1
|
Almadwahi NY, Alkadri AM, Fadhel A, Alshujaa M, Ahmed F, Badheeb M. Iatrogenic Vascular Injuries in Resource-Limited Setting: A 4-Year Experience Monocentric Retrospective Study. Open Access Emerg Med 2024; 16:57-64. [PMID: 38650668 PMCID: PMC11034556 DOI: 10.2147/oaem.s450213] [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: 11/17/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
Background Iatrogenic vascular injuries (IVIs) due to diagnostic and therapeutic interventions are known but rare or probably under-reported. We present our four-year findings on patients with IVIs after catheterization or surgery who underwent vascular surgical repairs in a resource-limited setting. Methods A retrospective case series study between Jun 2018 and Sep 2022 of 35 patients diagnosed with IVIs and treated surgically at our hospital was included. The data on IVIs including patient characteristics, causes and type of injury, treatment, and outcomes were collected and analyzed. Results The mean age was 37.12± 17.0 years, and most patients (65.7%) were male. Of the 35 IVIs, 21 were caused by percutaneous procedures, while 14 occurred intraoperatively and affected various arteries and veins. The main injured vessels were the femoral artery (20%) and direct blood vessel puncture made by non-qualified specialists (42.9%) during dialysis cannulation was the main cause. The intraoperative IVI affected the inferior vena cava in three patients, the aorta in two patients, the external iliac artery in four, the tibial and popliteal arteries in four, and the internal carotid artery in one. The following types of repairs were recorded: direct suture of the vessel with or without endarterectomy (71.4%), synthetic patch placement (25.7%), ligation (8.6%), bypass or interposition graft (14.3%), and thromboembolectomy (5.7%). Vascular repair was successful in 32 (91.4%) patients while three patients (8.6%) were expired. Complications occurred in 7 (20%) patients, of which superficial wound infections were the common complication (11.6%) and were treated with proper antibiotic therapy. Conclusion Prompt identification of IVIs, as well as proper triage for future treatment, can enhance patient outcomes. Our data showed that non-qualified specialists seem to be responsible for the majority of IVIs. For that, we emphasize the importance of performing vascular procedures by a qualified specialist with adequate training.
Collapse
Affiliation(s)
| | | | - Ali Fadhel
- Department of Cardio-Pediatric Surgery, School of Medicine, Sana’a University, Sana’a, Yemen
| | - Mohamed Alshujaa
- Department of Vascular Surgery, School of Medicine, Sana’a University, Sana’a, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
| | - Mohamed Badheeb
- Department of Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USA
| |
Collapse
|
2
|
Ben Romdhane M, Boufi M, Dona B, Hartung O, Alimi Y. Predictive factors of amputation in infra-inguinal vascular trauma: a monocentric experience. Ann Vasc Surg 2023:S0890-5096(23)00150-4. [PMID: 36906127 DOI: 10.1016/j.avsg.2023.02.035] [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: 12/14/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Infra-inguinal vascular injuries (IIVI) are emergencies involving both functional and vital prognosis. The choice between saving the limb or doing a first-line amputation is difficult even for an experienced surgeon. The aims of this work are to analyze early outcomes in our center and to identify predictive factors for amputation. M METHODS Between 2010 and 2017, we reviewed retrospectively patients with IIVI. The main criteria for judgement were: primary, secondary and overall amputation. Two groups of potential risk factors of amputation were analyzed: Those related to the patient: age, shock, ISS score; those related to the lesion: mechanism, above or below the knee, bone lesions, venous lesions and skin decay. A univariate and multivariate analysis were performed to determine the risk factor(s) independently associated with the occurrence of amputation. RESULTS 57 IIVI were found in 54 patients. The mean ISS was 32,3 ± 21. A primary amputation was performed in 19%, and secondary in 14% of cases. Overall amputation rate was 35% (n=19). Multivariate analysis reveals that the ISS is the only predictor of primary (p=0.009; OR:1.07; CI:1.01-1.12) and global (p=0.04; OR:1.07; IC:1.02-1.13) amputation. A threshold value of 41 was selected as a primary amputation risk factor with a negative predictive value of 97%. CONCLUSIONS The ISS is a good predictor of the risk of amputation in IIVI. A threshold of 41 is an objective criterion helping to decide for a first-line amputation. Advanced age and hemodynamic instability should not be important in the decision tree.
Collapse
Affiliation(s)
| | | | - Bianca Dona
- Vascular Surgery Department, Marseille, France
| | | | - Yves Alimi
- Vascular Surgery Department, Marseille, France
| |
Collapse
|
3
|
Davidovic LB, Koncar IB, Dragas MV, Markovic MD, Bogavac-Stanojevic N, Vujcic AD, Mitrovic AC, Ilic NS, Trailovic RD, Kostic DM. Treatment of vascular non-iatrogenic injuries of upper and lower extremities in tertiary vascular center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:74-81. [PMID: 36168950 DOI: 10.23736/s0021-9509.22.12243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to examine demographic and baseline characteristics of patients with vascular injuries of extremities and to define the most relevant factors which influenced an early outcome, as well as limb salvage after the management of vascular trauma. METHODS This study used the database that included 395 patients with peripheral arterial injuries, who were treated in the tertiary vascular university center in the period between 2005-2020. Exclusion criteria were isolated thoracic, abdominal and neck injuries as well as iatrogenic injuries and injuries of intravenous addicts. Univariate binary logistic regression analysis and multiple logistic regression were used to determine risk factors for lomb loss (after vascular reconstruction) or mortality. Decision to perform primary amputation (without vascular reconstruction) was based on surgeons' preference and experience. RESULTS Out of 395 vascular injuries treated in the period 2005-2020, 210 (53.2%) presented with non-iatrogenic vascular injuries of upper and lower extremities were analyzed. According to the univariate regression analysis, hemorrhage as the main clinical manifestation on admission (P=0.035) and early reintervention (P=0.048) increased, while an early patency of repaired artery (0.010) significantly decreased a 30-day amputation rate. Multivariate logistic regression analysis of these three variables showed that only early patency of repaired artery significantly decreased the early amputation rate (P=0.009). CONCLUSIONS Based on presented experience, the patency of vascular reconstruction plays a crucial role in limb salvage in patients with non-iatrogenic peripheral vascular injuries. All factors that might influence the patency should be in focus of improvement.
Collapse
Affiliation(s)
- Lazar B Davidovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor B Koncar
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia - .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko V Dragas
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav D Markovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Aleksandra D Vujcic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandar C Mitrovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola S Ilic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ranko D Trailovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan M Kostic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
4
|
Allain C, Godard E, Esperança P, Raul JS, Farrugia A. Fatal penetrating iliac wound: A case report with determination of physical activity and time to collapse. Forensic Sci Int 2023; 342:111537. [PMID: 36529084 DOI: 10.1016/j.forsciint.2022.111537] [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: 09/07/2022] [Revised: 11/17/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
A case of fatal left iliac penetrating wound in a thirty-year-old man, during a fight, was presented. The medical file described a transfixing five-centimeter large wound on the left iliac vein and a puncture wound on the left iliac artery. After performing an autopsy, we concluded that the death was secondary to multivisceral failure, secondary to hemorrhagic shock. The judge investigating the case requested a detailed forensic medical reconstructive opinion focusing on the sequence of events leading to the fatal blow. Our having access to the videorecording and the photographs of the crime scene, added to the testimonies of witnesses proved to be a great help to the investigation. The data from the crime scene video recordings allowed us to estimate the victim's physical activity after the fatal stabbing (running between 20 and 140 meters) and the time when he collapsed (between 32s and 1 min) after the stabbing which is rarely described with methods using Closed-Circuit Television material, especially in cases of fatal vascular injuries. Those data are usually estimated from eyewitnesses' accounts, which remain an unreliable method.
Collapse
Affiliation(s)
- Charlotte Allain
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France.
| | - Estelle Godard
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France
| | - Philippe Esperança
- Forensic Analysis Laboratory, 2 rue Henri Barbusse, 13001 Marseille, France
| | - Jean Sébastien Raul
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France
| | - Audrey Farrugia
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France
| |
Collapse
|
5
|
Johannesdottir BK, Geisner T, Gubberud ET, Gudbjartsson T. Civilian vascular trauma, treatment and outcome at a level 1-trauma centre. Scand J Trauma Resusc Emerg Med 2022; 30:74. [PMID: 36544205 PMCID: PMC9773450 DOI: 10.1186/s13049-022-01059-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce. METHODS A retrospective study on all adults admitted to a North-European level 1-trauma centre 2009-2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan-Meier) estimated. RESULTS Of 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13-1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury. CONCLUSIONS Traumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality. TRIAL REGISTRATION Retrospectively registered.
Collapse
Affiliation(s)
- B. K. Johannesdottir
- grid.412008.f0000 0000 9753 1393Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies vei 65, P.O. Box 1400, 5021 Bergen, Norway ,grid.14013.370000 0004 0640 0021Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - T. Geisner
- grid.412008.f0000 0000 9753 1393Western Norway Trauma Centre, Haukeland University Hospital, Bergen, Norway
| | - E. T. Gubberud
- grid.412008.f0000 0000 9753 1393Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies vei 65, P.O. Box 1400, 5021 Bergen, Norway
| | - T. Gudbjartsson
- grid.410540.40000 0000 9894 0842Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland ,grid.14013.370000 0004 0640 0021Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| |
Collapse
|
6
|
Ogunleye EO, Olusoji OO, Kanu OO. Vascular injuries: Aetiology, presentation and management outcomes at a tertiary hospital in Lagos, Nigeria. Niger Postgrad Med J 2022; 29:334-340. [PMID: 36308263 DOI: 10.4103/npmj.npmj_221_22] [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] [Indexed: 06/16/2023]
Abstract
UNLABELLED Vascular injuries lead to haemorrhagic shock and distal limb ischaemia, especially with an arterial injury. This life-threatening state mandates urgent evaluation and intervention to save life and limbs. The treatment aims to restore blood flow and replace lost blood within the golden hours, stabilising cardiovascular haemodynamics and averting irreversible ischaemic damage. The aim of this study was to analyse the clinical profile of vascular injuries, management and outcomes in our institution. MATERIALS AND METHODS This retrospective study covered the period from January 2015 to December 2021. Information of interest were extracted from the medical records of each participant. The results from the data analysis were presented in charts and tables. RESULTS Seventy-four patients aged 15-78 years (mean 32.30 ± 13.75 years) were included in this study. The male-to-female ratio was 3.6:1. The most common causes were gunshot injury, road traffic accident and iatrogenic injuries. The mean duration from injury to presentation was 9.85 h and mean duration from presentation to restoration of flow was 7.3 h. The most common injured artery was the femoral artery, whereas the most common vein was inferior vena cava. Primary vascular repair was done in majority of the cases. Amputation was performed in 18.9% with loss of viability of the limb. CONCLUSION Vascular injury though relatively uncommon remains a challenging and life-threatening disease predominantly in young adult males. Urgent intervention prevents limb loss and mortality. Favourable outcome is accomplished by improving emergency healthcare delivery and well-equipped vascular centres with adequately trained personnel in the nation's hospitals.
Collapse
Affiliation(s)
- Ezekiel Olayiwola Ogunleye
- Department of Surgery, Faculty of Clinical Sciences, Cardiothoracic Surgical Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olugbenga Oluseyi Olusoji
- Department of Surgery, Faculty of Clinical Sciences, Cardiothoracic Surgical Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Okezie Obasi Kanu
- Department of Surgery, Faculty of Clinical Sciences, Neurosurgical Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| |
Collapse
|
7
|
Herrero A, Souche R, Panaro F, Navarro F. Endovascular balloon occlusion during reconstruction of portal vein injury. Langenbecks Arch Surg 2020; 405:391-395. [PMID: 32361778 DOI: 10.1007/s00423-020-01886-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Repair of portal vein injury in a hostile abdomen can be very challenging, complicated by massive hemorrhage or stenosis. It can seldom be successfully carried out, even by experienced hepatobiliary surgeons. The ideal venous clamping technique is often not feasible and increases the risk of lethal portal vein laceration. The common mistake being the forceful use of clamps around the vein in the attempt to obtain vascular control, resulting in additional injuries. METHODS We provide a descriptive report of two cases detailing a careful step-by-step technique for the management of portal vein injury by inserting an endovascular balloon inflated with serum to control bleeding and repair the vein. RESULTS In patients who required this technique, no bleeding recurrence, nor portal vein thrombosis or stenosis was detected by CT-scan during follow-up. CONCLUSION The endovascular balloon occlusion technique for the reconstruction of portal vein injuries in hostile abdomen is a safe and life-saving procedure that should be part of the armamentarium of visceral surgeons.
Collapse
Affiliation(s)
- Astrid Herrero
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Regis Souche
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
- Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France.
| | - Fabrizio Panaro
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Francis Navarro
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| |
Collapse
|
8
|
Abstract
This review article summarizes the epidemiology of vascular injuries during urologic surgery and discusses intraoperative strategies to control bleedings. Techniques of vascular approaches (arteries and veins) are discussed and tricks for vascular repair are explained. Generally, vascular injuries during urologic surgery are rare. However, hemorrhage due to vascular injury is a common cause of critical morbidity and mortality in the perioperative period. Susceptibility to vascular complications such as oncological debulking and revision surgery increase risk for damage. As vascular injuries range from arrosion to avulsion, treatment is also broad, ranging from vascular suture to open or endovascular repair. Prevention of exsanguination requires visual control to stop the bleeding. The surgeon must act quickly to initiate appropriate repair, aiming for damage control and stabilization of the patient. Planning the surgery and consulting an experienced surgeon are decisive for successful management. Catastrophic bleeding has to be controlled and in the case of arterial injury it is often necessary to reconstitute perfusion. Reconstructions such as vascular anastomoses, patch angioplasty or interposition grafts are the preferred surgical techniques which are influenced by the nature of the injury. Vessels have to be thoroughly prepared before cross clamping to prevent injury by vascular clamps. Veins can often be ligated. Endovascular repair is also a possibility to control the bleeding, but nowadays it is often a definitive therapy method. For example, resuscitative endovascular balloon occlusion is useful to stabilize the patient and then to initiate vascular repair. Depending on the type of surgery performed, different vessels are concerned. Severe bleeding is usually located retroperitoneal affecting the aorta, renovisceral and iliac vessels. Predisposing urologic operations are lymphadenectomy, nephrectomy and (cysto)prostatectomy and also the laparoscopic approach can cause bleeding complications.
Collapse
Affiliation(s)
- J D Süss
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
| | - J Kranz
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - M Gawenda
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - J Steffens
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| |
Collapse
|
9
|
Meyer A, Huebner V, Lang W, Almasi-Sperling V, Rother U. In-hospital outcomes of patients with non-iatrogenic civilian vascular trauma. VASA 2020; 49:225-229. [PMID: 31983319 DOI: 10.1024/0301-1526/a000849] [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: 11/19/2022]
Abstract
Background: Morbidity, lesion pattern, management and short-term outcomes of civilian vascular trauma are rarely evaluated. Therefore, analysis of in hospital results in patients with non-iatrogenic vascular trauma in a tertiary referral hospital was performed. Patients and methods: Retrospective evaluation of patients with vascular trauma from 2007-2017 was done. 48 patients (34 male, 14 females, mean age 56 years) were included. Excluded were patients with iatrogenic vascular complications. Major cause of vascular trauma were traffic accidents in 43.8 %, fall from great heights in 27.1 %, sport and home related injuries in 16.8 %, suicidal injuries in 4.2 % and gunshot wounds in 2.1 % (other 6.3 %). 60.4 % of patients presented with blunt, 39.6 % of patients with penetrating vascular trauma. More than half of the cases included polytraumatized patients (54.4 %). Results: Most commonly affected were the popliteal (25.0 %) and the axillar artery (18.8 %). Aortic injuries were present in 14.6 % of cases, whereas the femoral and subclavian artery were involved in 12.6 % and 10.4 %. Vascular reconstruction was performed by interposition graft in 45.9 %, direct suture in 18.8 %, patchplasty in 10.4 %, ligation in 12.4 %, and implantation of stentgraft in 12.5 %. Postoperative complication rate was 54.2 %. Rate of in-hospital major amputation was 14.6 % and in-hospital mortality was 14.6 % as well. Comparison between blunt and penetrating trauma as to postoperative complication (p = 0.322), blood transfusion (p = 0.452) and amputation (p = 0.304) showed no significant differences, whereas lethality in blunt trauma was 20.6 % vs. 5.2 % in penetrating trauma. Injury severity score (ISS) was significantly elevated for blunt trauma patients (mean ISS Score blunt 32 vs 21 penetrating, p = 0.043). Conclusions: The majority of vascular lesions is caused by blunt trauma. Blunt lesions do also show a severe injury pattern, compared to penetrating trauma, and the complication rate remains high. However, by means of vascular reconstruction, limb salvage is feasible in a high percentage of cases.
Collapse
Affiliation(s)
- Alexander Meyer
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Viola Huebner
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
10
|
Abubakar A, Okpechi S. Bilateral vascular repair in a patient with multiple upper extremity injury presenting at a teaching hospital—Case report and literature review. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:30-35. [PMID: 35814970 PMCID: PMC9267045 DOI: 10.4103/jwas.jwas_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Penetrating trauma to the upper extremity will usually result in vascular injuries, which mostly also involves nerves and tendons. Morbidity related to upper extremity vascular injuries usually occurs due to the associated injuries of the nerves, tendons, and bone. Early presentation to a trauma centre and prompt intervention will reduce morbidity associated with upper extremity vascular injuries.
Collapse
|
11
|
Johannesdottir BK, Johannesdottir U, Jonsson T, Lund SH, Mogensen B, Gudbjartsson T. High Mortality from Major Vascular Trauma in Traffic Accidents: A Population-Based Study. Scand J Surg 2019; 109:328-335. [PMID: 31354052 DOI: 10.1177/1457496919863944] [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
BACKGROUND AND AIMS Injuries involving major arteries are an important cause of mortality and morbidity, most often from road traffic accidents. Our aim was to study the outcome of major vascular trauma from traffic accidents in an entire population, including patients who die at the scene and those who reach hospital alive. MATERIALS AND METHODS This was a retrospective analysis of all patients who sustained major vascular trauma in traffic accidents in Iceland from 2000 to 2011. Patient demographics, mechanism, and location of vascular injury and treatment were registered. Injury scores were calculated and overall survival estimated. RESULTS There were 62 individuals (mean age 44 years, 79% males) with 95 major vascular traumas, giving an incidence of 1.69/100,000 inhabitants (95% confidence interval: 1.27-2.21). A total of 33 died at the scene and 8 during transportation to hospital but 21 (34%) reached hospital alive. Most patients who succumbed had thoracic major vascular traumas (76%) or abdominal major vascular traumas (23%). Mean new injury severity score for the 21 admitted patients was 44. A total of 18 were operated with vascular repair, 3 with endovascular stent graft insertion. The mean hospital stay for discharged patients was 34 days. Altogether, 15 of the 62 patients (24%) survived to discharge from hospital, with a 5-year survival of 86% for discharged patients. CONCLUSION Every other patient with major vascular trauma following traffic accidents died at the scene and a further 13% died during transportation to hospital, most of whom sustained major vascular trauma to the thoracic aorta. However, one-third of the patients reached hospital alive and 71% of them survived to discharge, with excellent long-term survival.
Collapse
Affiliation(s)
- B K Johannesdottir
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - U Johannesdottir
- Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - T Jonsson
- Department of Iceland National Blood Bank, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - S H Lund
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - B Mogensen
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - T Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
12
|
González J, Angulo-Morales FJ, Lledó-García E. Vascular Injury During Urologic Surgery: Somebody Call My Mother. Curr Urol Rep 2019; 20:2. [PMID: 30649624 DOI: 10.1007/s11934-019-0869-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions. RECENT FINDINGS The frequency of intraoperative vascular injuries is increasing. However, literature concerning the management of iatrogenic operative vascular injuries is scarce. Although rare, intraoperative vascular injuries may be associated with potential catastrophic complications and death. The decision-making process following a potential life-threatening intraoperative vascular injury occurs in a very short time frame. Appropriate knowledge of the critical elements to identify the source of bleeding, initiate first-line hemostatic measures, select the candidate for damage control strategies, and perform the indicated operative repairing maneuvers and techniques have been proved crucial to ensure hemodynamic stability and bleeding cessation. The key surgical principles to counteract the impact of exsanguinating bleeding, and the aim to obtain the best achievable outcomes after definitive repair, are described in detail in this review.
Collapse
Affiliation(s)
- Javier González
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Francisco J Angulo-Morales
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Central de la Cruz Roja San José y Santa Adela, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
| | - Enrique Lledó-García
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
- Departmento de Cirugía, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
13
|
Diaz-Abele J, Safa B, Buntic RF, Islur A. USE of arterialized saphenous vein venous flow-through flaps as a temporizing measure for hand salvage in contaminated wounds presenting with limb ischemia: A case series. Microsurgery 2017; 38:362-368. [PMID: 28753228 DOI: 10.1002/micr.30206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/22/2017] [Accepted: 07/12/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vascular injuries resulting in limb ischemia are traditionally treated acutely with autologous or prosthetic bypass grafts. Traumatic contaminated injuries with soft tissue and vascular segmental loss are challenging as prosthetic bypasses are at risk of erosion, infection, and occlusion; and autologous bypasses are at risk of desiccation, blow-out, infection, and clotting. We propose a novel approach to these injuries by using arterialized saphenous vein venous flow-through free flaps (S-VFTF) as an autologous bypass, and present the results of its application in a series of cases. METHODS Spanning 2008 to 2015, four patients presenting with large contaminated crush/avulsion wounds with vascular injury underwent hand revascularization with S-VFTF, allowing the contaminated wounds to be serially debrided. Definitive soft tissue reconstruction was performed once the wound was considered clean. The S-VFTF skin paddle was de-epithelialized and the soft tissue defect covered with a free latissimus dorsi flap or a rectus abdominis myocutaneous flap. RESULTS All ischemic limbs were successfully reperfused and there were no take backs for perfusion issues. All S-VFTF remained patent at discharge and final follow-up. No partial or complete finger/hand amputations were required. All definitive coverage free flap survived with no complications. CONCLUSION The two-stage reconstruction presented may help reconstructive and vascular surgeons consider alternatives to traditional vascular reconstruction methods. This technique avoids an exposed vascular graft in an extensively contaminated open wound. It allows the surgeon to perform thorough and sufficient debridement of the wound, preventing definitive reconstruction in a not yet declared zone of injury.
Collapse
Affiliation(s)
- Julian Diaz-Abele
- Section of Plastic Surgery, University of Manitoba, Winnipeg, Canada
| | | | | | - Avinash Islur
- Section of Plastic Surgery, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
14
|
Mäkitie I, Mattila VM, Pihlajamäki H. Severe Vascular Gunshot Injuries of the Extremities: A Ten-Year Nation-Wide Analysis from Finland. Scand J Surg 2016; 95:49-54. [PMID: 16579256 DOI: 10.1177/145749690609500110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: Gunshot wounds affecting the main vessels of the extremities mostly threaten limb salvage. The purpose of this study was to analyse the nature and severity of civilian vascular gunshot injuries of the extremities using a nation-wide database. Material and Methods: Retrospective analysis of the Finnish Hospital Discharge Register, hospital records and death certificates over a 10-year period from January 1, 1990 to December 31, 1999. Results: Thirty-two individuals with the mean age of 33 years (17–68) sustained 43 severe vascular injuries to the extremities caused by gunshots. The incidence was 6.0 (95% CI: 4.1–8.5) per 10, 000, 000 person-years and did not change significantly during the period. Four of the injured died. The most common anatomical locations of vascular injuries were the femoral artery (6 lesions), popliteal artery (6) and superficial femoral artery (5). Use of alcohol was detected in ten cases (32% of patients) and of illegal drugs in seven cases (22%). Five patients (18% of non-fatal injuries) required vascular re-operation caused by post-operative problems. Five amputations were performed as primary treatment. Conclusions: Severe vascular gunshot injuries of the extremities are not common in Finland. The need for primary amputation or vascular re-operations is noteworthy.
Collapse
Affiliation(s)
- I Mäkitie
- Research Institute of Military Medicine, National Military Hospital, Helsinki, Finland
| | | | | |
Collapse
|
15
|
Al Wahbi A, Aldakhil S, Al Turki S, El Kayali A, Al Kohlani H, Al Showmer A. Risk factors for amputation in extremity vascular injuries in Saudi Arabia. Vasc Health Risk Manag 2016; 12:229-32. [PMID: 27307745 PMCID: PMC4888860 DOI: 10.2147/vhrm.s91452] [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] [Indexed: 11/23/2022] Open
Abstract
Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies.
Collapse
Affiliation(s)
- Abdullah Al Wahbi
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Salman Aldakhil
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saud Al Turki
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman El Kayali
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hussein Al Kohlani
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al Showmer
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
16
|
Altoijry A, Al-Omran M, Johnston KW, Mamdani M, Lindsay TF. Temporal trends in vascular trauma in Ontario, 1991-2009: a population-based study. CMAJ Open 2016; 4:E309-15. [PMID: 27398379 PMCID: PMC4933644 DOI: 10.9778/cmajo.20150046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vascular injuries add substantial complexity to trauma care, yet Canadian epidemiologic data on such injuries are not readily available. We conducted a retrospective cross-sectional study to examine temporal trends in the rate of hospital admissions for vascular injuries from 1991 to 2009 in Ontario. METHODS Individuals of any age admitted to hospital because of vascular trauma in Ontario were included. Details of vascular injury and patient demographic characteristics were recorded, hospital admission rates estimated and analyses stratified by sex, age, mechanism of injury, economic status and geographic location. Time-series analysis was used to examine trends in hospital admission rates. RESULTS Of the 8252 hospital admissions for vascular trauma, 4287 (52.0%) involved injuries to the upper limb and 1819 (22.0%) were due to transport-related causes. Overall, the annual rate declined significantly over time, from 3.3 per 100 000 in 1991 to 2.7 per 100 000 in 2009 (p < 0.01). The subgroups with the highest rates were young men, patients with a low economic status and those living in a rural location. Declines occurred in both sexes and in all age groups except those 65 years and older. The rates of vascular injury to the neck, thorax, upper limbs and lower limbs declined over time, but not the rate of abdominal vascular injury. Although the rate of non-transport-related vascular injuries declined, the rate of transport-related vascular injuries did not change significantly over time. Decreases in annual rates occurred in both low- and high-economic status groups and in urban populations but not in rural populations. INTERPRETATION Overall, the annual rate of hospital admissions for vascular trauma declined significantly in Ontario over the study period. Our findings have important implications for public health and the development of injury-prevention strategies, particularly for population subgroups at high risk of vascular injury.
Collapse
Affiliation(s)
- Abdulmajeed Altoijry
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - K Wayne Johnston
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - Thomas F Lindsay
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| |
Collapse
|
17
|
Baghi I, Herfatkar MR, Shokrgozar L, Poor-Rasuli Z, Aghajani F. Assessment of Vascular Injuries and Reconstruction. Trauma Mon 2015; 20:e30469. [PMID: 26839869 PMCID: PMC4727477 DOI: 10.5812/traumamon.30469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/24/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trauma is the third leading cause of death. In this regard, vascular injury plays a leading role in of morbidity and mortality rates. OBJECTIVES The present study aimed to assess the prevalence of vascular injuries and results of vascular reconstruction at a referral hospital in northern Iran. PATIENTS AND METHODS A retrospective observational study assessed 88 consecutive patients with vascular injury admitted to Poursina Hospital, Rasht in northern Iran, from October 2007 to October 2009. All study information was collected retrospectively from hospital charts. RESULTS Most of the affected patients (87/88) were male with a mean age of 29.12 ± 11.20 years. The mechanism of injury in 39.8% was blunt trauma and penetrating trauma in the rest. Of the 53 injured by penetrating trauma (60.2%), the most common cause was stabbing (94.3%). The most common cause of blunt trauma was road traffic accidents (93.1%). The most common mechanism for vascular injuries in upper extremities was penetrating trauma (86.0%) and in lower extremities was blunt trauma (60.0%). Fasciotomy was performed in 16 patients (18.2%) mostly in the lower extremities. Major amputation was required in 10% of the patients. In upper extremities, the most common type of revascularization was end to end anastomosis, followed by inter-position graft. The most common type of reconstruction in the lower extremity was bypass graft. All patients who underwent major amputation were admitted to the center with a delay of more than 6 hours after injury. CONCLUSIONS Major vascular injuries in our center occurred in young men, frequently because of stab wounds. Popliteal injuries mostly caused by motor vehicle accidents was the second most common arterial injury, followed by combined ulnar and radial injuries. Vascular reconstruction in the first hours after trauma may prevent many unnecessary and preventable amputation procedures.
Collapse
Affiliation(s)
- Iraj Baghi
- Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
- Department of General Surgery, Faculty of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Mohammad Rasool Herfatkar
- Department of General Surgery, Faculty of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Leila Shokrgozar
- Department of General Surgery, Faculty of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Zahra Poor-Rasuli
- Department of General Surgery, Faculty of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Fatemeh Aghajani
- General Physician, Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran
| |
Collapse
|
18
|
Pereira BMT, Chiara O, Ramponi F, Weber DG, Cimbanassi S, De Simone B, Musicki K, Meirelles GV, Catena F, Ansaloni L, Coccolini F, Sartelli M, Di Saverio S, Bendinelli C, Fraga GP. WSES position paper on vascular emergency surgery. World J Emerg Surg 2015; 10:49. [PMID: 26500690 PMCID: PMC4618918 DOI: 10.1186/s13017-015-0037-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 12/18/2022] Open
Abstract
Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).
Collapse
Affiliation(s)
- Bruno Monteiro T. Pereira
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Fabio Ramponi
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Dieter G. Weber
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | | | - Belinda De Simone
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Korana Musicki
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Guilherme Vieira Meirelles
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Fausto Catena
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Luca Ansaloni
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | | | | | - Cino Bendinelli
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | - Gustavo Pereira Fraga
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| |
Collapse
|
19
|
Khan FH, Yousuf KM, Bagwani AR. Vascular injuries of the extremities are a major challenge in a third world country. J Trauma Manag Outcomes 2015; 9:5. [PMID: 26229550 PMCID: PMC4520131 DOI: 10.1186/s13032-015-0027-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Traumatic vascular injuries of the extremities are a major challenge especially in the third world countries. These injuries are mostly due to poor traffic laws, street crimes, firearms and blast associated injuries. We therefore would like to share our 10 years of experience in dealing with vascular injuries in Pakistan. METHODS This was a retrospective observational study conducted in the department of vascular surgery of Liaquat National Hospital, Karachi, Pakistan. Patients' records were retrieved from the department and were reviewed. Cases with vascular injuries of upper and lower limb that presented with signs of salvageable limb and presented within 12 hours of injury were included in the study. Patients with more than 12 hours of presentation and in whom primary amputation was done, were excluded from the study. RESULTS There were 328 patients who presented with vascular injuries of the extremities that fell in the inclusion criteria. Limb salvage rate was 41 %, whereas 30-days perioperative mortality was 5.48 %. The major cause of limb loss was delay in presentation of more than 8 h of injury. Major vessels involved were popliteal artery (41.76 %), followed by femoral artery (27.43 %). CONCLUSION Vascular injuries are becoming a major contributor of limb loss in third world countries due to violence, terrorism and unavailability of vascular facilities. This morbidity can be reduced by improving law and order situation, evolving an effective emergency ambulatory system and with better training and provision of vascular services in remote areas so that the delay factor can be reduced.
Collapse
Affiliation(s)
- Fahad H Khan
- General Surgery, Civil Hospital, Baba-e-Urdu Road, Karachi, 75200 Pakistan
| | - Kamal M Yousuf
- Vascular Surgery, Liaquat National Hospital, Stadium Road, Karachi, 74800 Pakistan
| | - Anel R Bagwani
- General Surgery, Liaquat National Hospital, Stadium Road, Karachi, 74800 Pakistan
| |
Collapse
|
20
|
Soares LT, Bastos CC, Koury Junior A, Pereira AJF. Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.
Collapse
|
21
|
Abstract
Peripheral vascular injuries are the cause of high morbidity in trauma patients. Up to 5 % of all patients with injuries of the extremities present with concomitant vascular lesions. While open peripheral vascular injuries are associated with a high mortality at the scene of the accident, closed vascular injuries present the danger of developing critical tissue ischemia with a high risk of amputation and limb loss. Early diagnosis is crucial in order to rapidly restore and maintain adequate blood flow and downstream tissue perfusion. A correct diagnosis and early treatment of peripheral vascular injuries place enormous demands on interdisciplinary teams consisting of emergency physicians, orthopedic surgeons, vascular surgeons, anesthesiologists and radiologists. The top priority in the context of emergency care is hemorrhage control by applying direct pressure and dressings until definitive surgical treatment. Hypovolemic shock, reperfusion injury and compartment syndrome are complications of peripheral vascular injuries that must be recognized and treated in the early stages.
Collapse
|
22
|
Pezeshki Rad M, Mohammadifard M, Ravari H, Farrokh D, Ansaripour E, Saremi E. Comparing color Doppler ultrasonography and angiography to assess traumatic arterial injuries of the extremities. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e14258. [PMID: 25785180 PMCID: PMC4347799 DOI: 10.5812/iranjradiol.14258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 04/20/2014] [Accepted: 06/01/2014] [Indexed: 11/17/2022]
Abstract
Background: Traumatic events are one of the major causes of arterial injuries. Physical examination is not a good predictor of the extent of injuries and arteriography is considered as the gold standard for this purpose. In the recent years, noninvasive modalities are increasingly replacing diagnostic arteriography. Color Doppler ultrasonography (USG) is an excellent method to investigate arterial diseases. Objectives: The present study aimed to evaluate the diagnostic value of color Doppler USG compared to conventional angiography in traumatic arterial injuries of extremities. Patients and Methods: Seventy-five patients with extremity trauma suspicious for arterial injury were examined by color Doppler USG just before angiography. Doppler pattern and flow states were assessed, then angiography was performed. The results of duplex USG were compared with angiography. Results: Color Doppler USG had a sensitivity of 95% and specificity of 98% in diagnosis of arterial injury. Positive and negative predictive values of Doppler USG were 92.5% and 94.2%, respectively. Conclusions: Color Doppler USG can be used as a reliable modality with acceptable sensitivity and specificity values to screen hemodynamically stable patients with limb trauma suspicious for arterial injury.
Collapse
Affiliation(s)
- Masoud Pezeshki Rad
- School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahyar Mohammadifard
- School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran
- Corresponding author: Mahyar Mohammadifard, School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran. Tel: +98-5118414499, Fax: +98-5612226898, E-mail:
| | - Hassan Ravari
- School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Donya Farrokh
- School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Emad Ansaripour
- School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elena Saremi
- School of Medicine, Vascular and Endovascular Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
23
|
Non-iatrogenic civilian vascular trauma in a well-defined geographical region in Finland. Eur J Trauma Emerg Surg 2014; 41:545-9. [DOI: 10.1007/s00068-014-0460-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
|
24
|
Yoo TK, Min SK, Ahn S, Kim SY, Min SI, Park YJ, Ha J, Kim SJ. Major Vascular Injury During Nonvascular Surgeries. Ann Vasc Surg 2012; 26:825-32. [DOI: 10.1016/j.avsg.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/29/2011] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
|
25
|
Perkins Z, De'Ath H, Aylwin C, Brohi K, Walsh M, Tai N. Epidemiology and Outcome of Vascular Trauma at a British Major Trauma Centre. Eur J Vasc Endovasc Surg 2012; 44:203-9. [DOI: 10.1016/j.ejvs.2012.05.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/14/2012] [Indexed: 11/15/2022]
|
26
|
Cristián Salas D. Trauma vascular, visión del cirujano vascular. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
27
|
Acute ischemia of the lower limb after injury by gunshot: case report and review of literature. Eur J Trauma Emerg Surg 2011; 37:53-9. [PMID: 26814751 DOI: 10.1007/s00068-010-0035-8] [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: 01/10/2010] [Accepted: 06/06/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Civilian and military vascular trauma has evolved dramatically. It is estimated that 80% of all cases of vascular injuries are due to peripheral vascular trauma, most involving the lower extremities. Arterial below-knee injuries by gunshot still remain a challenge, with an associated rate of amputation of 20-54%. MATERIAL AND METHODS This case reports a 48 year-old male patient who sustained a gunshot below his left knee. At hospital admission, loss of substance and hemorrhage at the medial and lateral faces of the upper third of his left leg were present with signs of distal ischemia. Arteriography revealed infra-popliteal arterial lesions of the three arterial axes. Two reversed great saphenous vein interposition grafts were performed into the anterior and posterior tibial arteries with immediate revascularization of the left leg and foot. Later, soft tissue reconstruction was accomplished by a split-thickness skin graft. RESULTS At the fifth month of follow-up, the left leg and foot were viable with good healing, without limitations and with controlled pain. Posterior tibial and dorsalis pedis pulses were palpable. CONCLUSION This case report shows the importance of an adequate team approach for treatment of a gunshot extremity injury with vascular lesion. The authors want to highlight the scientific background evidence and the value of comparing worldwide civilian trauma center outcomes, mostly reported previously from the military field.
Collapse
|
28
|
Iatrogenic and Non-Iatrogenic Vascular Trauma in a District General Hospital: A 21-year Review. World J Surg 2010; 34:2363-7. [DOI: 10.1007/s00268-010-0647-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Jawas A, Hammad F, Eid HO, Abu-Zidan FM. Vascular injuries following road traffic collisions in a high-income developing country: a prospective cohort study. World J Emerg Surg 2010; 5:13. [PMID: 20482814 PMCID: PMC2892435 DOI: 10.1186/1749-7922-5-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 05/19/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The mechanism and pattern of vascular injury vary between different populations. The commonest mechanism of vascular injury in civilian practice is road traffic collisions. We aimed to prospectively study the incidence, detailed mechanism and anatomical distribution of hospitalized vascular trauma patients following road traffic collisions in a high-income developing country. METHODS Data were collected prospectively on road traffic collision injuries in the whole city of Al-Ain, United Arab Emirates, from April 2006 to October 2007 with full details of mechanism of injury and its relation to sustained injuries. RESULTS Out of 1008 patients in the registry, 13 patients had vascular injury, a calculated incidence of 1.87 cases/100 000 inhabitants per year. There were eight car occupants, four pedestrians, and one motorcyclist. Upper limb vascular injuries were the most common anatomical site (n = 4) followed by thoracic aorta (n = 3). All thoracic aortic injuries were acceleration injuries (pedestrians hit by a moving vehicle). None of the eight car occupants was wearing a seatbelt and the majority sustained a front impact deceleration injuries. The median injury severity score, hospital stay, and ICU stay were significantly higher in the vascular injury group compared with nonvascular group (P < 0.0001). Three patients died (23%); two due to severe liver trauma and one due to rupture thoracic aorta. CONCLUSIONS The incidence of hospitalized vascular injury due to road traffic collisions in Al-Ain city is 1.87 cases/100 000 inhabitants. These injuries occurred mainly in the upper part of the body. Seatbelt compliance of car occupants having vascular injuries was very low. Compliance with safety measures needs more enforcement in our community.
Collapse
Affiliation(s)
- Ali Jawas
- Trauma Group, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fayez Hammad
- Trauma Group, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Hani O Eid
- Emergency Department, Tawam Hospital; Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Trauma Group, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
- Department of Surgery Al-Ain Hospital, Al-Ain, United Arab Emirates
| |
Collapse
|
30
|
Chapellier X, Sockeel P, Baranger B. Management of penetrating abdominal vessel injuries. J Visc Surg 2010; 147:e1-12. [DOI: 10.1016/j.jviscsurg.2010.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
Klocker J, Falkensammer J, Pellegrini L, Biebl M, Tauscher T, Fraedrich G. Repair of Arterial Injury after Blunt Trauma in the Upper Extremity – Immediate and Long-term Outcome. Eur J Vasc Endovasc Surg 2010; 39:160-4. [DOI: 10.1016/j.ejvs.2009.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
|
32
|
Bains S, Vlachou P, Rayt H, Dennis M, Markose G, Naylor A. An observational cohort study of the management and outcomes of vascular trauma. Surgeon 2009; 7:332-5. [DOI: 10.1016/s1479-666x(09)80105-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Upper extremity arterial injuries: factors influencing treatment outcome. Injury 2009; 40:815-9. [PMID: 19523624 DOI: 10.1016/j.injury.2008.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 08/20/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to identify factors influencing surgical treatment outcome following upper extremity arterial injuries. METHODS This 15-year study (January 1992 to December 2006) included 167 patients with 189 civilian, iatrogenic or military upper extremity arterial injuries requiring surgical intervention. Patient data were prospectively entered into a vascular trauma database and retrospectively analysed. RESULTS The most frequently damaged vessel was the brachial artery (55% of injuries), followed by the axillary (21.7%), antebrachial (21.2%) and subclavian (2.1%) arteries. Three primary amputations (1.8%) were performed because of extensive soft-tissue destruction and signs of irreversible ischaemia on admission. Seven secondary amputations (4.2%) were due to graft failure, infection, anastomotic disruption or the extent of soft-tissue and nerve damage. Fasciotomy was required in 9.6% of cases. Operative mortality was 2.4% (four deaths). Early graft failure, compartment syndrome, associated skeletal and brachial plexus damage and a military mechanism of injury were found to be significant risk factors for limb loss (p<0.01). CONCLUSION Although careful physical examination should diagnose the majority of upper extremity arterial injuries, angiography is helpful in detailing their site and extent. Prompt reconstruction is essential for optimal results. Nerve trauma is the primary cause of long-term functional disability.
Collapse
|
34
|
Rudström H, Bergqvist D, Ögren M, Björck M. Iatrogenic Vascular Injuries in Sweden. A Nationwide Study 1987–2005. Eur J Vasc Endovasc Surg 2008; 35:131-8. [DOI: 10.1016/j.ejvs.2007.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 09/10/2007] [Indexed: 11/26/2022]
|
35
|
Oktar GL. Iatrogenic major venous injuries incurred during cancer surgery. Surg Today 2007; 37:366-9. [PMID: 17468815 DOI: 10.1007/s00595-006-3416-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 10/29/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE Iatrogenic operative injury to the major veins is associated with significant morbidity and mortality. This study was conducted to review the pattern, management, and outcome of iatrogenic major venous injuries incurred during cancer surgery. METHODS We reviewed 24 patients with collective 30 venous injuries, evaluating clinical characteristics; operative and postoperative data, including location and type of venous injury, operative repair, blood loss, and transfusion requirements; and outcome. RESULTS Thirty venous and 12 associated arterial injuries were identified. The two most common sites of venous trauma were the iliac and femoral veins with 10 (33.3%) and 9 (30.0%) injuries, respectively. Twenty-three (76.7%) of the venous injuries were repaired primarily or with end-to-end anastomosis, while the remaining injuries required interposition grafts, patch venoplasty, or venous ligation. Postoperative revision procedures were performed in 3 (12.5%) patients. Perioperative mortality was 16.7% and major complications developed in 11 (45.8%) patients. CONCLUSIONS Serious complications can be minimized by immediate recognition and prompt repair of iatrogenic vascular injuries. Close collaboration with a vascular surgeon during resection of tumors in proximity to the vascular structures may be helpful in preventing iatrogenic vascular injuries. In hospitals where tumor resection procedures are frequently performed, a vascular surgeon must be readily available.
Collapse
Affiliation(s)
- Gursel Levent Oktar
- Division of Cardiovascular Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
36
|
Abstract
OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.
Collapse
|
37
|
Ghallab NH. Overview of vascular injuries in Yemen: Experience from a single tertiary referral hospital. SURGICAL PRACTICE 2006. [DOI: 10.1111/j.1744-1633.2006.00281.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Ruppert V, Sadeghi-Azandaryani M, Mutschler W, Steckmeier B. [Vascular injuries in extremities]. Chirurg 2005; 75:1229-38; quiz 1239-40. [PMID: 15536512 DOI: 10.1007/s00104-004-0965-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Vascular injuries of the extremities account for most instances of vascular trauma (ca. 70%), and they entail a risk of amputation about 10-20%. According to the kind of force that has acted, arterial trauma is classified as direct or indirect. The scale of hemorrhage and peripheral ischemia depend on the nature and severity of the arterial lesion. In patients with multiple injuries, routine use of Doppler sonography and duplex sonography can facilitate early diagnosis and treatment of vascular injuries. With great certainty, clinical examination and an AB or WB index of >1.0 can rule out the presence of vascular injury that requires treatment. After excluding further life-threatening injuries, surgery should be performed immediately when there is critical ischemia, squirting hemorrhage, or a rapidly expanding hematoma. Angiography or duplex sonography findings determine the further procedure in vascular injuries that do not require immediate treatment. Occlusion of a reconstructed artery, manifestation of a compartment syndrome, and insufficient anticoagulation are the main factors affecting the risk of amputation.
Collapse
Affiliation(s)
- V Ruppert
- Gefässchirurgie Chirurgische Klinik und Poliklinik, Klinikum der LMU München
| | | | | | | |
Collapse
|
39
|
|
40
|
Giswold ME, Landry GJ, Taylor LM, Moneta GL. Iatrogenic arterial injury is an increasingly important cause of arterial trauma. Am J Surg 2004; 187:590-2; discussion 592-3. [PMID: 15135671 DOI: 10.1016/j.amjsurg.2004.01.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 01/19/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Iatrogenic arterial injuries (IAI) may result from any invasive diagnostic or therapeutic procedure. The relative occurrence and severity of IAI compared with those of penetrating and blunt vascular trauma is unknown. A review of arterial trauma at a university hospital level 1 trauma center, with a focus on iatrogenic injury, forms the basis of this report. METHODS Patients treated for arterial trauma from January 1994 through October 2002 were identified from prospectively maintained registries. Record review included injury etiology, type of repair, 30-day all-cause mortality, and permanent morbidity. Permanent morbidity was defined as amputation or loss of extremity function. RESULTS In all, 252 patients required treatment, 85 (33.7%) from IAI, 86 (34.1 %) from penetrating trauma, and 81 (32.1%) from blunt trauma. During the study period, the number of IAIs per year increased. Femoral artery injury from percutaneous intervention (50, 58.8%) was the most frequent IAI; intraoperative injury (including 14 tumor resections and 5 orthopedic procedures) was next most frequent (23, 27.1%). Three patients (3.5%) with IAI had permanent morbidity. The 30-day all-cause mortality was 7.1% (6) for patients with IAI. CONCLUSIONS Iatrogenic arterial injury is increasingly frequent and caused one third of the arterial trauma at our level 1 trauma center. These data suggest education and training regarding IAI deserves equal priority with the study of penetrating vascular trauma.
Collapse
Affiliation(s)
- Mary E Giswold
- Division of Vascular Surgery, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd., OP-11, Portland, OR 97239, USA
| | | | | | | |
Collapse
|
41
|
Oderich GS, Panneton JM, Hofer J, Bower TC, Cherry KJ, Sullivan T, Noel AA, Kalra M, Gloviczki P. Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication. J Vasc Surg 2004; 39:931-6. [PMID: 15111840 DOI: 10.1016/j.jvs.2003.11.040] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins. METHODS Clinical data and outcome in all patients with iatrogenic venous injuries during abdominal and pelvic operations between 1985 and 2002 were reviewed. RESULTS Forty patients (21 men, 19 women; mean age, 51 years [range, 27-87 years]) sustained 44 venous injuries. Injuries occurred during general (30%), colorectal (23%), orthopedic (20%), gynecologic (15%), and other (12%) operations. Factors leading to injury included oncologic resection (65%), difficult anatomic exposure (63%), previous operation (48%), recurrent tumor (28%), and radiation therapy (20%). All patients had substantial bleeding (mean, 3985 mL; range, 500-20,000 mL). Injuries were located in the inferior vena cava (n = 6), portal vein (n = 7), renal vein (n = 1), and iliac vein (n = 30). Repair was performed with venorrhaphy (64%), end-to-end anastomosis (14%), interposition graft (20%), and vessel ligation (2%). Seven patients (18%) died of injury-related causes, including multisystem organ failure (n = 4), uncontrollable bleeding (n = 2), and pulmonary embolism (n = 1). Thirteen patients (32.5%) had major injury-related complications, including repeat exploration because of bleeding (n = 6), multisystem organ failure (n = 6), and venous thrombosis (n = 4). In two patients (5%) unilateral lower extremity edema developed, with no evidence of thrombosis. There was no late graft or venous thrombosis. Variables associated with increased risk for death were massive bleeding, acidosis, hypotension, and hypothermia (P <.05). CONCLUSION Operative injuries of abdominal and pelvic veins occur in patients undergoing oncologic resection and those with difficult anatomic exposure, owing to previous operation, recurrent tumor, or radiation therapy. Massive blood loss, acidosis, hypotension, and hypothermia are associated with increased risk for death. Repair of venous injuries offers durable results with low incidence of graft or venous thrombosis.
Collapse
|