt trauma or gunshot wounds, right diaphragm injury and chronic diaphragmatic hernias. Diagnostic laparoscopy offers a diagnostic and therapeutic tool to prevent progression of occult TDI to chronic diaphragmatic hernias.
Topics: Adolescent; Adult; Aged; Diaphragm; Female; Humans; Laparotomy; Male; Middle Aged; Prevalence; South Africa; Thoracic Injuries; Treatment Outcome; Wounds, Gunshot; Wounds, Stab; Young Adult
PubMed: 28462659
DOI: 10.1308/rcsann.2017.0029 -
European Journal of Vascular and... Jul 2011To analyse management and outcomes of carotid artery (CA) injuries.
OBJECTIVE
To analyse management and outcomes of carotid artery (CA) injuries.
DESIGN
Retrospective study of the patients in the combat operations in Chechnya (1999-2002) and in peacetime (2003-2009).
MATERIALS
A total of 46 patients with missile (27) and stab (19) wounds, who had common and internal CA injury, underwent an open surgery. Temporary shunts (TSs) were placed in eight patients with more severe injuries.
METHODS
Retrospective analysis of patients' data.
RESULTS
CA ligation and CA repair were performed in 9 and 37 patients, respectively. Of the nine patients with CA ligation, five developed neurologic deficit; the remaining four patients died (100% of poor outcomes). Of the 37 patients with blood flow restoration, nine patients died and neurologic deficit persisted in two patients (30% of poor outcomes) (p < 0.05). Among patients with TS, three patients died and two had stable neurologic deficit (63% of poor results). Of the patients without TS, 10 patients died and five had neurologic disorders (56% of poor outcomes) (p = 0.53).
CONCLUSIONS
CA repair is the method of choice in CA injury. TS use does not result in a decreased mortality rate or neurologic deficit reduction in patients with severe injuries.
Topics: Adult; Anastomosis, Surgical; Blast Injuries; Carotid Artery Injuries; Chi-Square Distribution; Female; Humans; Ligation; Male; Multiple Trauma; Neck Injuries; Nervous System Diseases; Retrospective Studies; Risk Assessment; Risk Factors; Russia; Severity of Illness Index; Suture Techniques; Time Factors; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries; Veins; Warfare; Wounds, Penetrating; Wounds, Stab
PubMed: 21388840
DOI: 10.1016/j.ejvs.2011.01.025 -
Scientific Reports Apr 2020Aside from severe traumatic brain injury, uncontrolled bleeding and corresponding haemorrhage shock are the leading causes of traumatic deaths. No established...
PURPOSE
Aside from severe traumatic brain injury, uncontrolled bleeding and corresponding haemorrhage shock are the leading causes of traumatic deaths. No established recommendations exist about venous access placement for severely injured, bleeding children at a pre-hospital scene. This study sought to evaluate the association between pre-hospital venous access placement and mortality in a paediatric trauma population by analysing the Japan Trauma Data Bank (JTDB).
METHODS
This epidemiologic study compared the outcomes of severe traumatic paediatric patients with or without venous access placement at a pre-hospital scene. Data were obtained from JTDB from 2004 to 2015.
RESULTS
Of 4,109 patients who met our inclusion criteria, 144 patients received venous access placement and 3,965 patients did not. The probability of survival was lower in the venous access group than in the no access group (0.90 [0.67-0.97] vs. 0.97 [0.90-0.99], p < 0.01). After multivariable logistic analysis, venous access placement did not improve survival to hospital discharge (odds ratio = 1.40, confidence interval = 0.32-6.15, p = 0.653).
CONCLUSIONS
The probability of survival was lower in the venous access group than in the no access group. Survival outcome at discharge was not affected by venous access placement at a pre-hospital scene.
Topics: Child; Cohort Studies; Female; Hospitals; Humans; Logistic Models; Male; Treatment Outcome; Veins; Wounds and Injuries
PubMed: 32286495
DOI: 10.1038/s41598-020-63564-w -
Annals of Surgery May 1988During the past 11 years, 31 patients with major juxtahepatic venous injuries were treated with the atriocaval shunt. Penetrating injuries occurred in 27 patients (87%),...
During the past 11 years, 31 patients with major juxtahepatic venous injuries were treated with the atriocaval shunt. Penetrating injuries occurred in 27 patients (87%), and injuries from blunt trauma occurred in four patients. Shock was present on admission in 28 patients (90%). Resuscitative thoracotomy for cardiovascular collapse was required in 13 patients (42%). Juxtahepatic venous injuries included the vena cava in 23 patients (74%) and the hepatic veins alone in five patients (16%). One patient had an isolated portal venous injury, and two patients died before their vascular injuries could be delineated. Technical problems related to the shunt occurred in seven patients. Most were related to delays in placement or problems encountered in obtaining vascular control of the suprarenal vena cava. Major hepatic resection was performed in 11 patients (35%). Twenty-five patients died of their injuries. No patient survived who required resuscitative thoracotomy, hepatic resection, or when technical problems with the shunt occurred. Six patients (19%) survived and were discharged from the hospital. All sustained gunshot wounds to the retro-hepatic vena cava. Four of the six survivors had serious postoperative complications, but none were related to the shunt. Major juxtahepatic venous injuries are highly lethal. The atriocaval shunt will permit the salvage of some patients where other methods are not possible. Avoidance of delay and alternative shunting techniques that eliminate difficult maneuvers may improve survival in the future.
Topics: Adolescent; Adult; Anastomosis, Surgical; Cardiac Surgical Procedures; Emergencies; Heart Atria; Hemorrhage; Hemostasis, Surgical; Hepatectomy; Humans; Male; Middle Aged; Multiple Trauma; Resuscitation; Thoracotomy; Time Factors; Vena Cava, Inferior; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 3377566
DOI: 10.1097/00000658-198805000-00010