1
|
MAURO D, MIYAZAWA B, NASCIMENTO S, ALVES T, SCORPIONE J. Superior mesenteric vein injury in penetrating abdominal trauma: Case report and a literature review. Trauma Case Rep 2024; 52:101045. [PMID: 39021887 PMCID: PMC11252073 DOI: 10.1016/j.tcr.2024.101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/20/2024] Open
Abstract
Injury in the superior mesenteric vein (SMV) is notably rare among abdominal visceral vascular lesions and has high morbidity and mortality. A case of a young patient victim of abdominal stab wound (ASW) with an injury to the SMV and infrarenal aorta was reported. Several factors contributed to the favorable outcome of the patient including rapid response to trauma, hemodynamic stability, and the absence of patient comorbidities. The operative method initially includes rapid abdominal bleeding control and great saphenous patch preparation for the treatment of venous injury associated with damage control surgery and hemodynamic resuscitation at the intensive care unit. The patient was admitted to the surgical emergency room and, despite the severity of the injuries, presented a favorable result after operative treatment.
Collapse
Affiliation(s)
- D.M. MAURO
- Surgical Clinic Department, State University of Londrina, 60 Robert Koch Avenue, Operária, Londrina, PR 86038-350, Brazil
| | - B. MIYAZAWA
- Surgical Clinic Department, State University of Londrina, 60 Robert Koch Avenue, Operária, Londrina, PR 86038-350, Brazil
| | - S.J. NASCIMENTO
- State University Of Londrina, Centre of Health Sciences, 380 Celso Garcia Cid Highway, PR-445, University Campus, Londrina, PR 86057-970, Brazil
| | - T.S. ALVES
- State University Of Londrina, Centre of Health Sciences, 380 Celso Garcia Cid Highway, PR-445, University Campus, Londrina, PR 86057-970, Brazil
| | - J.G.N. SCORPIONE
- Surgical Clinic Department, State University of Londrina, 60 Robert Koch Avenue, Operária, Londrina, PR 86038-350, Brazil
| |
Collapse
|
2
|
Chen J, Zheng W, Liu T, Li X, Xin Z, Han Z, Wu Y. Successfully saving a child with destuctive iliac artery damage by hybrid surgery. J Cardiothorac Surg 2024; 19:470. [PMID: 39068409 PMCID: PMC11282611 DOI: 10.1186/s13019-024-02851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/14/2024] [Indexed: 07/30/2024] Open
Abstract
Non-iatrogenic trauma of the iliac artery is rarely reported but is always life-threatening. In this report, we describe the case of a child with complete transection and partial disappearance of the iliac artery caused by bicycle handlebar impalement. He experienced catastrophic hemorrhage, malignant arrhythmia, and difficulty in exploring transected vessel stumps. Aggressive infusion, blood transfusion in time, and pediatric vascular characteristics help delay the deterioration during anesthesia induction. Eventually he was successfully rescued by performing interventional balloon occlusion and open revascularization after more than 7 h post-trauma. A series of interventions and precautionary methods may benefit such severely injured patients; thus, these methods should be highlighted.
Collapse
Affiliation(s)
- Jianfeng Chen
- Department of Vascular Surgery, XuanWu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Wei Zheng
- Department of Vascular Surgery, XuanWu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Tingting Liu
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xianling Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhong Xin
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhonglong Han
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yingfeng Wu
- Department of Vascular Surgery, XuanWu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| |
Collapse
|
3
|
Wikström MB, Stene-Hurtsén A, Åström J, Hörer TM, Nilsson KF. The effect of an endovascular Heaney maneuver to achieve total hepatic isolation on survival, hemodynamic stability, retrohepatic bleeding, and collateral flow in a porcine model. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02482-2. [PMID: 38456908 DOI: 10.1007/s00068-024-02482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Combining resuscitative endovascular balloon occlusion of the aorta (REBOA) and the inferior vena cava (REBOVC) with open surgery is a new hybrid approach for treating retrohepatic vena caval injuries. We compared endovascular total hepatic isolation with supraceliac REBOA ± suprahepatic REBOVC and no occlusion in experimental retrohepatic vena cava bleeding regarding survival, bleeding volume, hemodynamic stability, and arterial collateral blood flow. METHODS Twenty-five anesthetized pigs (n = 6-7/group) were randomized to REBOA; REBOA + REBOVC; REBOA + infra and suprahepatic REBOVC + portal vein occlusion (endovascular Heaney maneuver, four-balloon-occlusion, 4BO) or no occlusion. After balloon inflation, free bleeding was initiated from an open sheath in the retrohepatic vena cava. Bleeding volume, right internal thoracic artery (RITA) blood flow, hemodynamics, and arterial blood variables were measured until death or up to 90 min. RESULTS The REBOA group had a longer median survival time (63 min) compared with the 4BO (24 min, P = 0.02) and no occlusion (30 min, P = 0.02) groups, not versus the REBOA + REBOVC group (49 min, P > 0.05). The first 15 min accumulated bleeding was comparable in all groups (P > 0.05); Thereafter, bleeding volume was higher in the REBOA group versus the 4BO group (P < 0.05), not versus the other groups. RITA blood flow and MAP were higher in the REBOA group versus the other groups after 10 min of bleeding (P < 0.05). CONCLUSIONS Endovascular Heaney maneuver was not beneficial for survival or hemodynamic stability in this porcine model, whereas supraceliac REBOA was. Anatomical differences in thoracoabdominal collaterals between pigs and humans must be considered when interpreting these results.
Collapse
Affiliation(s)
- Maria B Wikström
- Department of Emergency, Arvika Hospital, Region Värmland, Arvika, Sweden.
- School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Anna Stene-Hurtsén
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Region Örebro Län, Sweden
| | - Jens Åström
- Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Region Dalarna, Sweden
| | - Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Region Örebro Län, Sweden
| | - Kristofer F Nilsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Region Örebro Län, Sweden
| |
Collapse
|
4
|
Choi D, Kang BH, Jung K, Lim SH, Moon J. Risk Factors and Management of Blunt Inferior Vena Cava Injury: A Retrospective Study. World J Surg 2023; 47:2347-2355. [PMID: 37423908 DOI: 10.1007/s00268-023-07110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38-70%. To date, most studies on traumatic IVC injuries have evaluated blunt rather than penetrating injuries. We aimed to identify the clinical features and risk factors that affect the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients. METHODS We retrospectively analyzed patients diagnosed with blunt IVC injury over 8 years at a single trauma center. Clinical and biochemical parameters; transfusion, surgical, and resuscitation methods; associated injuries; intensive care unit stay; and complications data were compared between survival and death groups to identify clinical features and risk factors of blunt IVC injury-related mortality. RESULTS Twenty-eight patients with blunt IVC injury were included during the study periods. Twenty-five (89%) patients underwent surgical treatment, and the mortality was 54%. The mortality rate according to the IVC injury location was the lowest for supra-hepatic IVC injury (25%, n = 2/8), whereas it was the highest for retrohepatic IVC injury (80%, n = 4/5). In the logistic regression analysis, Glasgow Coma Scale (GCS) (odds ratio [OR] = 0.566, 95% confidence interval [CI] [0.322-0.993], p = 0.047) and red blood cell (RBC) transfusion for 24 h (OR = 1.132, 95% CI [0.996-1.287], p = 0.058) were independent predictors for mortality. CONCLUSIONS Low GCS score and high-volume packed RBC transfusion requirements for 24 h were significant predictors of mortality in patients with blunt IVC injuries. Unlike IVC injuries caused by penetrating trauma, supra-hepatic IVC injuries caused by blunt trauma have a good prognosis.
Collapse
Affiliation(s)
- Donghwan Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Byung Hee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sang-Hyun Lim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jonghwan Moon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
| |
Collapse
|
5
|
Nyberger K, Caragounis EC, Djerf P, Wahlgren CM. Management and outcomes of firearm-related vascular injuries. Scand J Trauma Resusc Emerg Med 2023; 31:35. [PMID: 37420263 DOI: 10.1186/s13049-023-01098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Violence due to firearms is a major global public health issue and vascular injuries from firearms are particularly lethal. The aim of this study was to analyse population-based epidemiology of firearm-related vascular injuries. METHODS This was a retrospective nationwide epidemiological study including all patients with firearm injuries from the national Swedish Trauma Registry (SweTrau) from January 1, 2011 to December 31, 2019. There were 71,879 trauma patients registered during the study period, of which 1010 patients were identified with firearm injuries (1.4%), and 162 (16.0%) patients with at least one firearm-related vascular injury. RESULTS There were 162 patients admitted with 238 firearm-related vascular injuries, 96.9% men (n = 157), median age 26.0 years [IQR 22-33]. There was an increase in vascular firearm injuries over time (P < 0.005). The most common anatomical vascular injury location was lower extremity (41.7%) followed by abdomen (18.9%) and chest (18.9%). The dominating vascular injuries were common femoral artery (17.6%, 42/238), superficial femoral artery (7.1%, 17/238), and iliac artery (7.1%, 17/238). Systolic blood pressure (SBP) < 90 mmHg or no palpable radial pulse in the emergency department was seen in 37.7% (58/154) of patients. The most common vascular injuries in this cohort with hemodynamic instability were thoracic aorta 16.5% (16/97), femoral artery 10.3% (10/97), inferior vena cava 7.2% (7/97), lung vessels 6.2% (6/97) and iliac vessels 5.2% (5/97). There were 156 registered vascular surgery procedures including vascular suturing (22%, 34/156) and bypass/interposition graft (21%, 32/156). Endovascular stent was placed in five patients (3.2%). The 30-day and 90-day mortality was 29.9% (50/162) and 33.3% (54/162), respectively. Most deaths (79.6%; 43/54) were within 24-h of injury. In the multivariate regression analysis, vascular injury to chest (P < 0.001) or abdomen (P = 0.002) and injury specifically to thoracic aorta (P < 0.001) or femoral artery (P = 0.022) were associated with 24-h mortality. CONCLUSIONS Firearm-related vascular injuries caused significant morbidity and mortality. The lower extremity was the most common injury location but vascular injuries to chest and abdomen were most lethal. Improved early hemorrhage control strategies seem critical for better outcome.
Collapse
Affiliation(s)
- Karolina Nyberger
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden.
- Department of Trauma, Emergency Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Eva-Corina Caragounis
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pauline Djerf
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Carl-Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
6
|
Wikström MB, Åström J, Stene Hurtsén A, Hörer TM, Nilsson KF. A porcine study of ultrasound-guided versus fluoroscopy-guided placement of endovascular balloons in the inferior vena cava (REBOVC) and the aorta (REBOA). Trauma Surg Acute Care Open 2023; 8:e001075. [PMID: 37205275 PMCID: PMC10186488 DOI: 10.1136/tsaco-2022-001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives In fluoroscopy-free settings, alternative safe and quick methods for placing resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC) are needed. Ultrasound is being increasingly used to guide the placement of REBOA in the absence of fluoroscopy. Our hypothesis was that ultrasound could be used to adequately visualize the suprahepatic vena cava and guide REBOVC positioning, without significant time-delay, when compared with fluoroscopic guidance, and compared with the corresponding REBOA placement. Methods Nine anesthetized pigs were used to compare ultrasound-guided placement of supraceliac REBOA and suprahepatic REBOVC with corresponding fluoroscopic guidance, in terms of correct placement and speed. Accuracy was controlled by fluoroscopy. Four intervention groups: (1) fluoroscopy REBOA, (2) fluoroscopy REBOVC, (3) ultrasound REBOA and (4) ultrasound REBOVC. The aim was to carry out the four interventions in all animals. Randomization was performed to either fluoroscopic or ultrasound guidance being used first. The time required to position the balloons in the supraceliac aorta or in the suprahepatic inferior vena cava was recorded and compared between the four intervention groups. Results Ultrasound-guided REBOA and REBOVC placement was completed in eight animals, respectively. All eight had correctly positioned REBOA and REBOVC on fluoroscopic verification. Fluoroscopy-guided REBOA placement was slightly faster (median 14 s, IQR 13-17 s) than ultrasound-guided REBOA (median 22 s, IQR 21-25 s, p=0.024). The corresponding comparisons of the REBOVC groups were not statistically significant, with fluoroscopy-guided REBOVC taking 19 s, median (IQR 11-22 s) and ultrasound-guided REBOVC taking 28 s, median (IQR 20-34 s, p=0.19). Conclusion Ultrasound adequately and quickly guide the placement of supraceliac REBOA and suprahepatic REBOVC in a porcine laboratory model, however, safety issues must be considered before use in trauma patients. Level of evidence Prospective, experimental, animal study. Basic science study.
Collapse
Affiliation(s)
- Maria B Wikström
- Örebro University School of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden
- Centrum för Klinisk Forskning, Region Värmland, Karlstad, Sweden
- Emergency Department, Arvika Hospital, Arvika, Sweden
| | - Jens Åström
- Department of Anesthesiology, Falun Hospital, Region Dalarna, Sweden
| | - Anna Stene Hurtsén
- Örebro University School of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Tal M Hörer
- Örebro University School of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Kristofer F Nilsson
- Örebro University School of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| |
Collapse
|
7
|
Zambetti BR, Patel DD, Stuber JD, Zickler WP, Hosseinpour H, Anand T, Nelson AC, Stewart C, Joseph B, Magnotti LJ. Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury. J Am Coll Surg 2023; 236:753-759. [PMID: 36728440 DOI: 10.1097/xcs.0000000000000540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset. STUDY DESIGN Patients undergoing operative repair for IAI were identified from the Trauma Quality Improvement Program database during a 5-year timespan, ending in 2019. Age, sex, race, severity of injury, severity of shock, type of iliac repair (open or endovascular), mechanism, morbidity and mortality were recorded. Patients with IAI were stratified by both type of repair and mechanism and compared. Multivariable logistic regression analysis was used to identify independent predictors of mortality. RESULTS Operative IAI was identified in 507 patients. Of these injuries, 309 (61%) were penetrating and 346 (68.2%) involved the external iliac artery. The majority of patients were male (82%) with a median age and ISS of 31 and 20, respectively. Endovascular repair was performed in 31% of cases. For patients with penetrating injuries, the type of repair impacted neither morbidity nor mortality. For blunt-injured patients, endovascular repair was associated with lower morbidity (29.3% vs 41.3%; p = 0.082) and significantly reduced mortality (14.6% vs 26.7%; p = 0.037) compared with the open-repair approach. Multivariable logistic regression identified endovascular repair as the only modifiable risk factor associated with decreased mortality (odds ratio 0.34; 95% CI 0.15 to 0.79; p = 0.0116). CONCLUSIONS Traumatic IAI causes significant morbidity and mortality. Endovascular repair was identified as the only modifiable predictor of decreased mortality in blunt-injured patients with traumatic IAI. Therefore, for select patients with blunt IAIs, an endovascular repair should be the preferred approach.
Collapse
Affiliation(s)
- Benjamin R Zambetti
- From the Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD (Zambetti)
| | - Devanshi D Patel
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN (Patel, Stuber)
| | - Jacqueline D Stuber
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN (Patel, Stuber)
| | - William P Zickler
- Division of Vascular Surgery, Mount Sinai Hospital, New York, NY (Zickler)
| | - Hamidreza Hosseinpour
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Tanya Anand
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Adam C Nelson
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Collin Stewart
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Bellal Joseph
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| | - Louis J Magnotti
- Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ (Hosseinpour, Anand, Nelson, Stewart, Joseph, Magnotti)
| |
Collapse
|
8
|
Gopireddy DR, Kee-Sampson JW, Vulasala SSR, Stein R, Kumar S, Virarkar M. Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds. J Clin Imaging Sci 2023; 13:1. [PMID: 36751564 PMCID: PMC9899476 DOI: 10.25259/jcis_99_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.
Collapse
Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Joanna W. Kee-Sampson
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sai Swarupa Reddy Vulasala
- Department of Internal Medicine, East Carolina University Health Medical Center, Greenville, North Carolina, United States
| | - Rachel Stein
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States
| |
Collapse
|
9
|
Successful management of impaled ice-pick stab injury of the suprarenal aorta - lessons learnt. Trauma Case Rep 2022; 40:100663. [PMID: 35665198 PMCID: PMC9157008 DOI: 10.1016/j.tcr.2022.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/24/2022] Open
|
10
|
Acharya SS, Karmacharya RM, Vaidya S, Adhikari MM, Upadhyay G, Bhandari N, Bhatt S. Traumatic gastric laceration with injury of splenic and celiac vessel following intentional self-harm by crashing of motor vehicle: A case report. Ann Med Surg (Lond) 2022; 78:103827. [PMID: 35734650 PMCID: PMC9207041 DOI: 10.1016/j.amsu.2022.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
Intra-abdominal injury due to blunt trauma accounts for 5–10% of all traumatic cases. It usually occurs secondary to motor vehicle collision, pedestrian injury, and falls. Typically these result in injury to solid abdominal organs–liver and spleen, hollow visceral organs, and rarely the abdominal vasculature. Blunt abdominal trauma causing concurrent injury to the hepatic branch of the celiac artery and the associated vein along with gastric laceration is a rare presentation and has a high mortality rate, thereby warranting prompt evaluation. While the initial stabilization should follow Advanced Trauma Life Support guidelines, the adherence to nonoperative management or operative care depends upon the severity of the injury and the patient's clinical status. Here, we present an unusual case of gastric and splenic laceration with damage to the hepatic branch of celiac artery, splenic artery, and the associated vein following blunt abdominal trauma in a 12-year-old child following intentional self-harm by crashing a self-inflicted motor vehicle. Despite the negative preoperative radiological finding, the case was managed successfully with the laparotomic correction of the damaged stomach segment, splenectomy, and repair of the damaged artery, and ligation of the transected vein to control hemorrhage. Traumatic gastric and splenic laceration with injury to the hepatic branch of the celiac artery. Exploratory laparotomy reveals a concealed rent in the hepatic branch of the celiac artery causing a source of continuous blood flow. Surgical repair of the damaged viscera and artery, splenectomy, and ligation of the transected vein.
Collapse
Affiliation(s)
- Shiwani Sharma Acharya
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
- Corresponding author.
| | - Robin Man Karmacharya
- Cardio-Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Cardio-Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Mahesh Mani Adhikari
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Gaurav Upadhyay
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Niroj Bhandari
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| |
Collapse
|
11
|
Wang S, Zhou T, Yu N, Liu R. An extremely rare disconnection of the external iliac artery and novel collateral remodeling in an endometrial stromal sarcoma woman. BMC Womens Health 2022; 22:160. [PMID: 35545775 PMCID: PMC9092857 DOI: 10.1186/s12905-022-01746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Injury to the external iliac artery can have serious consequences and can be extremely challenging for surgeons. Here, we report a patient with bizarre disconnection of the external iliac artery during a laparoscopic operation. Case presentation On May 27, 2020, during a laparoscopic pelvic lymphadenectomy operation to treat endometrial stromal sarcoma, we encountered an unusual anatomy: abnormal disconnection of the left external iliac artery in a 26-year-old female patient. The proximal and distal ends of the left external iliac artery demonstrated old narrowing without active bleeding, and the distance between the two disconnected ends was more than 3 cm. The scenario was surprising to all the staff in the operating theater. After a comprehensive assessment of skin temperature, arterial pulsation and arterial blood flow, a multidisciplinary team determined that collateral circulation of the left lower limb had been established and could meet the blood supply of the lower limbs, which was also confirmed three times by computed tomography angiography and Doppler ultrasound of the blood vessels in the abdomen and lower limbs. Sixteen months after the operation, the patient had no obvious abnormality, and the daily activities of the left lower limb were not affected. Follow-up after treatment for the patient is still in progress. Conclusions We describe the details of the whole case of disconnection of the external iliac artery. We hope to summarize the experience and lessons learned through this case and a relevant literature review to improve the safety and orderliness of our future clinical work.
Collapse
Affiliation(s)
- Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Nan Yu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| |
Collapse
|
12
|
Hagisawa K, Kinoshita M, Takeoka S, Ishida O, Ichiki Y, Saitoh D, Hotta M, Takikawa M, Torres Filho IP, Morimoto Y. H12-(ADP)-liposomes for hemorrhagic shock in thrombocytopenia: Mesenteric artery injury model in rabbits. Res Pract Thromb Haemost 2022; 6:e12659. [PMID: 35224415 PMCID: PMC8847883 DOI: 10.1002/rth2.12659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Damage control resuscitation improves patient outcomes after severe hemorrhage and coagulopathy. However, effective hemostasis methods for these critical situations are lacking. OBJECTIVE We evaluated the hemostatic efficacy of fibrinogen γ-chain (HHLGGAKQAGDV, H12)-coated, adenosine-diphosphate (ADP)-encapsulated liposomes (H12-[ADP]-liposomes) in thrombocytopenic rabbits with hemorrhagic shock. METHODS Acute thrombocytopenia (80%) was induced in rabbits that also received mesenteric vessel injury, leading to hemorrhagic shock. Five minutes after injury, subjects received intravenous bolus injection with H12-(ADP)-liposomes (20 mg/kg), followed by isovolemic transfusion with stored red blood cells (RBCs)/platelet poor plasma (PPP) (RBC:PPP = 1:1 [vol/vol]), or lactated Ringer solution every 5 min to compensate blood loss. One group received H12-(phosphate buffered saline [PBS]) liposomes followed by RBC/PPP. Additional groups were received isovolemic transfusion with RBC/platelet rich plasma (PRP) (RBC:PRP = 1:1 [vol/vol]), RBC/PPP, PPP alone, or lactated Ringer solution. RESULTS Treatment with H12-(ADP)-liposomes followed by RBC/PPP transfusion and RBC/PRP transfusion effectively stopped bleeding in all thrombocytopenic rabbits. In contrast, three of 10 rabbits treated with RBC/PPP failed hemostasis, and no rabbits receiving lactated Ringer solution stopped bleeding or survived. Twenty-four hours after hemorrhage, 80% of rabbits receiving H12-(ADP)-liposome followed by RBC/PPP transfusion survived and 70% of rabbits receiving RBC/PRP transfusion also survived, although RBC/PPP-transfused rabbits showed 40% survival. Rabbits receiving H12-(ADP)-liposomes followed by lactated Ringer solution showed a transient hemostatic potential but failed to survive. H12-(PBS)-liposomes showed no beneficial effect on hemostasis. Neither the PPP group nor the lactated Ringer group survived. CONCLUSION H12-(ADP)-liposome treatment followed by RBC/PPP may be effective in lethal hemorrhage after mesenteric vessel injury in coagulopathic rabbits.
Collapse
Affiliation(s)
- Kohsuke Hagisawa
- Department of PhysiologyNational Defense Medical CollegeTokorozawaJapan
| | - Manabu Kinoshita
- Department of Immunology and MicrobiologyNational Defense Medical CollegeTokorozawaJapan
| | - Shinji Takeoka
- Institute for Advanced Research of Biosystem Dynamics, Research Institute for Science and EngineeringWaseda UniversityShinjuku‐kuJapan
| | - Osamu Ishida
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Yayoi Ichiki
- Central Research LaboratoryNational Defense Medical CollegeTokorozawaJapan
| | - Daizoh Saitoh
- Division of TraumatologyNational Defense Medical College Research InstituteTokorozawaJapan
| | - Morihiro Hotta
- Institute for Advanced Research of Biosystem Dynamics, Research Institute for Science and EngineeringWaseda UniversityShinjuku‐kuJapan
| | - Masato Takikawa
- Institute for Advanced Research of Biosystem Dynamics, Research Institute for Science and EngineeringWaseda UniversityShinjuku‐kuJapan
| | - Ivo P. Torres Filho
- Hemorrhage and Edema ControlUnited States Army Institute of Surgical ResearchJBSA Fort Sam HoustonSan AntonioTexasUSA
| | - Yuji Morimoto
- Department of PhysiologyNational Defense Medical CollegeTokorozawaJapan
| |
Collapse
|
13
|
García A, Millán M, Burbano D, Ordoñez CA, Parra MW, González Hadad A, Herrera MA, Pino LF, Rodríguez-Holguín F, Salcedo A, Franco MJ, Ferrada R, Puyana JC. Damage control in abdominal vascular trauma. Colomb Med (Cali) 2022; 52:e4064808. [PMID: 35027780 PMCID: PMC8754163 DOI: 10.25100/cm.v52i2.4808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
In patients with abdominal trauma who require laparotomy, up to a quarter or a third will have a vascular injury. The venous structures mainly injured are the vena cava (29%) and the iliac veins (20%), and arterial vessels are the iliac arteries (16%) and the aorta (14%). The initial approach is performed following the ATLS principles. This manuscript aims to present the surgical approach to abdominal vascular trauma following damage control principles. The priority in a trauma laparotomy is bleeding control. Hemorrhages of intraperitoneal origin are controlled by applying pressure, clamping, packing, and retroperitoneal with selective pressure. After the temporary bleeding control is achieved, the compromised vascular structure must be identified, according to the location of the hematomas. The management of all lesions should be oriented towards the expeditious conclusion of the laparotomy, focusing efforts on the bleeding control and contamination, with a postponement of the definitive management. Their management of vascular injuries includes ligation, transient bypass, and packing of selected low-pressure vessels and bleeding surfaces. Subsequently, the unconventional closure of the abdominal cavity should be performed, preferably with negative pressure systems, to reoperate once the hemodynamic alterations and coagulopathy have been corrected to carry out the definitive management.
Collapse
Affiliation(s)
- Alberto García
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia Fundación Valle del Lili Department of Surgery Division of Transplant Surgery Cali Colombia
| | - Daniela Burbano
- Universidad de Caldas, Departamento de Cirugía. Manizales, Colombia. Universidad de Caldas Universidad de Caldas Departamento de Cirugía Manizales Colombia
| | - Carlos A Ordoñez
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA Broward General Level I Trauma Center Department of Trauma Critical Care Fort LauderdaleFL USA
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Centro Médico Imbanaco, Cali, Colombia. Centro Médico Imbanaco Cali Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - María Josefa Franco
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Centro Médico Imbanaco, Cali, Colombia. Centro Médico Imbanaco Cali Colombia
| | - Juan Carlos Puyana
- University of Pittsburgh. Critical Care Medicine. Pittsburgh, PA, USA. University of Pittsburgh University of Pittsburgh Critical Care Medicine PittsburghPA USA
| |
Collapse
|
14
|
Feliciano DV. Abdominal vascular hemorrhage. Surg Open Sci 2022; 7:52-57. [PMID: 35028551 PMCID: PMC8741595 DOI: 10.1016/j.sopen.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022] Open
Abstract
Major abdominal vascular injuries are noted in 5%-10% of patients undergoing laparotomy for blunt trauma. In contrast, injuries to named abdominal vessels are present in 20%-25% of patients undergoing laparotomy after gunshot wounds and in 10% after stab wounds. Hence, all surgeons performing laparotomies after abdominal trauma must be familiar with techniques for exposure and management of these injuries.
Collapse
Affiliation(s)
- David V. Feliciano
- University of Maryland School of Medicine, Shock Trauma Center/Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| |
Collapse
|
15
|
Prevalence and outcome of abdominal vascular injury in severe trauma patients based on a TraumaRegister DGU international registry analysis. Sci Rep 2021; 11:20247. [PMID: 34642399 PMCID: PMC8511261 DOI: 10.1038/s41598-021-99635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
Abstract
This study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. The impact of arterial, venous and mixed vascular injuries on patients' outcome was of interest, as in particular the relevance of venous vessel injury may be underestimated and not adequately assessed in literature so far. All patients of TraumaRegister DGU with the following criteria were included: online documentation of european trauma centers, age 16-85 years, presence of abdominal vascular injury and Abbreviated Injury Scale (AIS) ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries. Reporting in this study adheres to the STROBE criteria. A total of 2949 patients were included. All types of abdominal vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n = 606, 33%) and venous injury alone (n = 95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10-1.98, p = 0.010). Abdominal arterial and venous injury in patients suffering from severe trauma were associated with a comparable rate of hemodynamic instability at the time of admission. 24 h as well as in-hospital mortality rate were similar in in patients with venous injury and arterial injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible subtle venous injury.
Collapse
|
16
|
Melmer PD, Clatterbuck B, Parker V, Castater CA, Klingensmith NJ, Ramos CR, Busby S, Hurst SD, Koganti D, Williams KN, Grant AA, Smith RN, Benarroch-Gampel J, Dente CJ, Rajani RR, Todd SR, Sciarretta JD. Superior Mesenteric Artery and Vein Injuries: Operative Strategies and Outcomes. Vasc Endovascular Surg 2021; 56:40-48. [PMID: 34533371 DOI: 10.1177/15385744211042491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.
Collapse
Affiliation(s)
- Patrick D Melmer
- Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, USA
| | - Brant Clatterbuck
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | | | - Christine A Castater
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Nathan J Klingensmith
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher R Ramos
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Stephanie Busby
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Stuart D Hurst
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Keneesha N Williams
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - April A Grant
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi N Smith
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jaime Benarroch-Gampel
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher J Dente
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Ravi R Rajani
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Samual R Todd
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jason D Sciarretta
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| |
Collapse
|
17
|
Stonko DP, Azar FK, Betzold RD, Morrison JJ, Fransman RB, Holcomb J, Bee T, Fabian TC, Skarupa DJ, Stein DM, Kozar RA, O'Connor JV, Scalea TM, DuBose JJ, Feliciano DV. Contemporary Management and Outcomes of Injuries to the Inferior Vena Cava: A Prospective Multicenter Trial From PROspective Observational Vascular Injury Treatment. Am Surg 2021:31348211038556. [PMID: 34384266 DOI: 10.1177/00031348211038556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Injuries to the inferior vena cava (IVC), while uncommon, have a high mortality despite modern advances. The goal of this study is to describe the diagnosis and management in the largest available prospective data set of vascular injuries across anatomic levels of IVC injury. METHODS The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from November 2013 to January 2019. Demographics, diagnostic modalities, injury patterns, and management strategies were recorded and analyzed. Comparisons between anatomic levels were made using non-parametric Wilcoxon rank-sum statistics. RESULTS 140 patients from 19 institutions were identified; median age was 30 years old (IQR 23-41), 75% were male, and 62% had penetrating mechanism. The suprarenal IVC group was associated with blunt mechanism (53% vs 32%, P = .02), had lower admission systolic blood pressure, pH, Glasgow Coma Scale (GCS), and higher ISS and thorax and abdomen AIS than the infrarenal injury group. Injuries were managed with open repair (70%) and ligation (30% overall; infrarenal 37% vs suprarenal 13%, P = .01). Endovascular therapy was used in 2% of cases. Overall mortality was 42% (infrarenal 33% vs suprarenal 66%, P<.001). Among survivors, there was no difference in first 24-hour PRBC transfusion requirement, or hospital or ICU length of stay. CONCLUSIONS Current PROOVIT registry data demonstrate continued use of ligation extending to the suprarenal IVC, limited adoption of endovascular management, and no dramatic increase in overall survival compared to previously published studies. Survival is likely related to IVC injury location and total injury burden.
Collapse
Affiliation(s)
- David P Stonko
- Department of Surgery, 588543The Johns Hopkins Hospital, Baltimore, MD, USA.,137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Faris K Azar
- St Mary's Medical Center, West Palm Beach, FL, USA; 1782Florida Atlantic University, Boca Raton, FL, USA
| | - Richard D Betzold
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Jonathan J Morrison
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Ryan B Fransman
- Department of Surgery, 588543The Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Holcomb
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany Bee
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Deborah M Stein
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA.,University of California, San Francisco, CA, USA
| | - Rosemary A Kozar
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - James V O'Connor
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Thomas M Scalea
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Joseph J DuBose
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - David V Feliciano
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| |
Collapse
|
18
|
Perea LL, Hazelton JP, Fox N, Gaughan JP, Porter J, Goldenberg A. Pediatric Major Vascular Injuries: A 16-Year Institutional Experience From a Combined Adult and Pediatric Trauma Center. Pediatr Emerg Care 2021; 37:403-406. [PMID: 30335690 DOI: 10.1097/pec.0000000000001642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Vascular injury in pediatric trauma patients is uncommon but associated with a reported mortality greater than 19% in some series. The purpose of this study was to characterize pediatric major vascular injuries (MVIs) and analyze mortality at a high-volume combined adult and pediatric trauma center. METHODS A retrospective review (January 2000 to May 2016) was conducted of all pediatric (<18 years old) trauma patients who presented with a vascular injury. A total of 177 patients were identified, with 60 (34%) having an MVI, defined as injury in the neck, torso, or proximal extremity. Patients were then further analyzed based on location of injury, mechanism, age, and race. P ≤ 0.05 was deemed significant. RESULTS Of the 60 patients with MVI, the mean age was 14.3 years (range, 4-17 years). Mean intensive care unit length of stay (LOS) was 5.4 days, and mean hospital LOS was 12.5 days. Blunt mechanism was more common in patients 14 years or younger; penetrating trauma was more common amongst patients older than 14 years. Overall, blunt injuries had a longer intensive care unit LOS compared with penetrating trauma (7.8 vs 3.1 days; P = 0.016). A total of 33% (n = 20) of MVIs occurred in the torso, with 50% (n = 10) of these from blunt trauma. Location of injury did correlate with mortality; 45% (n = 9) of torso MVIs resulted in death (penetrating n = 7, blunt n = 2). Overall mortality from an MVI was 15.3% (n = 9); all were torso MVIs. Higher Injury Severity Score and Glasgow Coma Scale score were found to be independently associated with mortality. CONCLUSIONS Our experience demonstrates that MVIs are associated with a significant mortality (15.3%), with a majority of those resulting from gunshot wounds, more than 9-fold greater than the overall mortality of pediatric trauma patients at our institution (1.6%). Further research should be aimed at improving management strategies specific for MVIs in the pediatric trauma patient as gun violence continues to afflict youth in the United States.
Collapse
Affiliation(s)
| | | | - Nicole Fox
- From the Division of Trauma, Department of Surgery
| | - John P Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden, NJ
| | - John Porter
- From the Division of Trauma, Department of Surgery
| | | |
Collapse
|
19
|
Naeem M, Hoegger MJ, Petraglia FW, Ballard DH, Zulfiqar M, Patlas MN, Raptis C, Mellnick VM. CT of Penetrating Abdominopelvic Trauma. Radiographics 2021; 41:1064-1081. [PMID: 34019436 PMCID: PMC8262166 DOI: 10.1148/rg.2021200181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/12/2020] [Indexed: 12/24/2022]
Abstract
Penetrating abdominopelvic trauma usually results from abdominal cavity violation from a firearm injury or a stab wound and is a leading cause of morbidity and mortality from traumatic injuries. Penetrating trauma can have subtle or complex imaging findings, posing a diagnostic challenge for radiologists. Contrast-enhanced CT is the modality of choice for evaluating penetrating injuries, with good sensitivity and specificity for solid-organ and hollow viscus injuries. Familiarity with the projectile kinetics of penetrating injuries is an important skill set for radiologists and aids in the diagnosis of both overt and subtle injuries. CT trajectography is a useful tool in CT interpretation that allows the identification of subtle injuries from the transfer of kinetic injury from the projectile to surrounding tissue. In CT trajectography, after the entry and exit wounds are delineated, the two points can be connected by placing cross-cursors and swiveling the cut planes obliquely in orthogonal planes to obtain a double-oblique orientation to visualize the wound track in profile. The path of the projectile and its ensuing damage is not always straight, and the imaging characteristics of free fluid of different attenuation in the abdomen (including hemoperitoneum) can support the diagnosis of visceral and vascular injuries. In addition, CT is increasingly used for evaluation of patients after damage control surgery and helps guide the management of injuries that were overlooked at surgery. An invited commentary by Paes and Munera is available online. Online supplemental material is available for this article. ©RSNA, 2021.
Collapse
Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Mark J. Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Frank W. Petraglia
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - David H. Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Michael N. Patlas
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Constantine Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Vincent M. Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| |
Collapse
|
20
|
Haqqani MH, Levin SR, Kalish JA, Brahmbhatt TS, Richman AP, Siracuse JJ, Farber A, Jones DW. High Mortality and Venous Thromboembolism Risk Following Major Penetrating Abdominal Venous Injuries. Ann Vasc Surg 2021; 76:193-201. [PMID: 34153491 DOI: 10.1016/j.avsg.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Penetrating injuries to the inferior vena cava and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought to determine the relationship between iliocaval injury, VTE and mortality. METHODS The National Trauma Data Bank was queried for penetrating abdominal trauma from 2015-2017. Univariate analyses compared baseline characteristics and outcomes based on presence of iliocaval injury. Multivariable analyses determined the effect of iliocaval injury on VTE and mortality. RESULTS Of 9,974 patients with penetrating abdominal trauma, 329 had iliocaval injury (3.3%). Iliocaval injury patients were more likely to have a firearm mechanism (83% vs. 43%, P < 0.001), concurrent head (P = 0.036), spinal cord (P < 0.001), and pelvic injuries (P < 0.001), and higher total injury severity score (median 20 vs. 8.0, P < 0.001). They were more likely to undergo 24-hr hemorrhage control surgery (69% vs. 17%, P < 0.001), but less likely to receive VTE chemoprophylaxis during admission (64% vs. 68%, P = 0.04). Of patients undergoing iliocaval surgery, 64% underwent repair, 26% ligation, and 10% unknown. Iliocaval injury patients had higher rates of VTE (12% vs. 2%), 24-hr mortality (23% vs. 2.0%) and in-hospital mortality (33% vs. 3.4%) (P < 0.001 for all). VTE rates were similar following repair (14%) and ligation (17%). Iliocaval injury patients also had higher rates of cardiac complications (10.3% vs. 1.4%), acute kidney injury (8.2% vs. 1.3%), extremity compartment syndrome (4.0 vs. 0.2%), and unplanned return to OR (7.9% vs. 2.5%) (P < 0.001 for all). In multivariable analyses, iliocaval injury was independently associated with risk of VTE (OR 2.12; 95% CI, 1.29-3.48; P = 0.003), and in-hospital mortality (OR = 9.61; 95% CI, 4.96-18.64; P < 0.001). CONCLUSION Iliocaval injuries occur in <5% of penetrating abdominal trauma but are associated with more severe injury patterns and high mortality rates. Regardless of repair type, survivors should be considered high risk for developing VTE.
Collapse
Affiliation(s)
- Maha H Haqqani
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Tejal S Brahmbhatt
- Division of Acute Care and Trauma Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Aaron P Richman
- Division of Acute Care and Trauma Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Alik Farber
- Division of Acute Care and Trauma Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical Center, University of Massachusetts Medical School, Worcester, MA.
| |
Collapse
|
21
|
Simonit F, Marcuzzi G, Desinan L. A bizarre case of fatal main renal artery partial laceration without primary kidney injury due to a single stab wound in the chest. Leg Med (Tokyo) 2021; 51:101892. [PMID: 33910129 DOI: 10.1016/j.legalmed.2021.101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
Reno-vascular injuries are a rare type of renal injury, and their second most frequent cause is penetrating wounds. The majority of the reports and of the studies are present in the urological and radiological literature and they focus on the clinical approach to such injuries. In the case here presented, an 18-year-old male died after being stabbed in the left hemithorax. During body examination, thoracic organs were found to be unremarkable (except for a small peripheral laceration of the left lung), but the diaphragm was transfixed and the upper wall of the left main renal artery was lacerated. The adjacent renal vein, the kidney, the aorta, the vena cava and the surrounding internal structures were not damaged (except for a small laceration of the pancreatic tail). A massive haemothorax and a large retroperitoneal haematoma in the left kidney area were observed. The cause of death was attributed to haemorrhagic shock following a partial laceration of the left main renal artery due to the stab wound to the chest. No other cases of similar fatal renovascular injuries due to stab wounds have been published in the current forensic literature.
Collapse
Affiliation(s)
- Francesco Simonit
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy.
| | - Gabriella Marcuzzi
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy.
| | - Lorenzo Desinan
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy.
| |
Collapse
|
22
|
Aabdi M, Jabi R, Mellagui Y, Bkiyar H, Bouzinae M, Housni B. Inferior vena cava injury after blunt trauma: Case report. Int J Surg Case Rep 2021; 81:105791. [PMID: 33773374 PMCID: PMC8024919 DOI: 10.1016/j.ijscr.2021.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
Inferior vena cava injury is a rare injury with high rate mortality. Few clinical cases have described the clinical findings and radiologic appearance of this kind of injury. We describe a rare clinical case of inferior vena cava hematoma. The management depends on the hemodynamic stability of the patient and the level of injury, it might be surgical, endoscopic.
Introduction inferior vena cava IVC injury is rare with lethal outcomes, the clinical signs depends on the location and associated injuries, andt he treatment might be endovascular, surgical. Clinical case A 25 years with no medical history was admitted to the emergency department after a car accident. After intubation and hemodynamic stabilization, the computerized tomography CT scan showed hepatic laceration with a rupture of the IVC in the retro-hepatic portion, he was admitted to the operation room for damage control laparotomy; the patient died 12 h after the operation despite appropriate management. Conclusion IVC are rare and lethal, the CT scan remains the gold standard and the evolution of endovascular techniques decreased the mortality rate.
Collapse
Affiliation(s)
- Mohammed Aabdi
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Rachid Jabi
- General Surgery Department, Mohammed VI University Hospital Center, Mohammed I University, Morocco.
| | - Yassine Mellagui
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Houssam Bkiyar
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Mohammed Bouzinae
- General Surgery Department, Mohammed VI University Hospital Center, Mohammed I University, Morocco.
| | - Brahim Housni
- Anesthesiology and Intensive Care Unit Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| |
Collapse
|
23
|
American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries. J Trauma Acute Care Surg 2021; 89:1197-1211. [PMID: 33230049 DOI: 10.1097/ta.0000000000002968] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries, bleeding, and hemorrhagic shock ensure that, despite advances in both diagnostic and therapeutic technologies, immediate open surgical repair remains the mainstay of treatment for traumatic abdominal vascular injuries. Because of their devastating nature, abdominal vascular injuries remain a significant source of morbidity and mortality among trauma patients. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seek to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of abdominal vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
Collapse
|
24
|
Abukhalaf SA, Mohammed KA, Imam A, Ashker AM, Gabri EM, Abusada M, Khalayleh H, Khalaileh A. Splenic Vein as an Autologous Graft in Traumatic SMV Injuries: A Missed Valuable Alternative. Ann Vasc Surg 2021; 74:521.e1-521.e7. [PMID: 33556513 DOI: 10.1016/j.avsg.2021.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/04/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Traumatic superior mesenteric artery (SMA) and vein (SMV) injuries are rare but often lethal. The ideal management options of traumatic SMV injury are still controversial. Management options include venous repair and ligation. Splenic vein turndown procedure (SVTP) is a rare procedure that has been described in only 6 cases in the literature. Here, we reviewed the literature on the usage of the splenic vein turndown procedure (SVTP) as an alternative option in patients with traumatic SMV injury. METHODS We performed a narrative review for the available literature on the usage of the splenic vein as an autologous graft in the management of the SMV injury. We included all studies of SVTP in traumatic SMV injuries only. RESULTS We included only 5 studies. In total, 7 patients underwent SVTP. Five patients presented with a penetrating abdominal vascular trauma (AVT) and 2 patients with a blunt AVT. The advantages of the SVTP include no need for additional incisions to harvest potential autologous grafts, minimally increased operative time, and 1 less anastomotic site compared to other conduit options. CONCLUSIONS In cases of traumatic SMV injuries with associated splenic or pancreatic injuries that need distal pancreatosplenectomy, surgeons may consider SVTP as an ideal management option rather than primary repair or ligation.
Collapse
Affiliation(s)
| | | | - Ashraf Imam
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel
| | - Ashraf M Ashker
- Department of General Surgery, Al Shifa Medical Complex, Gaza, Palestine
| | - Eyad M Gabri
- Department of General Surgery, Shuhada Al Aqsa Hospital, Gaza, Palestine
| | - Marwan Abusada
- Department of General Surgery, Al Shifa Medical Complex, Gaza, Palestine
| | - Harbi Khalayleh
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; The Department of Surgery, Kaplan Medical Center, Israel
| | - Abed Khalaileh
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel.
| |
Collapse
|
25
|
Kochuba M, Rozycki GF, Feliciano D. Outcome after ligation of major veins for trauma. J Trauma Acute Care Surg 2021; 90:e40-e49. [PMID: 33502152 DOI: 10.1097/ta.0000000000003014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Kochuba
- From the Division of Acute Care Surgery, Department of Surgery, UF Health Jacksonville Medical Center (M.K.), University of Florida-Jacksonville, Jacksonville, Florida; Division of Acute Care and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University School of Medicine (G.F.R.), Johns Hopkins University; and Division of Surgical Critical Care, Department of Shock Trauma Center, Shock Trauma Center (D.F.), University of Maryland Medical Center, University of Maryland, Baltimore, Maryland
| | | | | |
Collapse
|
26
|
Raszka A, Thomopoulos T, Corpataux JM, Hahnloser D, Longchamp A, Longchamp J. A Gardening Session Turns Into a Life Threatening Aortic Transection. EJVES Vasc Forum 2021; 50:28-31. [PMID: 33604587 PMCID: PMC7873653 DOI: 10.1016/j.ejvsvf.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Penetrating injuries to the sub-diaphragmatic aorta are challenging, with high mortality rates. Most penetrating aortic trauma results from gunshots or stab wounds. This case reports a successful aortic bypass, following partial aortic transection caused by an accidental fall on a utility knife. REPORT A healthy 82 year old woman was admitted to the emergency department following penetrating abdominal trauma following an accidental fall on an 18 cm long utility knife. On admission, the patient was haemodynamically stable, with no neurological deficit. Computed tomography angiography revealed multiple abdominal injuries to the stomach, duodenum, L4-L5 left vertebrae, and infrarenal abdominal aorta. The patient underwent urgent midline laparotomy, followed by successful aortic repair using a 14 mm polyester graft. The gastric and duodenal lesions were repaired with an omental patch. The post-operative course was uneventful. DISCUSSION Penetrating abdominal trauma with visceral lesions and aortic transection are high risk injuries, albeit rarely described in the literature. A low threshold for imaging, and multidisciplinary management by vascular and visceral surgeons are essential for timely recognition and successful intervention.
Collapse
Affiliation(s)
- Ania Raszka
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Theodoros Thomopoulos
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Corpataux
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Switzerland
| | - Justine Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
27
|
Exposure of the abdominal aorta and visceral branches for hemorrhage control: A 2020 EAST Master Class Video Presentation. J Trauma Acute Care Surg 2021; 89:e84-e88. [PMID: 32833414 DOI: 10.1097/ta.0000000000002803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapid control of abdominal hemorrhage is a potentially life-saving surgical skill. Although open exposure and control of the abdominal aorta and its visceral branches is a fundamental part of surgical training, familiarity with the anatomy and spacial relationships of the surrounding structures can be challenging for even the experienced surgeon. CONTENT (DESCRIPTION OF VIDEO) Using a fresh perfused cadaver, this video provides a step by step visual guide for aortic exposure from the diaphragmatic hiatus to the iliac bifurcation. Key maneuvers including control of the supraceliac aorta, left medial visceral rotation with identification of superior mesenteric and celiac arteries, and exposure of the perirenal aorta and proximal renal vessels are outlined. Damage control and definitive management strategies are discussed and potential tips and pitfalls in addressing intraabdominal hemorrhage are highlighted. CONCLUSION The critical application of aortic exposure for hemorrhage control is a life-saving intervention if done rapidly and effectively. This requires a sound understanding of aortic anatomy and necessary steps for adequate exposure and subsequent repair. This video outlines the necessary steps to perform these interventions.
Collapse
|
28
|
Asensio JA, Dabestani PJ, Miljkovic SS, Wenzl FA, Kessler JJ, Kalamchi LD, Kotaru TR, Agrawal DK. Traumatic penetrating arteriovenous fistulas: a collective review. Eur J Trauma Emerg Surg 2021; 48:775-789. [PMID: 33386864 DOI: 10.1007/s00068-020-01574-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Traumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes. METHODS A literature search was performed on MEDLINE Complete-Pubmed from 1829-2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected. INCLUSION CRITERIA patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF's. EXCLUSION CRITERIA articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded. RESULTS There were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)-126 (43.3%), Gunshot wounds (GSW)-94 (32.3%), miscellaneous-35 (12%), mechanism unspecified-36 (12.4%). Anatomic area: neck-69 (23.7%) patients, thorax-46 (15.8%), abdomen-87 (30%), upper and lower extremities-89 (30.6%). Most commonly involved vessels-vertebral artery-38 (13%), popliteal vein-32 (11.7%). Angiography was diagnostic-265 patients (91.1%). INTERVENTIONS Surgical- 202 (59.6%), Endovascular-118 (34.8%). Associated: aneurysms/pseudoaneurysms-129 (44.3%). CONCLUSION Most AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.
Collapse
Affiliation(s)
- Juan A Asensio
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA.
| | - Parinaz J Dabestani
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Stephanie S Miljkovic
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Florian A Wenzl
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - John J Kessler
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Louay D Kalamchi
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Tharun R Kotaru
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Devendra K Agrawal
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| |
Collapse
|
29
|
Agarwal H, Kumar V, Kumar A, Priyadarshini P, Gamanagatti S, Kumar S. Control of Traumatic Superior Mesenteric Vein Pseudoaneurysm With a Covered Endovascular Stent Using Transhepatic Approach. Am Surg 2020:3134820972089. [PMID: 33342250 DOI: 10.1177/0003134820972089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Harshit Agarwal
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPNATC, 28730AIIMS, New Delhi, India
| | - Vivek Kumar
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPNATC, 28730AIIMS, New Delhi, India
| | - Abhinav Kumar
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPNATC, 28730AIIMS, New Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPNATC, 28730AIIMS, New Delhi, India
| | | | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPNATC, 28730AIIMS, New Delhi, India
| |
Collapse
|
30
|
Castater CA, Carlin M, Parker VD, Sciarretta C, Koganti D, Nguyen J, Grant AA, Smith RN, Ramos CR, Sciarretta JD, Dente CJ, Rajani R, Todd SR. Intra-abdominal Inferior Vena Cava Injuries: Operative Strategies and Outcomes. Am Surg 2020; 87:1316-1326. [PMID: 33345550 DOI: 10.1177/0003134820973395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.
Collapse
Affiliation(s)
- Christine A Castater
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Margo Carlin
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | | | | | - Deepika Koganti
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA.,Morehouse School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - April A Grant
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi N Smith
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher R Ramos
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jason D Sciarretta
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher J Dente
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Ravi Rajani
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Samual R Todd
- 1371Emory University School of Medicine, 71741Grady Memorial Hospital, Atlanta, GA, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
31
|
Balachandran G, Bharathy KGS, Sikora SS. Penetrating injuries of the inferior vena cava. Injury 2020; 51:2379-2389. [PMID: 32838960 DOI: 10.1016/j.injury.2020.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 02/02/2023]
Abstract
Inferior vena cava (IVC) injuries occur in 0.5-5% of cases of penetrating abdominal injury. Uncommonly encountered in general surgical and trauma practice, they remain extremely lethal despite advances in resuscitation and critical care. Important factors determining treatment outcomes are the hemodynamic status of the patient at presentation, the level and extent of injury, and the presence of associated injuries. Operative approaches and techniques for definitive repair are to be tailored to the condition of the patient, type of injury, and available expertise. In a patient with severe hemodynamic compromise, damage control principles take priority to stop bleeding and save life. The most commonly employed strategies are venorrhaphy or ligation. Retro-hepatic and supra-hepatic caval injuries are particularly challenging in terms of exposure and repair, and are associated with high fatality. Endovascular approaches are being used in select cases with success. This paper reviews in detail the epidemiology, injury patterns, management protocols, and outcomes of IVC injuries due to penetrating abdominal trauma.
Collapse
Affiliation(s)
- Gayatri Balachandran
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india
| | - Kishore G S Bharathy
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india
| | - Sadiq S Sikora
- Department of Surgical Gastroenterology, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka 560103, india.
| |
Collapse
|
32
|
Sheehan BM, Grigorian A, Maithel S, Borazjani B, Fujitani RM, Kabutey NK, Lekawa M, Nahmias J. Penetrating Abdominal Aortic Injury: Comparison of ACS-Verified Level-I and II Trauma Centers. Vasc Endovascular Surg 2020; 54:692-696. [PMID: 32787694 DOI: 10.1177/1538574420947234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. METHODS We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. RESULTS PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). CONCLUSION Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.
Collapse
Affiliation(s)
- Brian Matthew Sheehan
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Areg Grigorian
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Shelley Maithel
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Boris Borazjani
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Roy M Fujitani
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Nii-Kabu Kabutey
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Michael Lekawa
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, 8788University of California, Irvine School of Medicine, CA, USA
| |
Collapse
|
33
|
Fitzgerald CA, Tootla Y, Morse BC, Benarroch-Gampel J, Ramos CR, Nguyen J. Traumatic Blunt Injuries to the Celiac Artery: A 5-Year Review From a Level I Trauma Center. Am Surg 2020; 86:1651-1655. [PMID: 32683941 DOI: 10.1177/0003134820933572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Injury to the celiac artery secondary to a blunt mechanism of trauma is an extremely rare injury that accounts for only 1%-2% of all visceral vascular lesions. Although rare, this injury is associated with significant mortality. Despite this high mortality, there are currently only a few published case series of blunt celiac artery injuries in the literature. This study sought to review all cases of blunt celiac artery injuries that presented to our Level I trauma center over a 5-year period. METHODS This was a retrospective chart review of all patients who presented with a traumatic blunt celiac artery injury between January 2012 and March 2017. RESULTS A total of 10 patients met the inclusion criteria for this study. The majority of patients were male (7/10, 70%), the average age was 38.3 ± 16.1 years, and overall mortality was 20% (2/10). On average, patients spent 10.2 ± 6.5 days in the hospital, 4.4 ± 4.5 days in the ICU, and 1.6 ± 2.0 days on the ventilator. The majority of patients presented with either an intimal dissection (3/10, 30%) or an intraluminal thrombus (3/10, 30%). Other injuries included pseudoaneurysms (2/10, 20%), complete avulsion (1/10, 10%), and an intimal dissection with thrombus (1/10, 10%). Of these injuries, 2 (20%) were noted to have retrograde flow on imaging studies including computed tomography angiography and a visceral angiogram. The majority of patients (8/10, 80%) were managed nonoperatively, and 5 (50%) patients were discharged home on aspirin. One patient who was initially managed nonoperatively required an unplanned return to the operating room for ischemic bowel, liver, and stomach. There were no other complications noted. DISCUSSION Traumatic blunt injury to the celiac artery is rare. Although there are multiple treatment options, there is currently no consensus in regard to management guidelines. In this case series, the majority of patients were successfully managed nonoperatively suggesting that a selective approach for intervention on patients with a blunt celiac artery injury should be considered.
Collapse
Affiliation(s)
| | - Yasmin Tootla
- 1371 Department of Surgery, Emory University, Atlanta, GA, USA
| | - Bryan C Morse
- 92602 Department of Surgery, Maine Medical Center, Portland, ME, USA
| | | | | | - Jonathan Nguyen
- 1374 Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| |
Collapse
|
34
|
Hughes M, Perkins Z. Outcomes following resuscitative thoracotomy for abdominal exsanguination, a systematic review. Scand J Trauma Resusc Emerg Med 2020; 28:9. [PMID: 32028977 PMCID: PMC7006065 DOI: 10.1186/s13049-020-0705-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/19/2020] [Indexed: 12/11/2022] Open
Abstract
Background Resuscitative thoracotomy is a damage control procedure with an established role in the immediate treatment of patients in extremis or cardiac arrest secondary to cardiac tamponade however Its role in resuscitation of patients with abdominal exsanguination is uncertain. Objective The primary objective of this systematic review was to estimate mortality based on survival to discharge in patients with exsanguinating haemorrhage from abdominal trauma in cardiac arrest or a peri arrest clinical condition following a resuscitative thoracotomy. Methods A systematic literature search was performed to identify original research that reported outcomes in resuscitative thoracotomy either in the emergency department or pre-hospital environment in patients suffering or suspected of suffering from intra-abdominal injuries. The primary outcome was to assess survival to discharge. The secondary outcomes assessed were neurological function post procedure and the role of timing of intervention on survival. Results Seventeen retrospective case series were reviewed by a single author which described 584 patients with isolated abdominal trauma and an additional 1745 suffering from polytrauma including abdominal injuries. Isolated abdominal trauma survival to discharge ranged from 0 to 18% with polytrauma survival of 0–9.7% with the majority below 1%. Survival following a thoracotomy for abdominal trauma varied between studies and with no comparison non-intervention group no definitive conclusions could be drawn. Timing of thoracotomy was important with improved mortality in patients not in cardiac arrest or having the procedure performed just after a loss of signs of life. Normal neurological function at discharge ranged from 100 to 28.5% with the presence of a head injury having a negative impact on both survival and long-term morbidity. Conclusions Pre-theatre thoracotomy may have a role in peri-arrest or arrested patient with abdominal trauma. The best outcomes are achieved with patients not in cardiac arrest or who have recently arrested and with no head injury present. The earlier the intervention can be performed, the better the outcome for patients, with survival figures of up to 18% following a resuscitative thoracotomy. More high-quality evidence is required to demonstrate a definitive mortality benefit for patients.
Collapse
Affiliation(s)
- Michael Hughes
- Scarborough Hospital, York Teaching Hospital NHS Trust, Woodlands drive, Scarborough, YO12 6QL, UK.
| | | |
Collapse
|
35
|
Maithel S, Grigorian A, Fujitani RM, Kabutey NK, Sheehan BM, Gambhir S, Chen SL, Nahmias J. Incidence, morbidity, and mortality of traumatic superior mesenteric artery injuries compared to other visceral arteries. Vascular 2019; 28:142-151. [DOI: 10.1177/1708538119893827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectivesCeliac artery, superior mesenteric artery, and inferior mesenteric artery injuries are often grouped together as major visceral artery injuries with an incidence of <1%. The mortality rates range from 38–75% for celiac artery injuries and 25–68% for superior mesenteric artery injuries. No large series have investigated the mortality rate of inferior mesenteric artery injuries. We hypothesize that from all the major visceral artery injuries, superior mesenteric artery injury leads to the highest risk of mortality in adult trauma patients.MethodsThe Trauma Quality Improvement Program (2010–2016) was queried for patients with injury to the celiac artery, superior mesenteric artery, or inferior mesenteric artery. A multivariable logistic regression model was used for analysis. Separate subset analyses using blunt trauma patients and penetrating trauma patients were performed.ResultsFrom 1,403,466 patients, 1730 had single visceral artery injuries with 699 (40.4%) involving the celiac artery, 889 (51.4%) involving the superior mesenteric artery, and 142 (8.2%) involving the inferior mesenteric artery. The majority of patients were male (79.2%) with a median age of 39 years old, and median injury severity score of 22. Compared to celiac artery and inferior mesenteric artery injuries, superior mesenteric artery injuries had a higher rate of severe (grade >3) abbreviated injury scale for the abdomen (57.5% vs. 42.5%, p < 0.001). The overall mortality for patients with a single visceral artery injury was 20%. Patients with superior mesenteric artery injury had higher mortality compared to those with celiac artery and inferior mesenteric artery injuries (23.7% vs. 16.3%, p < 0.001). After controlling for covariates, traumatic superior mesenteric artery injury increased risk of mortality (OR = 1.72, CI = 1.24–2.37, p < 0.01) in adult trauma patients, while celiac artery ( p = 0.59) and inferior mesenteric artery ( p = 0.31) injury did not. After stratifying by mechanism, superior mesenteric artery injury increased risk of mortality (OR = 3.65, CI = 2.01–6.45, p < 0.001) in adult trauma patients with penetrating mechanism of injury but not in those with blunt force mechanism (OR = 1.22, CI = 0.81–1.85, p = 0.34).ConclusionsCompared to injuries of the celiac artery and inferior mesenteric artery, traumatic superior mesenteric artery injury is associated with a higher mortality. Moreover, while superior mesenteric artery injury does not act as an independent risk factor for mortality in adult patients with blunt force trauma, it nearly quadruples the risk of mortality in adult trauma patients with penetrating mechanism of injury. Future prospective research is needed to confirm these findings and evaluate factors to improve survival following major visceral artery injury.
Collapse
Affiliation(s)
- Shelley Maithel
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Areg Grigorian
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Roy M Fujitani
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Nii-Kabu Kabutey
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Brian M Sheehan
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Sahil Gambhir
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Samuel L Chen
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Irvine Department of General Surgery, University of California, Orange, CA, USA
| |
Collapse
|
36
|
Drucker CB, Bhardwaj A, Benalla O, Crawford RS, Sarkar R. Modeling variability in the inferior vena cava into fenestrated endografts for retrohepatic caval injuries. J Vasc Surg Venous Lymphat Disord 2019; 8:62-72. [PMID: 31843249 DOI: 10.1016/j.jvsv.2019.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 06/24/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Injury of the retrohepatic inferior vena cava (IVC) is rare, but extremely fatal. Open repair of these injuries is challenging. Various maneuvers, including atriocaval shunting and total vascular isolation, have been described, but are poorly tolerated in the severely injured patient. Endovascular repair is an attractive alternative strategy, but effective hemostasis of complex injuries requires an endograft that excludes the injury while permitting flow from the hepatic veins. Unfortunately, IVC and hepatic vein anatomy is highly variable and has not been clearly described in injured patients. Our purpose was to characterize critical human IVC morphology in trauma patients, and develop the design parameters of an off-the-shelf fenestrated endograft intended for caval deployment. METHODS One hundred consecutive adult trauma patients with an admission computed tomography scan including a portal venous phase of the abdomen were reviewed. Specific anatomic measurements including segmental IVC lengths and diameters were obtained. Multiple theoretical endografts were modeled to optimize caval coverage in the retrohepatic segment, assuming 10% to 40% oversizing for seal. RESULTS This sample population had a mean age of 50 years, height of 173 cm, and weight 84 kg. Seventy-one percent were male and 89% had a blunt mechanism of injury. The median caval length from the renal veins to right atrium was 111 mm (interquartile range [IQR], 102-120 mm), diameter was 22 mm (IQR, 19-26 mm), and hepatic venous orifice area was 336 mm2 (IQR, 267-432 mm2). All patients had a landing zone of at least 12 mm in the suprahepatic and 10 mm in the suprarenal segments. Three models of graft length were developed to accommodate patients with segmental and overall dimensions in the smallest half, third quartile, and fourth quartile. These could provide 95% of patients with coverage of the retrohepatic segment without risk of hepatic or renal vein occlusion. Four graft diameters were developed for cross-sectional fit. Graft diameters of 20, 24, 30, and 38 mm could provide adequate coverage in, respectively, 11%, 35%, 49%, and 16% of patients. These combinations of graft length and diameter would accommodate 93% of patients. CONCLUSIONS We defined human IVC morphology essential for endovascular therapy and developed parameters for fenestrated IVC endografts to address retrohepatic caval injuries in trauma patients. Although additional study and testing are required, this proof-of-concept study supports the hypothesis that exclusion of the most devastating retrohepatic IVC injuries can be achieved with a reasonable number of off-the-shelf fenestrated endografts. These findings form the basis for additional research toward the development of novel devices for endovascular therapy of these often lethal injuries.
Collapse
Affiliation(s)
- Charles B Drucker
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md
| | - Abhishek Bhardwaj
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Oussama Benalla
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Robert S Crawford
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Rajabrata Sarkar
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md.
| |
Collapse
|
37
|
Howley IW, Stein DM, Scalea TM. Outcomes and complications for portal vein or superior mesenteric vein injury: No improvement in the era of damage control resuscitation. Injury 2019; 50:2228-2233. [PMID: 31635905 DOI: 10.1016/j.injury.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/18/2019] [Accepted: 10/06/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Portal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. METHODS We reviewed patients presenting to our Level 1 trauma centre over ten-years with PV/SMV injuries, analysing physiology, operative management, associated injuries, and outcomes. RESULTS Twenty-four patients had 7 PV and 15 SMV injuries, 2 had both; all had operative exploration. Sixty-seven percent had penetrating trauma. While many had normal vitals, profound acidosis was common. All patients had ≥2 additional abdominal injuries, liver most common (50%). Additional abdominal vascular injuries were more common in non-survivors than survivors: IVC 46% vs 22%, common hepatic artery 20% vs 0%, SMA 26% vs 11%. The mean injury severity score (ISS) was 32.4, and the mean new injury severity score (NISS) was 44.5. Mortality was 63%. Eleven patients died from exsanguination, two from SMV thrombosis, and two from sequelae of other injuries. All survivors had venorrhaphy, as did 8 non-survivors. Non-survivors were also shunted; had ligation; or bypass, shunting, and ligation. Three exsanguinated prior to repair. Two survivors had SMV related complications. One with proximal SMV injury developed severe venous congestion and multiple enterocutaneous fistulae. Another developed an arterioportal fistula, managed with embolisation and percutaneous portal vein stenting. CONCLUSION Despite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.
Collapse
Affiliation(s)
- Isaac W Howley
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deborah M Stein
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
38
|
Impact of inferior vena cava ligation on mortality in trauma patients. J Vasc Surg Venous Lymphat Disord 2019; 7:793-800. [DOI: 10.1016/j.jvsv.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/09/2019] [Indexed: 11/15/2022]
|
39
|
Maithel S, Grigorian A, Kabutey NK, Sheehan BM, Gambhir S, Wolf RF, Jutric Z, Nahmias J. Hepatoportal Venous Trauma: Analysis of Incidence, Morbidity, and Mortality. Vasc Endovascular Surg 2019; 54:36-41. [DOI: 10.1177/1538574419878577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. Methods: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. Results: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries ( P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). Conclusion: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.
Collapse
Affiliation(s)
- Shelley Maithel
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Areg Grigorian
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Nii-Kabu Kabutey
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Brian M. Sheehan
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Sahil Gambhir
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Ronald F. Wolf
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Zeljka Jutric
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine Medical Center, Orange, CA, USA
| |
Collapse
|
40
|
|
41
|
Siracuse JJ, Cheng TW, Farber A, James T, Zuo Y, Kalish JA, Jones DW, Kalesan B. Vascular repair after firearm injury is associated with increased morbidity and mortality. J Vasc Surg 2019; 69:1524-1531.e1. [DOI: 10.1016/j.jvs.2018.07.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/29/2018] [Indexed: 11/16/2022]
|
42
|
Kakkos SK, Tsolakis IA, Markopoulos G, Maroulis I, Koletsis E, Fligou F, Panagopoulos K, Papadoulas S, Lampropoulos G, Ntouvas I, Nikolakopoulos KM, Papageorgopoulou CP, Kouri A. Presentation patterns and prognosis of 109 isolated venous injuries in 99 patients. Phlebology 2019; 34:698-706. [DOI: 10.1177/0268355519837870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To identify outcome predictors of isolated venous injuries (VIs). Methods Retrospective analysis of prospectively collected information. Results A total of 99 patients with 109 isolated VI were included. All-cause mortality was 18/99 (18%) and mortality related to the VI was 10/99 (10%). On multivariate analysis, independent predictors of all-cause mortality included age (odds ratio – OR – 1.06, p = 0.042), external cause – trauma and foreign body retention – of VI (OR 34.62, p = 0.002) and the number of red blood cell units transfused intraoperatively (OR 2.10, p < 0.001), while independent predictors of VI-related mortality included external cause of VI (OR 47.60, p = 0.001) and the number of red blood cell units transfused intraoperatively (OR 1.72, p = 0.003). Conclusions VIs due to external causes have a high mortality rate. On the other hand, VIs due to internal causes (iatrogenic injuries during a surgical procedure) are managed promptly and have a very low mortality related to the VI.
Collapse
Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Markopoulos
- Department of Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, University of Patras Medical School, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras Medical School, Patras, Greece
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Lampropoulos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | | | | | - Anastasia Kouri
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| |
Collapse
|
43
|
Tariq U, Petit J, Thomas A, Abt P, Toy F, Lopez R, Bhanushali A, Ninalowo H. Traumatic Inferior Vena Cava Laceration Acutely Repaired with Endovascular Stent Graft and Associated Complications Salvaged by Surgery. J Vasc Interv Radiol 2019; 30:273-276. [DOI: 10.1016/j.jvir.2018.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022] Open
|
44
|
Prichayudh S, Rassamee P, Sriussadaporn S, Pak-Art R, Sriussadaporn S, Kritayakirana K, Samorn P, Narueponjirakul N, Uthaipaisanwong A. Abdominal vascular injuries: Blunt vs. penetrating. Injury 2019; 50:137-141. [PMID: 30509568 DOI: 10.1016/j.injury.2018.11.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/31/2018] [Accepted: 11/24/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Abdominal vascular injuries (AVIs) remain a great challenge since they are associated with significant mortality. Penetrating injury is the most common cause of AVIs; however, some AVI series had more blunt injuries. There is little information regarding differences between penetrating and blunt AVIs. The objective of the present study was to identify the differences between these two mechanisms in civilian AVI patients in terms of patient's characteristics, injury details, and outcomes. METHOD From January 2007 to January 2016, we retrospectively collected the data of AVI patients at King Chulalongkorn Memorial hospital, including demographic data, details of injury, the operative managements, and outcomes in terms of morbidity and mortality. The comparison of the data between blunt and penetrating AVI patients was performed. RESULTS There were 55 AVI patients (28 blunt and 27 penetrating). Majority (78%) of the patients in both groups were in shock on arrival. Blunt AVI patients had significantly higher injury severity score (mean(SD) ISS, 36(20) vs. 25(9), p = 0.019) and more internal iliac artery injuries (8 vs. 1, p = 0.028). On the other hand, penetrating AVI patients had more aortic injuries (5 vs. 0, p = 0.046), and inferior vena cava injuries (7 vs. 0, p = 0.009). Damage control surgery (DCS) was performed in 45 patients (82%), 25 in blunt and 20 in penetrating. The overall mortality rate was 40% (50% in blunt vs. 30% in penetrating, p = 0.205). CONCLUSIONS Blunt AVI patients had higher ISS and more internal iliac artery injuries, while penetrating AVI patients had more aortic injuries and vena cava injuries. Majority of AVI patients in both groups presented with shock and required DCS.
Collapse
|
45
|
Branco BC, Musonza T, Long MA, Chung J, Todd SR, Wall MJ, Mills JL, Gilani R. Survival trends after inferior vena cava and aortic injuries in the United States. J Vasc Surg 2018; 68:1880-1888. [DOI: 10.1016/j.jvs.2018.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/09/2018] [Indexed: 10/28/2022]
|
46
|
Siracuse JJ, Farber A, James T, Cheng TW, Zuo Y, Kalish JA, Jones DW, Kalesan B. Readmissions after Firearm Injury Requiring Vascular Repair. Ann Vasc Surg 2018; 56:36-45. [PMID: 30500659 DOI: 10.1016/j.avsg.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Firearm injuries can be morbid and potentially have high resource utilization. Historically, trauma and vascular surgery patients are at higher risk for readmissions. Our goal was to assess the risk for readmission among patients undergoing vascular repair after a firearm injury. METHODS The National Readmission Database was queried from 2011 to 2014. All firearm injuries with or without vascular repair were analyzed. Multivariable analysis was conducted to assess the effect of concurrent vascular repair on readmissions at 30, 90, and 180 days. RESULTS There were 42,184 firearm injury admissions identified, where 93.3% did not undergo vascular repair and 6.7% required vascular repair. The overall in-hospital death rate was 8.2%. Average age was 29.9 ± 0.2 years, and 89.2% were male. Intent was most frequently assault (61.2%) followed by unintentional injury (26.5%), suicide (5.2%), and legal intervention (3.1%). Patients with vascular repair compared to those without vascular repair were more frequently admitted at teaching hospitals (85.2% vs. 81.8%, P = 0.042), had higher Agency for Healthcare Research and Quality (AHRQ) extreme severity of illness, AHRQ risk of mortality, New Injury Severity Score (NISS), and had more diagnoses and procedures (P < 0.0001). Patients with vascular repair compared to those without vascular repair also more frequently sustained abdominal/pelvis injury (40.4% vs. 23.4%, P < 0.0001) and were more likely to have anemia (5.9% vs. 3.6%, P = 0.009). Patients undergoing vascular repair had a higher rate for 30-day (8.9% vs. 5.5%, P = 0.0001), 90-day (18.1% vs 9.5%, P < 0.0001), and 180-day (22.3% vs. 13%, P < 0.0001) readmission. Kaplan-Meier analysis of unadjusted data showed a higher readmission rate over time with vascular repair. Multivariable analysis demonstrated that vascular repair was not associated with higher 30-day readmission (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.92-1.72, P = 0.14) but was for 90-day (OR 1.38, 95% CI 1.14-1.68, P = 0.001) and 180-day readmission (OR 1.24, 95% CI 1.06-1.45, P = 0.009). Additional factors associated with 30-day readmission were higher NISS, discharge to a care facility, and Elixhauser score. Other factors associated with 90-day readmission were unintentional intent of injury, NISS, discharge to a care facility, and Elixhauser score. Factors also associated with 180-day readmission were insurance type, unintentional intent of injury, NISS, care facility discharge, and Elixhauser score. CONCLUSIONS Firearm injury resulting in vascular injury was associated with increased readmissions at 90 and 180 days. This study establishes baseline rates for readmission after vascular repair for firearm traumas and allows opportunity for improvement through targeted interventions for these patients. Vascular surgeons can have a more active role in managing this high-profile public health issue.
Collapse
Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Thea James
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Yi Zuo
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventative Medicine & Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Bindu Kalesan
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventative Medicine & Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA.
| |
Collapse
|
47
|
Kamber HM, Al-Marzooq TJM, Neamah HR, Hassan QA. Outcomes of Operative Management of 96 Cases with Traumatic Retroperitoneal Hematoma: A Single-Institution Experience. Open Access Maced J Med Sci 2018; 6:2128-2132. [PMID: 30559874 PMCID: PMC6290419 DOI: 10.3889/oamjms.2018.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/28/2018] [Accepted: 10/30/2018] [Indexed: 12/02/2022] Open
Abstract
AIM: To analyse our experiences in the management of traumatic retroperitoneal hematoma (RPH), highlighting the various challenges faced and to report on the outcome of these patients. METHODS: From May 2014 to May 2017, all patients with traumatic RPH who underwent surgical treatment were retrospectively analysed. The kind of injury, intraoperative findings, sites of hematoma, postoperative morbidity and the overall outcomes were recorded. RESULTS: Ninety-six patients; 53 with blunt trauma and 43 with penetrating injury, were included in this study. The centre-medial hematoma was observed in 24 (25%) patients, lateral hematoma in 46 (47.9%) patients, pelvic hematoma in 19 (19.8%) patients, and multiple zone hematomas in 7 (7.3%) patients. All cases were managed surgically. Exploration of the retroperitoneal space was done in 72 cases. Thirty-three patients died, and the overall death rate was 34.4%. CONCLUSION: Surgical exploration should be done in RPH caused by penetrating injury, but the need for urgent exploration in blunt injury is not so high, and it depends on the anatomical site of hematoma, concomitant organ injury and the hemodynamic status of patients.
Collapse
Affiliation(s)
- Harth Mohamed Kamber
- Division of Urology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | - Haider Raheem Neamah
- Division of Cardiovascular Surgery, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Qays Ahmed Hassan
- Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| |
Collapse
|
48
|
Lim KH, Park J. Successful conservative treatment of acute traumatic occlusions of the celiac artery and superior mesenteric artery: A case report emphasizing the importance of the visceral collateral circulations. Medicine (Baltimore) 2018; 97:e13270. [PMID: 30431612 PMCID: PMC6257666 DOI: 10.1097/md.0000000000013270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Blunt injury of major visceral arteries such as celiac artery (CA) and superior mesenteric artery (SMA) are very rare but fatal, therefore, these injuries are challenging to trauma surgeons. The patient with occlusion of CA or SMA is theoretically viable by visceral collateral circulation. However, there are very rare cases in clinics. To date, there have been few reports of both CA and SMA occlusions after blunt trauma. Herein we describe our successful conservative treatment of patients with both CA and SMA occlusions. PATIENT CONCERNS Fifteen-year-old girl suffering from schizophrenia was transferred to our hospital after a fall from 3-floor-height with a purpose of suicide. DIAGNOSES An abdominal computed tomography (CT) scan with contrast enhancement showed proximal CA and proximal SMA occlusions with surrounding retroperitoneal hematoma, however, distal parts of occlusion were supplied by the collateral vessels (enlarged marginal artery of left colon from inferior mesenteric artery and pancreaticoduodenal arcade). INTERVENTIONS She was treated by only supportive care without anticoagulant due to retroperitoneal hematoma. OUTCOMES The patient was discharged 25 days after admission without complications. LESSONS We think that our patient could survive because her vascular status was healthy and collateral circulations were plenty according to the young age. We believe that this case can provide a basis for ligation in these forbidding and handless major visceral arterial injuries such as CA or SMA.
Collapse
|
49
|
Superior mesenteric vein injury in penetrating abdominal trauma: A case report. Int J Surg Case Rep 2018; 52:40-44. [PMID: 30368199 PMCID: PMC6202787 DOI: 10.1016/j.ijscr.2018.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/14/2018] [Accepted: 09/20/2018] [Indexed: 11/20/2022] Open
Abstract
Superior mesenteric vein and inferior vena cava injuries are associated with high mortality. Damage control surgery is an effective strategy to stabilize the patient initially. Second-look operations allow to identify injuries which might not have been discernable at first. A mature hospital system with rapid response to trauma is integral when handling gunshot injuries.
Introduction Injury to the superior mesenteric vein (SMV) is considerably rare amongst abdominal visceral vascular injuries. Multiple factors play a role in identifying such injuries, leading to the high morbidity and mortality associated. Case presentation We report a twenty-six-year-old male sustaining a SMV injury following a self-inflected gun shot. Initial assessment of the patient reveals hemodynamic instability and intraabdominal hemorrhage. Surgically approaching the patient was performed in two stages. Midline laparotomy was performed to control the active bleeding and stabilize the patient. Kocherizing the duodenum reveals that the source of retroperitoneal bleeding was from the SMV and one of the supra-renal tributaries of the Inferior Vena Cava (IVC). Several stitches were taken in a figure-of-eight manner to control the bleeding. Second-look operation was performed to rule out other injuries and permeant closure of the abdominal wall. Proper psychiatric care was ensured before transferal of the patient in good conditions to another healthcare facility specialized in mental health. Discussion High mortality rates reaching up to 65% are reported in similar cases. Multiple factors have contributed to the patient’s favorable outcome, including rapid trauma response, absences of other associated injuries, and the patient’s baseline healthy status. Conclusion The principle of damage control surgery in trauma is an effective strategy to stabilize the patient and rule out other injuries which might not have been discernible initially.
Collapse
|
50
|
Tsai R, Raptis D, Raptis C, Mellnick VM. Traumatic abdominal aortic injury: clinical considerations for the diagnostic radiologist. Abdom Radiol (NY) 2018; 43:1084-1093. [PMID: 29492608 DOI: 10.1007/s00261-018-1523-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Traumatic abdominal aortic injury (TAAI) is a severe complication of penetrating and blunt trauma with significant morbidity and mortality, particularly if diagnosis is delayed. In patients with life-threatening injuries, accurate and prompt diagnosis of TAAI can be made with computed tomography (CT). Once the diagnosis of TAAI is made, the radiologist should provide an accurate description of the aortic lesion and the extent of injury in order to guide management whether it be non-operative, open aortic repair, or endoluminal stent repair. The purpose of this article is to review the key imaging aspects of TAAI and to discuss how the key CT imaging findings affect clinical management.
Collapse
Affiliation(s)
- Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA.
| | - Demetrios Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| | - Constantine Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, St. Louis, MO, 63108, USA
| |
Collapse
|