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Fernandez-Miranda JC, Hwang P, Grant G. Endoscopic Endonasal Surgery for Resection of Giant Craniopharyngioma in a Toddler-Multimodal Presurgical Planning, Surgical Technique, and Management of Complications: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 19:E68-E69. [PMID: 31814025 DOI: 10.1093/ons/opz384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
A 2-yr-old patient with a giant craniopharyngioma presented with seizures and panhypopituitarism. The lesion was initially approached at an outside institution with a transfrontal cyst fenestration, but progressive growth occurred later. Multiple management options were considered; we recommended an endoscopic endonasal approach with the goal of maximal safe resection. Virtual reality simulation and 3-dimensional printing were employed to evaluate whether the absence of pneumatization of the sinuses and the overall size of the nasal cavity could preclude effective surgical access. Our lab results suggested the binostril approach was feasible. A wide surgical exposure was performed from planum sphenoidale to clivus and from orbit to orbit. After removing the large calcified tumor portion, we found an accurate plane of dissection between tumor capsule, hypothalami, and visual pathways. By the end of resection, arterial bleeding was encountered secondary to an avulsion of the posterior communicating artery from the posterior cerebral artery. An angled aneurysm clip was placed with a single-shaft applier to secure the site of injury without narrowing the parent artery. Immediate and delayed magnetic resonance imaging and computed tomography angiography studies showed gross total resection, no stroke, and no pseudoaneurysm formation. On postoperative day 9, patient developed neurological decline and pneumocephalus secondary to necrotic nasoseptal flap. Two endonasal repairs with a lateral nasal wall flap were attempted with no success. A temporoparietal fascia flap was then harvested and transposed from the temporal to the pterygopalatine fossa to successfully repair the skull base defect. The patient has made an extraordinary recovery with no neurological sequalae. The patient's parents provided consent for the procedure and use of intraoperative photos and videos for academic purposes. Institutional Review Board approval was not required.
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Affiliation(s)
- Juan C Fernandez-Miranda
- Stanford University Medical Center, Stanford, California.,Lucile Packard Children's Hospital Stanford, Stanford, California
| | - Peter Hwang
- Stanford University Medical Center, Stanford, California.,Lucile Packard Children's Hospital Stanford, Stanford, California
| | - Gerald Grant
- Stanford University Medical Center, Stanford, California.,Lucile Packard Children's Hospital Stanford, Stanford, California
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102
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Cárdenas Ruiz-Valdepeñas E, Kaen A, Tirado-Caballero J, Di Somma A, Iglesias Pais M, Vázquez Domínguez M, Márquez Rivas J, Villa Fernández JM. Basilar Artery Injury During Endonasal Surgery: Stepwise to Control Bleeding. Oper Neurosurg (Hagerstown) 2021; 20:282-288. [PMID: 33372208 DOI: 10.1093/ons/opaa367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraoperative injury during endoscopic endonasal surgery of the carotid artery has been previously described in the literature. However, the accidental damage of the basilar artery in such scenario is not defined. OBJECTIVE To define the protocol of action for massive bleeding from an artery in the posterior fossa. METHODS The reported patient was diagnosed with a partially calcified clival chordoma featured by a huge intradural component. An endoscopic endonasal transpterygoid transclival approach was selected for the treatment of this tumor. During the surgical procedure, the basilar artery injury was injured, causing intense bleeding. We present and discuss the surgical maneuvers that could save a patient's life after this dramatic complication. RESULTS Different techniques were performed in order to control the massive bleeding, including injection of hemotastic matrix with thrombin (Floseal©), bipolar coagulation, and vessel reconstruction by means of a vascular clip. Finally, an autologous muscle graft reinforced with an overlying fibrin sealant patch (Tachosil©) was chosen and was an effective technique. Afterwards, the patient was treated with a flow diverter device to occlude an iatrogenic pseudoaneurysm. A monoplegia of the right upper limb was the only remarkable sequel 6 mo after surgery. CONCLUSION The muscle graft together with the coordinated action with interventional neuroradiology for the reconstruction of the vessel are possibly the best options to try to preserve the neurological function. In such a scenario, the assumption of potential ischemic events prevails over the intraoperative death of the patient.
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Affiliation(s)
| | - Ariel Kaen
- Department of Neurosurgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Jorge Tirado-Caballero
- Department of Neurosurgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Javier Márquez Rivas
- Department of Neurosurgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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103
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Shan C, Xu Y. [Application of a new temporary intravascular shunt device in limb injury of dogs]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:734-741. [PMID: 34142501 DOI: 10.7507/1002-1892.202012060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness and safety of a new temporary intravascular shunt (TIVS) device for limb injury in dogs. Methods Eighteen adult beagle dogs, male or female, weighing (20±2) kg, were taken for experiment. A semi-amputated limb model was made by circular amputating the knee joint of one hindlimb, which retained only skin, femoral artery, femoral vein, femoral nerve, and femur. Then the femoral artery was clamped for 2 hours in all animals, resulting in the ischemic environment of the distal limbs. The animals were randomly divided into 3 groups ( n=6). In group A, the bypass was started by using a new TIVS device and replenishing saline through the infusion port; In group B, after intravenous injection of heparin sodium solution, the bypass was started by using a new TIVS device and replenishing 3% heparin sodium solution through the infusion port; In group C, the bypass was started by using the self-made bypass tube. The bypass was end after 12 hours. The general vital signs (body temperature, heart rate, blood pressure) before and after bypass were measured, and the time required for the insertion of the bypass tube, the patency during the bypass, shedding, and thrombosis were recorded. Routine blood test and blood coagulation indicators [white blood cell (WBC), red blood cell (RBC), platelet (PLT), hemoglobin (HGB), activated partial thromboplastin time (APTT), fibrinogen (Fib)] and biochemical indicators [lactic dehydrogenase (LDH) and creatine kinase (CK)] were recorded before bypass and after 3, 6, 9, and 12 hours of bypass, respectively. The gastrocnemius muscles on the surgical side before and after bypass were harvested and the muscle necrosis, the wet-to-dry weight ratio, and the content of malondialdehyde (MDA) and myeloperoxidase (MPO) were measured. In addition, the gastrocnemius muscle and femoral artery were observed after bypass by HE staining. Results There was no significant difference in body temperature, heart rate, and blood pressure between groups before and after bypass ( P>0.05). Compared with groups A and B, the time required for the insertion of the bypass tube in group C was significantly longer ( P<0.05), and the number of thrombus in the bypass tube, the blockage time significantly increased ( P<0.05). Shedding and sliding of bypass tube occurred in 3 cases of group C, but no shedding or sliding of bypass tube occurred in groups A and B; there was no significant difference in the incidence of shedding between groups ( P=1.000). There was no significant difference ( P>0.05) in routine blood test, blood coagulation indicators, LDH, CK, MPO, MDA, and wet-to-dry weight ratio between groups before bypass. After bypass, the routine blood test and blood coagulation indicators of the 3 groups did not change significantly, and the differences between groups was not significant ( P>0.05); LDH and CK gradually increased ( P<0.05), and group C significantly higher than groups A and B at 12 hours ( P<0.05). After bypass, thrombosis was seen in the bypass tube, the distal gastrocnemius muscle necrosis occurred in group C, and the femoral artery injury was slightly heavier than that in groups A and B. Conclusion The new TIVS device is safe and effective and has the advantages of convenient implantation, lower thrombosis rate, and less limb ischemia-reperfusion injury.
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Affiliation(s)
- Changmeng Shan
- Kunming Medical University, Kunming Yunan, 650000, P.R.China
| | - Yongqing Xu
- Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650000, P.R.China
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104
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Karimi Alavije M, Karbalaie Niya MH, Sadeghzadeh-Bazargan A, Nikkhah M, Faraji A, Motamed N, Safarnezhad Tameshkel F, Zamani F. Cutaneous hemorrhagic bullae in a patient with COVID-19: A case report. Med J Islam Repub Iran 2021; 35:15. [PMID: 33996666 PMCID: PMC8111639 DOI: 10.47176/mjiri.35.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Indexed: 11/09/2022] Open
Abstract
COVID-19 was first discovered in Wuhan, China, and has spread rapidly around the world. The most important manifestation of COVID-19 was ARDS-like lung injury at first, but the involvement of other organs, such as kidney, heart, liver, and skin, was gradually reported. It is important to report and share all atypical manifestations of this disease to help other physicians to gain more knowledge about this new viral disease. As mentioned, there are also studies that show different types of cutaneous involvement in these patients, but due to the lack of more detailed studies in this field, and on the other hand, the possible usefulness of skin lesions as a diagnostic or alarming sign in the COVID-19 era, in this study we report a COVID-19 patient with a large hemorrhagic blister similar to sepsis-induced skin lesion. Despite the lack of common symptoms of the disease, the lung scan of the patient was positive for COVID-19.
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Affiliation(s)
| | - Mohammad Hadi Karbalaie Niya
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Nikkhah
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Faraji
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Motamed
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
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105
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Altoijry A, Lindsay TF, Johnston KW, Mamdani M, Al-Omran M. Vascular injury-related in-hospital mortality in Ontario between 1991 and 2009. J Int Med Res 2021; 49:300060520987728. [PMID: 33512260 PMCID: PMC7871087 DOI: 10.1177/0300060520987728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Trauma-related vascular injuries are major contributors to morbidity and mortality worldwide. We conducted a retrospective, population-based, cross-sectional study to examine temporal trends and factors associated with traumatic vascular injury-related in-hospital mortality in Ontario, Canada from 1991 to 2009. METHODS We obtained data on Ontario hospital admissions for traumatic vascular injury, including injury mechanism and body region; and patient age, sex, socioeconomic status, and residence from the Canadian Institute for Health Information Discharge Abstract Database and Registered Persons Database from fiscal years 1991 to 2009. We performed time series analysis of vascular injury-related in-hospital mortality rates and multivariable logistic regression analysis to identify significant mortality-associated factors. RESULTS The overall in-hospital mortality rate for trauma-related vascular injury was 5.5%. A slight but non-significant decline in mortality occurred over time. The likelihood of vascular injury-related in-hospital mortality was significantly higher for patients involved in transport-related accidents (odds ratio [OR[=2.21, 95% confidence interval [CI], 1.76-2.76), age ≥65 years (OR = 4.34, 95% CI, 2.25-8.38), or with thoracic (OR = 2.24, 95% CI, 1.56-3.20) or abdominal (OR = 2.45, 95% CI, 1.75-3.42) injuries. CONCLUSIONS In-hospital mortality from traumatic vascular injury in Ontario was low and stable from 1991 to 2009.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Thomas F Lindsay
- Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - K Wayne Johnston
- Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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106
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Groot OQ, Hundersmarck D, Lans A, Bongers MER, Karhade AV, Zhang Y, van Tol FR, Verlaan JJ, Mohebali J, Schwab JH. Postoperative adverse events secondary to iatrogenic vascular injury during anterior lumbar spinal surgery. Spine J 2021; 21:795-802. [PMID: 33152509 DOI: 10.1016/j.spinee.2020.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anterior lumbar spine surgery (ALSS) requires mobilization of the great vessels, resulting in a high risk of iatrogenic vascular injury (VI). It remains unclear whether VI is associated with increased risk of postoperative complications and other related adverse outcomes. PURPOSE The purpose of this study was to (1) assess the incidence of postoperative complications attributable to VI during ALSS, and (2) outcomes secondary to VI such as procedural blood loss, transfusion of blood products, length of stay (LOS), and in hospital mortality. STUDY DESIGN Retrospective propensity-score matched, case-control study at 2 academic and 3 community medical centers, PATIENT SAMPLE: Patients 18 years of age or older, undergoing ALSS between January 1st, 2000 and July 31st, 2019 were included in this analysis. OUTCOME MEASURES The primary outcome was the incidence of postoperative complications attributable to VI, such as venous thromboembolism, compartment syndrome, transfusion reaction, limb ischemia, and reoperations. The secondary outcomes included estimated operative blood loss (milliliter), transfused blood products, LOS (days), and in-hospital mortality. METHODS In total, 1,035 patients were identified, of which 75 (7.2%) had a VI. For comparative analyses, the 75 VI patients were paired with 75 comparable non-VI patients by propensity-score matching. The adequacy of the matching was assessed by testing the standardized mean differences (SMD) between VI and non-VI group (>0.25 SMD). RESULTS Two patients (2.7%) had VI-related postoperative complications in the studied period, which consisted of two deep venous thromboembolisms (DVTs) occurring on day 3 and 7 postoperatively. Both DVTs were located in the distal left common iliac vein (CIV). The VI these patients suffered were to the distal inferior vena cava and the left CIV, respectively. Both patients did not develop additional complications in consequence of their DVTs, however, did require systemic anticoagulation and placement of an inferior vena cava filter. There was no statistical difference with the non-VI group where no instances (0%) of postoperative complications were reported (p=.157). No differences were found in LOS or in hospital mortality between the two groups (p=.157 and p=.999, respectively). Intraoperative blood loss and blood transfusion were both found to be higher in the VI group in comparison to the non-VI group (650 mL, interquartile range [IQR] 300-1400 vs. 150 mL, IQR 50-425, p≤.001; 0 units, IQR 0-3 vs. 0 units, IQR 0-1, p=.012, respectively). CONCLUSION This study found a low number of serious postoperative complications related to VI in ALSS. In addition, these complications were not significantly different between the VI and matched non-VI ALSS cohort. Although not significant, the found DVT incidence of 2.7% after VI in ALSS warrants vigilance and preventive measures during the postoperative course of these patients.
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Affiliation(s)
- Olivier Q Groot
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX.
| | - Dennis Hundersmarck
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX
| | - Amanda Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX
| | - Michiel E R Bongers
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Yue Zhang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Floris R van Tol
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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107
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Avadiappan S, Morrison MA, Jakary A, Felton E, Stoller S, Hess CP, Molinaro AM, Braunstein SE, Mueller S, Lupo JM. Relationship between 7T MR-angiography features of vascular injury and cognitive decline in young brain tumor patients treated with radiation therapy. J Neurooncol 2021; 153:143-52. [PMID: 33893923 DOI: 10.1007/s11060-021-03753-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Although radiation therapy (RT) is a common treatment for pediatric brain tumors, it is associated with detrimental long-term effects such as impaired cognition, vascular injury, and increased stroke risk. This study aimed to develop metrics that describe vascular injury and relate them to the presence of cerebral microbleeds (CMBs) and cognitive performance scores. METHODS Twenty-five young adult survivors of pediatric brain tumors treated with either whole-brain (n = 12), whole-ventricular (n = 7), or no RT (n = 6) underwent 7T MRI and neurocognitive testing. Simultaneously acquired MR angiography and susceptibility-weighted images were used to segment CMBs and vessels and quantify their radii and volume. RESULTS Patients treated with whole-brain RT had significantly lower arterial volumes (p = 0.003) and a higher proportion of smaller vessels (p = 0.003) compared to the whole-ventricular RT and non-irradiated control patients. Normalized arterial volume decreased with increasing CMB count (R = - 0.66, p = 0.003), and decreasing trends were observed with time since RT and at longitudinal follow-up. Global cognition and verbal memory significantly decreased with smaller normalized arterial volume (p ≤ 0.05). CONCLUSIONS Arterial volume is reduced with increasing CMB presence and is influenced by the total brain volume exposed to radiation. This work highlights the potential use of vascular-derived metrics as non-invasive markers of treatment-induced injury and cognitive impairment in pediatric brain tumor patients.
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108
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Kmeid M, Liu X, Ballentine S, Lee H. Idiopathic Non-Cirrhotic Portal Hypertension and Porto-Sinusoidal Vascular Disease: Review of Current Data. Gastroenterology Res 2021; 14:49-65. [PMID: 34007347 PMCID: PMC8110235 DOI: 10.14740/gr1376] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Idiopathic non-cirrhotic portal hypertension (INCPH) is a clinicopathologic disease entity characterized by the presence of clinical signs and symptoms of portal hypertension (PH) in the absence of liver cirrhosis or known risk factors accountable for PH. Multiple hematologic, immune-related, infectious, hereditary and metabolic risk factors have been associated with this disorder. Still, the exact etiopathogenesis is largely unknown. The recently proposed porto-sinusoidal vascular disease (PSVD) scheme broadens the spectrum of the disease by also including patients without clinical PH who are found to have similar histopathologic findings on core liver biopsies. Three histomorphologic lesions have been identified as specific for PSVD to include obliterative portal venopathy, nodular regenerative hyperplasia and incomplete septal cirrhosis/fibrosis. However, these findings are often subtle, under-recognized and subjective with low interobserver agreement among pathologists. Additionally, the natural history of the subclinical forms of the disease remains unexplored. The clinical course is more favorable compared to cirrhosis patients, especially in the absence of clinical PH or liver dysfunction. There are no universally accepted guidelines in regard to diagnosis and treatment of INCPH/PSVD. Hence, this review emphasizes the need to raise awareness of this entity by highlighting its complex pathophysiology and clinicopathologic associations. Lastly, formulation of standardized diagnostic criteria with clinical validation is necessary to avoid misclassifying vascular diseases of the liver and to develop and implement targeted therapeutic strategies.
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Affiliation(s)
- Michel Kmeid
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Xiuli Liu
- Department of Pathology and Laboratory Medicine, University of Florida at Gainesville, FL, USA
| | - Samuel Ballentine
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hwajeong Lee
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
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Abstract
Severe COVID-19 can manifest as multiorgan dysfunction with pulmonary involvement being the most common and prominent. As more reports emerge in the literature, it appears that an exaggerated immune response in the form of unfettered complement activation and a cytokine storm may be a key driver of the widespread organ injury seen in this disease. In addition, these patients are also known to be hypercoagulable with a high rate of thrombosis and a higher-than-expected failure rate of anticoagulation. While macrovascular thrombosis is common in these individuals, the frequent finding of extensive microvascular thromboses in several series and case reports, raises the possibility of thrombotic microangiopathy (TMA) as being a contributing factor in the thrombotic and multi-organ complications of the disease. If this is correct, rapidly identifying a TMA and treating the underlying pathophysiology may allow for better outcomes in these critically ill patients. To further explore this, we reviewed the published literature on COVID-19, looking for reports describing TMA-like presentations. We summarize our findings here along with a discussion about presentation, pathophysiology, and a suggested treatment algorithm.
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110
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Laverty RB, Brock SG, Walters TJ, Kauvar DS. Outcomes of Arterial Grafts for the Reconstruction of Military Lower Extremity Arterial Injuries. Ann Vasc Surg 2021; 76:59-65. [PMID: 33831531 DOI: 10.1016/j.avsg.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/02/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Lower extremity (LE) arterial injuries are common in military casualties and limb salvage is a primary goal. Bypass grafts are the most common reconstructions; however, their specific outcomes are largely unreported. We sought to describe the outcomes of LE arterial grafts among combat casualties and their association with limb loss. METHODS Retrospective cohort study of 2004-2012 Iraq/Afghanistan casualties with LE arterial injury undergoing bypass graft from a database containing follow-up until amputation, death, or military discharge. Primary outcome was composite graft complications (GC-thrombosis, stenosis, pseudoaneurysm, blowout, and/or arteriovenous fistula). RESULTS Two hundred and twenty-two grafts were included (99 femoral, 73 popliteal, 48 tibial). 56 (26%) had at least one GC; thrombosis was most common in femoral, stenosis most common in popliteal and tibial. GC was not associated with graft level but was associated with synthetic conduit (P = 0.01) and trended towards an association with multiple-level arterial injuries (P = 0.07). Four of eight (50%) synthetic grafts had amputations, all within 72h. Two of the eight synthetic grafts thrombosed, and both limbs were amputated. There were 52 total amputations. Amputation was performed in 13 (23%) of limbs with a GC and 24% of those without (P = 0.93) Overall, 24 (11%) of grafts thrombosed, 16 within 48h and 13 (25%) in limbs undergoing amputation (P = 0.001 for association of thrombosis with amputation). CONCLUSION GC are common among LE bypass grafts in combat casualties but are not associated with limb loss. Thrombosis is predominantly early and is associated with amputation. Closer attention to ensuring early patency may improve limb salvage.
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Affiliation(s)
- Robert B Laverty
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
| | | | - Thomas J Walters
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - David S Kauvar
- Vascular Surgery Service, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas; Department of Surgery, Uniformed Services University, Bethesda, Maryland.
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111
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Bhullar A, Alcantara S, Yu PJ, Epstein LM. It works there too! Use of the endovascular occlusion balloon to rescue left subclavian vein injury during lead extraction. HeartRhythm Case Rep 2021; 7:395-7. [PMID: 34194988 DOI: 10.1016/j.hrcr.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hundersmarck D, Hietbrink F, Leenen LPH, De Borst GJ, Heng M. Blunt popliteal artery injury following tibiofemoral trauma: vessel-first and bone-first strategy. Eur J Trauma Emerg Surg 2021; 48:1045-1053. [PMID: 33743028 PMCID: PMC9001538 DOI: 10.1007/s00068-021-01632-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/26/2021] [Indexed: 12/01/2022]
Abstract
Purpose Blunt popliteal artery injury (BPAI) is a potentially limb-threatening sequela of tibiofemoral (knee) dislocations and fractures. Associated amputation rates for all popliteal artery (PA) injuries range between 10 and 50%. It is unclear whether PA repair or bone stabilization should be performed first. We analyzed (long-term) clinical outcomes of BPAI patients that received initial PA repair (vessel-first, VF) versus initial external stabilization (bone-first, BF). Methods Retrospectively, all surgically treated BPAI patients between January 2000 and January 2019, admitted to two level 1 trauma centers were included. Clinical outcomes were determined, stratified by initial management strategy (VF and BF). Treatment strategy was determined by surgeon preference, based on associated injuries and ischemia duration. Primary outcomes (amputation and mortality) and secondary outcomes (claudication and complications) were determined. Results Of 27 included BPAI patients, 15 were treated according to the VF strategy (56%) and 12 according to the BF strategy (44%). Occlusion was the most frequently encountered BPAI in 18/27 patients (67%). Total delay and in-hospital delay were comparable between groups (p = 1.00 and p = 0.82). Revascularization was most frequently performed by PA bypass (59%). All patients had primary limb salvage during admission (100%). One secondary amputation due to knee pain was performed in the BF group (4%). During a median clinical follow-up period of 2.7 years, three PA re-interventions were performed, two in the BF group and one in the VF group. None suffered from (intermittent) claudication. Conclusion Blunt popliteal artery injury (BPAI) is a rare surgical emergency. Long-term outcomes of early revascularization for BPAI appear to be good, independent of initial management strategy. The BF strategy may be preferred in case of severe orthopedic injury, if allowed by total ischemia duration. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01632-0.
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Affiliation(s)
- Dennis Hundersmarck
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, 55 Fruit Street, Boston, USA. .,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J De Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, 55 Fruit Street, Boston, USA
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Mizrachi A, Ben-Aharon I, Li H, Bar-Joseph H, Bodden C, Hikri E, Popovtzer A, Shalgi R, Haimovitz-Friedman A. Chemotherapy-induced acute vascular injury involves intracellular generation of ROS via activation of the acid sphingomyelinase pathway. Cell Signal 2021; 82:109969. [PMID: 33647448 PMCID: PMC10402763 DOI: 10.1016/j.cellsig.2021.109969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Abstract
Several categories of chemotherapy confer substantial risk for late-term vascular morbidity and mortality. In the present study, we aimed to investigate the mechanism of acute chemotherapy-induced vascular injury in normal tissues. Specifically, we looked at activation of the acid sphingomyelinase (ASMase)/ceramide pathway, which leads to generation of reactive oxygen species (ROS) and induction of oxidative stress that may result in vascular injury. In particular, we focused on two distinct drugs, doxorubicin (DOX) and cisplatin (CIS) and their effects on normal endothelial cells. In vitro, DOX resulted in increased ASMase activity, intra-cellular ROS production and induction of apoptosis. CIS treatment generated significantly reduced effects in endothelial cells. In-vivo, murine femoral arterial blood flow was measured in real-time, during and after DOX or CIS administration, using fluorescence optical imaging system. While DOX caused constriction of small vessels and disintegration of large vessels' wall, CIS induced minor vascular changes in arterial blood flow, correlating with the in vitro findings. These results demonstrate that DOX induces acute vascular injury by increased ROS production, via activation of ASMase/ceramide pathway, while CIS increases ROS production and its immediate extracellular translocation, without causing detectable acute vascular injury. Our findings may potentially lead to the development of new strategies to prevent long-term cardiovascular morbidity in cancer survivors.
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Affiliation(s)
- Aviram Mizrachi
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Otorhinolaryngology Head and Neck Surgery and Center for Translational Research in Head and Neck Cancer, Rabin Medical Center, Petah Tikva, Israel
| | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hongyan Li
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hadas Bar-Joseph
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chloe Bodden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Elad Hikri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Otorhinolaryngology Head and Neck Surgery and Center for Translational Research in Head and Neck Cancer, Rabin Medical Center, Petah Tikva, Israel
| | - Aron Popovtzer
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Otorhinolaryngology Head and Neck Surgery and Center for Translational Research in Head and Neck Cancer, Rabin Medical Center, Petah Tikva, Israel
| | - Ruth Shalgi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Egorov AI, Converse RR, Griffin SM, Styles JN, Sams E, Hudgens E, Wade TJ. Latent Toxoplasma gondii infections are associated with elevated biomarkers of inflammation and vascular injury. BMC Infect Dis 2021; 21:188. [PMID: 33602170 PMCID: PMC7890825 DOI: 10.1186/s12879-021-05882-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/09/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Toxoplasma gondii is a protozoan parasite that infects cats as definitive hosts and other warm-blooded animals including humans as intermediate hosts. It forms infectious cysts in the brain, muscle and other tissues establishing life-long latent infection. Approximately 10% of the US population is infected. While latent infections are largely asymptomatic, they are associated with neurological deficits and elevated risks of neuropsychiatric diseases. METHODS This cross-sectional epidemiological study investigated associations of T. gondii infections with biomarkers of inflammation and vascular injury: soluble intercellular adhesion molecule 1 (ICAM-1), soluble vascular cell adhesion molecule 1 (VCAM-1), C-reactive protein (CRP), and serum amyloid A (SAA). Serum samples from 694 adults in the Raleigh-Durham-Chapel Hill, North Carolina metropolitan area were tested for IgG antibody response to T. gondii, and for the above biomarkers using commercially available assays. RESULTS T. gondii seroprevalence rate in this sample was 9.7%. Seropositivity was significantly associated with 11% (95% confidence limits 4, 20%) greater median levels of VCAM-1 (p = 0.003), and marginally significantly with 9% (1, 17%), and 36% (1, 83%) greater median levels of ICAM-1, and CRP, respectively (p = 0.04 for each) after adjusting for sociodemographic and behavioral covariates, while the 23% (- 7, 64%) adjusted effect on SAA was not statistically significant (p = 0.15). CONCLUSIONS Latent infections with T. gondii are associated with elevated biomarkers of chronic inflammation and vascular injury that are also known to be affected by ambient air pollution.
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Affiliation(s)
- Andrey I. Egorov
- United States Environmental Protection Agency, Office of Research and Development, EPA, MD 58-C, 109. T.W. Alexander Drive, Research Triangle Park, NC 27711 USA
| | - Reagan R. Converse
- United States Environmental Protection Agency, Office of Research and Development, EPA, MD 58-C, 109. T.W. Alexander Drive, Research Triangle Park, NC 27711 USA
| | - Shannon M. Griffin
- United States Environmental Protection Agency, Office of Research and Development, Cincinnati, OH USA
| | - Jennifer N. Styles
- United States Environmental Protection Agency, Office of Research and Development, EPA, MD 58-C, 109. T.W. Alexander Drive, Research Triangle Park, NC 27711 USA
- Gillings School of Global Public Health, Environmental Sciences and Engineering Department, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Elizabeth Sams
- United States Environmental Protection Agency, Office of Research and Development, EPA, MD 58-C, 109. T.W. Alexander Drive, Research Triangle Park, NC 27711 USA
| | - Edward Hudgens
- United States Environmental Protection Agency, Office of Research and Development, EPA, MD 58-C, 109. T.W. Alexander Drive, Research Triangle Park, NC 27711 USA
| | - Timothy J. Wade
- United States Environmental Protection Agency, Office of Research and Development, EPA, MD 58-C, 109. T.W. Alexander Drive, Research Triangle Park, NC 27711 USA
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Go S, Mochizuki S, Yamada K, Takahashi S. Thoracic aortic stent graft placement and simultaneous screw removal for a screw hitting the aorta. Trauma Case Rep 2021; 32:100401. [PMID: 33644287 PMCID: PMC7892983 DOI: 10.1016/j.tcr.2021.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 10/26/2022] Open
Abstract
Vascular injury caused by spinal screw displacement is a rare complication of spinal fusion surgery. Here, we report a case with no perforation of the aortic wall, which we treated by means of simultaneous thoracic endovascular aorta repair (TEVAR) and screw removal. An 82-year-old female underwent corrective spinal fixation. Postoperatively, a screw became displaced from the vertebrae and contacted the outer membrane of the descending aorta. To prevent rupture of the aorta, we performed stent graft placement from the right common femoral aorta. We left a flexion-resistant catheter in the left arm and moved the patient into an abdominal position with the left arm extended upward to enable immediate insertion of a guidewire and occlusion balloon if necessary. Then we removed the displaced screw with a drill. This safe and effective method can prevent possible aortic injuries secondary to displaced spinal screws. The key to our method is the simultaneous performance of TEVAR and screw removal, made possible through patient repositioning.
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Affiliation(s)
- Seimei Go
- Akane-Foundation Tsuchiya General Hospital, Department of Cardiovascular Surgery, Japan
| | - Shingo Mochizuki
- Akane-Foundation Tsuchiya General Hospital, Department of Cardiovascular Surgery, Japan
| | - Kazunori Yamada
- Akane-Foundation Tsuchiya General Hospital, Department of Cardiovascular Surgery, Japan
| | - Shinya Takahashi
- Hiroshima University, Department of Cardiovascular Surgery, Japan
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Tang A, Tobert D, Kakarmath S, Harris M, Khurana B. Radiological and clinical features of traumatic atlanto-occipital dislocation. Emerg Radiol 2021; 28:713-722. [PMID: 33538940 DOI: 10.1007/s10140-021-01912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We aimed to describe the findings of traumatic atlanto-occipital dislocation (AOD) on cervical spine CTs and differences leading to varying treatment of these patients. METHODS We retrospectively identified 20 adult patients with AOD from cervical spine CTs demonstrating fracture or fracture dislocations over 19 years at 2 major trauma centers. Medical records were reviewed and craniovertebral junction (CVJ) metrics measured on CT. Intubation, Glasgow Coma Scale (GCS), additional injuries, occiput/atlas/axis fracture, concurrent atlantoaxial subluxation, vascular injury on CT angiography, and ligamentous injury on MRI were noted. RESULTS Using the Traynelis Classification, eight patients had type 2 and eight patients type 3 AOD. Four of 5 patients who died within 14 days of CT had type 2 AOD. Three patients had medial/lateral AOD. Of the patients who survived initial injuries, a greater percentage who underwent surgical or halo fixation versus non-operatively treated patients had abnormal CVJ measurements including BDI (62.5% vs 0%), atlantoaxial subluxation (75% vs 14.3%), ligamentous injury (80% vs 66.7%), intubation (62.5% vs 28.6%), GCS<8 (62.5% vs 14.3%), and additional injuries (75% vs 71.4%) on presentation. MRI helped identify 2 cases of type 2 AOD and surgical decision making in 8 cases. CONCLUSIONS Types 2 and 3 were the most common, and type 2 is the deadliest type of AOD. A greater proportion of patients who undergo surgical or halo fixation have abnormal CT/MR findings with neurologic impairment at presentation. MRI aided detection of potentially missed type 2 AOD and was critical for surgical decision making.
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Affiliation(s)
- Anji Tang
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Daniel Tobert
- Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Sujay Kakarmath
- Center for Clinical Data Science, Mass General Brigham, 100 Cambridge St., Boston, MA, 02115, USA
| | - Mitchel Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA. .,Trauma Imaging Research and Innovation Center, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Tsai CSC, Yu SCH. Inadvertent arterial & venous injury by bone marrow biopsy needle: case report on rescue embolization techniques. CVIR Endovasc 2020; 3:80. [PMID: 33159602 PMCID: PMC7648822 DOI: 10.1186/s42155-020-00172-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bone marrow biopsy is a common medical procedure for diagnosis and characterization of haematological diseases. It is generally regarded as a safe procedure with low rate of major complications. Inadvertent vascular injury is however an uncommon but important complication of bone marrow biopsy procedure. The knowledge of a safe and effective embolization method is crucial for interventional radiologists to reduce significant patient morbidity and mortality, shall such inadvertent vascular injury occurs. CASE PRESENTATION Bedside bone marrow biopsy was performed for an elderly gentleman to evaluate for his underlying acute leukaemia. Biopsy needle inadvertently injured the internal iliac artery and vein during the procedure. Coil embolization was carefully performed across injured arterial segment via the culprit biopsy needle until contrast cessation. Concomitant venous injury was subsequently confirmed on angiography when the needle was withdrawn for a short distance from the iliac artery. This venous injury was tackled by further withdrawing the biopsy needle to distal end of the bone marrow tract for tract embolization with coils and gelatin sponges. High caution was made to avoid coil dislodgement into the iliac vein, to prevent pulmonary embolism. Patient was clinically stable throughout the procedure. Post-procedure contrast CT shows no pelvic haematoma or contrast extravasation. CONCLUSIONS This case illustrates rescue embolization techniques for rare life-threatening concomitant internal iliac arterial and venous injuries by a bone marrow biopsy needle. Interventional radiologists can play an important role in carrying out precise embolization to avoid significant patient morbidity and mortality in the case of life-threatening haemorrhage.
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Affiliation(s)
- Chris Siu-Chun Tsai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Simon Chun-Ho Yu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
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Chaudhary SD, Ghoti SD. Thrombosis of the Superficial Femoral Artery following Fixation of Intertrochanteric Fracture of the Femur using a Dynamic Hip Screw. J Orthop Case Rep 2020; 10:15-18. [PMID: 33708702 PMCID: PMC7933628 DOI: 10.13107/jocr.2020.v10.i08.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Vascular injuries in orthopedic surgery are relatively rare but potentially limb and life threatening. They are most commonly encountered in knee and hip arthroplasty but also have been reported in trauma surgeries. Pertrochanteric fractures of proximal femur are among the most common fractures encountered in elderly osteoporotic patients. Positioning on fracture table, traction, and reduction maneuvers employed during fixation of these fractures, place the vessels at risk by bringing them closer to the bone. Iatrogenic vascular injuries can occur if adequate care is not taken during instrumentation for fracture fixation. CASE REPORT We are reporting a case of 62 years female who underwent fixation of an intertrochanteric fracture of femur using a dynamic hip screw (DHS) and subsequently started developing ischemic changes in the operated lower limb on the 3rd post-operative day. Angiography revealed thrombosis of the superficial femoral artery at the level of the third screw of the DHS and the patient ultimately landed up with an amputation. CONCLUSION Operating surgeon should be aware of the risk of iatrogenic vascular injury during fixation of pertrochanteric fractures. Good surgical technique and simple precautionary measures can minimize the risk of this devastating complication.
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Affiliation(s)
- Sumedh D Chaudhary
- Department of Orthopaedics, Indira Gandhi Government Medical College, Nagpur. Maharashtra. India
| | - Santosh D Ghoti
- Department of Orthopaedics, Indira Gandhi Government Medical College, Nagpur. Maharashtra. India
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120
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Longchamp A, Longchamp J, Manzocchi Besson S, Danzer D. Trapped by the Entrapment. EJVES Vasc Forum 2020; 49:1-3. [PMID: 33078168 PMCID: PMC7481521 DOI: 10.1016/j.ejvsvf.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Popliteal entrapment syndrome results from extrinsic compression of the popliteal artery by the surrounding musculotendinous structures and is a rare cause of limb ischaemia. The purpose of this report is to highlight potential mistakes in the management of popliteal entrapment. Report In 2000, a 23 year old man underwent a popliteal to popliteal artery bypass surgery for what was initially diagnosed as a traumatic popliteal artery thrombosis. After being initially lost to follow up for 13 years, this “unspecified traumatic” thrombosis led to several inappropriate endovascular and open procedures misinterpreted as being caused by late graft failure. These included thrombectomy, aneurysmorrhaphy, polytetrafluoroethylene covered stent graft, a redo femoropopliteal bypass, and bypass thrombolysis. The diagnosis was reached 19 years after the initial surgery, when the patient underwent a redo bypass using a retrogeniculate approach. An abnormal lateral insertion of the gastrocnemius muscle medial head, and its accessory slip, constricted the artery, and also involved the popliteal vein (Type V), thus explaining previous revascularisation failures. Surgery consisted of resecting the accessory slip and the aneurysmal bypass. The artery was reconstructed with the cephalic vein. The patient was discharged on clopidogrel 75 mg, with no further complication, and a patent bypass at six months. Based on post-operative imaging (duplex ultrasound and magnetic resonance imaging), with forced plantarflexion and dorsiflexion, asymptomatic popliteal entrapment was also present on the contralateral side. Discussion The finding of an isolated popliteal artery lesion in a young individual should be considered to be caused by popliteal artery entrapment, unless proven otherwise. Definitive surgical release of the popliteal artery should be favoured over other strategies. Popliteal entrapment may be overlooked by confounding anamnestic factors, leading to inappropriate treatment. Popliteal entrapment should be ruled out in any isolated popliteal artery lesion in a young individual.
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Affiliation(s)
- Alban Longchamp
- Department of Vascular Surgery, Sion Hospital, Sion, Switzerland.,Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Sara Manzocchi Besson
- Department of Vascular Surgery, Sion Hospital, Sion, Switzerland.,Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Danzer
- Department of Vascular Surgery, Sion Hospital, Sion, Switzerland.,Division of Cardiovascular and Vascular Surgery, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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121
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Geith MA, Nothdurfter L, Heiml M, Agrafiotis E, Gruber M, Sommer G, Schratzenstaller TG, Holzapfel GA. Quantifying stent-induced damage in coronary arteries by investigating mechanical and structural alterations. Acta Biomater 2020; 116:285-301. [PMID: 32858190 DOI: 10.1016/j.actbio.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Abstract
Vascular damage develops with diverging severity during and after percutaneous coronary intervention with stent placement and is the prevailing stimulus for in-stent restenosis. Previous work has failed to link mechanical data obtained in a realistic in vivo or in vitro environment with data collected during imaging processes. We investigated whether specimens of porcine right coronary arteries soften when indented with a stent strut shaped structure, and if the softening results from damage mechanisms inside the fibrillar collagen structure. To simulate the multiaxial loading scenario of a stented coronary artery, we developed the testing device 'LAESIO' that can measure differences in the stress-stretch behavior of the arterial wall before and after the indentation of a strut-like stamp. The testing protocol was optimized according to preliminary experiments, more specifically equilibrium and relaxation tests. After chemical fixation of the specimens and subsequent tissue clearing, we performed three-dimensional surface and second-harmonic generation scans on the deformed specimens. We analyzed and correlated the mechanical response with structural parameters of high-affected tissue located next to the stamp indentation and low-affected tissue beyond the injured area. The results reveal that damage mechanisms, like tissue compression as well as softening, fiber dispersion, and the lesion extent, are direction-dependent, and the severity of them is linked to the strut orientation, indentation pressure, and position. The findings highlight the need for further investigations by applying the proposed methods to human coronary arteries. Additional data and insights might help to incorporate the observed damage mechanisms into material models for finite element analyses to perform more accurate simulations of stent-implantations.
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Affiliation(s)
- Markus A Geith
- Institute of Biomechanics, Graz University of Technology, Graz, Austria; Biomedical Engineering Department, King's College London, London, United Kingdom
| | | | - Manuel Heiml
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | | | | | - Gerhard Sommer
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | - Thomas G Schratzenstaller
- Medical Device Laboratory, Regensburg Center of Biomedical Engineering, Technical University of Applied Sciences Regensburg, Regensburg, Germany
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria; Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway.
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122
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Demir D, Smeets R, Schurink GWH, Mees BME. Use of thoracic stent grafts to control major iliac vein bleeding. J Vasc Surg Venous Lymphat Disord 2021; 9:1058-61. [PMID: 33039546 DOI: 10.1016/j.jvsv.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022]
Abstract
Major venous bleeding is a feared complication during abdominal surgery. Management usually consists of open repair or ligation, despite technically demanding surgical exposure. We present two cases of major iliac vein hemorrhage during abdominal surgery that were controlled by using thoracic stent grafts.
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123
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Polcz JE, White JM, Ronaldi AE, Dubose JJ, Grey S, Bell D, White PW, Rasmussen TE. Temporary intravascular shunt use improves early limb salvage after extremity vascular injury. J Vasc Surg 2020; 73:1304-1313. [PMID: 32987146 DOI: 10.1016/j.jvs.2020.08.137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The use of temporary intravascular shunts (TIVSs) allow for restoration of distal perfusion and reduce ischemic time in the setting of arterial injury. As a damage control method, adjunct shunts restore perfusion during treatment of life-threatening injuries, or when patients require evacuation to a higher level of care. Single-center reports and case series have demonstrate that TIVS use can extend the opportunity for limb salvage. However, few multi-institutional studies on the topic have been reported. The objective of the present study was to characterize TIVS use through a multi-institutional registry and define its effects on early limb salvage. METHODS Data from the Prospective Observation Vascular Injury Treatment registry was analyzed. Civilian patients aged ≥18 years who had sustained an extremity vascular injury from September 2012 to November 2018 were included. Patients who had a TIVS used in the management of vascular injury were included in the TIVS group and those who had received treatment without a TIVS served as the control group. An unadjusted comparison of the groups was conducted to evaluate the differences in the baseline and outcome characteristics. Double robust estimation combining logistic regression with propensity score matching was used to evaluate the effect of TIVS usage on the primary end point of limb salvage. RESULTS TIVS use was identified in 78 patients from 24 trauma centers. The control group included 613 patients. Unmatched analysis demonstrated that the TIVS group was more severely injured (mean ± standard deviation injury severity score, 18.83 ± 11.76 for TIVS vs 14.93 ± 10.46 for control; P = .002) and had more severely mangled extremities (mean ± standard deviation abbreviated injury scale, extremity, score 3.23 ± 0.80 for TIVS vs 2.95 ± 0.87 for control; P = .008). Logistic regression demonstrated that propensity-matched control patients had a three times greater likelihood of amputation compared with the TIVS patients (odds ratio, 3.6; 95% confidence interval, 1.2-11.1; P = .026). Concomitant nerve injury and orthopedic fracture were associated with a greater risk of amputation. The median follow-up for the TIVS group was 12 days (interquartile range, 4-25 days) compared with 9 days (interquartile range, 4-18 days) for the control group. CONCLUSIONS To the best of our knowledge, the present study is the first multicenter, matched-cohort study to characterize early limb salvage as a function of TIVS use in the setting of extremity vascular injury. Shunts expedite limb perfusion and resulted in lower rates of amputation during the early phase of care. The use of TIVS should be one part of a more aggressive approach to restore perfusion in the most injured patients and ischemic limbs.
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Affiliation(s)
- Jeanette E Polcz
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md
| | - Joseph M White
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md.
| | - Alley E Ronaldi
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md
| | - Joseph J Dubose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Md
| | - Scott Grey
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md
| | - Devin Bell
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md
| | - Paul W White
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md
| | - Todd E Rasmussen
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md
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Champagne PO, Passeri T, Jabre R, Bernat AL, Voormolen EH, Froelich S. Vertebrobasilar Artery Encasement by Skull Base Chordomas: Surgical Outcome and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:375-383. [PMID: 32324880 DOI: 10.1093/ons/opaa091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Vascular encasement by skull base chordomas can increase surgical risk and hinder completeness of resection. However, the evidence behind this remains anecdotic. OBJECTIVE To give a better portrayal of chordomas encasing vertebrobasilar arteries mainly in regard of surgical vascular risk and its impact on extent of resection. METHODS A retrospective cohort study comparing skull base chordomas with encasement (≥180o encirclement) of the vertebrobasilar arteries to a control group of skull base chordomas with intradural extension. Data gathered involved pre- and postoperative volumetric analysis of the tumor, degree of encasement of involved vessel, occurrence of complication, and survival data including progression-free survival (PFS) and overall survival (OS). RESULTS A total of 24 patients with vertebrobasilar encasement were included in the study and an equal number of control cases were randomly selected from the same time period, totalizing 48 patients. Lower clival tumors with condyle involvement were more likely to have encasement. Gross total resection (GTR) rate was significantly lower in the encasement group (13% vs 42%, P = .023). Rates of postoperative new neurological deficit, CFS leak and 30 d postoperative mortality were not statistically different between groups. There was no statistically significant difference in mean PFS (P = .608) and OS (P = .958). CONCLUSION Skull base chordomas encasing vertebrobasilar arteries are highly challenging tumors. This study demonstrates that although safe resection is possible, GTR is hindered by the presence of encasement. We advocate letting the tumor's adherence to vessels lead the resection, leaving a small piece of tumor behind if adherent to the vessels.
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Affiliation(s)
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Roland Jabre
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
- Neurosurgery Service, Department of Surgery, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Eduard H Voormolen
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
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Chen DC, Zhong QH, Chen S. [Basics of vascular damage and progress of diagnosis and treatment in radiation intestinal injury]. Zhonghua Wei Chang Wai Ke Za Zhi 2020; 23:817-822. [PMID: 32810958 DOI: 10.3760/cma.j.cn.441530-20200511-00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiation intestinal injury is one of the most common complications after abdominal pelvic radiotherapy, which seriously affects the quality of life for patients. According to the site of occurrence, it is divided into radiation enteritis, colitis and proctitis. The pathological characteristics of radiation intestinal injury mainly include interstitial fibrosis, mucosal edema, ulcers, and inflammatory cell infiltration, and significant vascular lesions as well. It showed telangiectasia and hemorrhage under endoscopy. Under ultrasound examination, it showed diffusive thickening of the intestinal wall and increased blood flow signals. In addition, it also has other features such as increased thickness of the distal sigmoid colon and rectal wall, and increased width of the presacral space. The key factors in the incidence and development of radiation intestinal injury include angiostatin, PDGF, CXCL16, etc. The mechanisms to be clarified include abnormally heightened angiostatin through which signal pathways specifically affect vascular endothelial cells and inhibit angiogenesis and vascular homeostasis, how CXCL16 expressed by macrophages interacting with receptor promotes the transformation of fibroblasts and vascular smooth muscle cells into myofibroblasts, etc. Therapy targeted on basics of vascular damage will be a promising field of radiation intestinal injury research.
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Affiliation(s)
- D C Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Q H Zhong
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - S Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, China
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Hemachandran N, Gamanagatti S, Sharma R, Shanmuganathan K, Kumar A, Gupta A, Kumar S. Revised AAST scale for splenic injury (2018): does addition of arterial phase on CT have an impact on the grade? Emerg Radiol 2021; 28:47-54. [PMID: 32705369 DOI: 10.1007/s10140-020-01823-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether an additional arterial phase (AP) leads to a change in the grade of splenic injury according to the 2018 revision of the AAST Organ Injury Scale, which has incorporated vascular injuries into the grading system and also to study its impact on management. METHODS In this retrospective study, 527 patients who sustained blunt abdominal trauma and had underwent dual-phase CT (AP and portal venous phase (PVP)) from December 2014 to October 2016 (23 months) were included. Two experienced radiologists independently graded the splenic injury according to the revised system in 2 blinded ways (AP + PVP and PVP alone). Receiver operator characteristic (ROC) curves were generated for grade of injury on both the phases for all splenic interventions. RESULTS Splenic injuries were detected in 154 patients, and splenic vascular injuries were detected in 52 of them. Of these, 22 vascular injuries were detected only on the AP, leading to a change in the grade of injury according to the new system in 18 patients. The AUC for ROC curves was generated for the grade of injury on AP + PVP vs. PVP alone for angioembolization (0.80 vs. 0.71, p value 0.002), and all splenic interventions (0.89 vs. 0.83, p value 0.003) showed higher AUC for AP + PVP. CONCLUSION Addition of AP leads to a significant change in the grading of splenic injuries according to the revised grading system due to increased detection of vascular injuries. Accurate classification of splenic injuries using additional AP would lead to better triage of patients for splenic interventions or conservative management.
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Montorfano L, Sarkissyan M, Wolfers M, Rodríguez F, Pla F, Montorfano M. POCUS and POCDUS: essential tools for the evaluation and management of carotid artery pseudoaneurysms after a gunshot wound. Ultrasound J 2020; 12:35. [PMID: 32696140 PMCID: PMC7374642 DOI: 10.1186/s13089-020-00182-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evaluation of asymptomatic penetrating vascular injuries can be done with Point-of-care ultrasound (POCUS) and Point-of-care Doppler ultrasound (POCDUS). CASE PRESENTATION A 21-year-old woman was admitted to the Emergency Department with a small wound and pain on the left side of her neck. The patient stated she was standing outside her home and suddenly felt acute pain in the neck. She denied trauma or being assaulted and reported no significant past medical or surgical history. On physical exam the only positive finding was a small gunshot entry wound on the left side of her neck without hard signs of vascular injury. Bedside POCUS demonstrated soft tissue swelling and a hematoma next to the left carotid artery. A round in shape bullet was visualized in contact with the posterior left common carotid artery wall and two small saccular pseudoaneurysms were seen at left common carotid artery wall. POCDUS showed a patent left carotid artery and turbulent flow in the two saccular aneurysms. A computed tomography angiogram (CTA) was performed confirming the findings and a stent in left carotid artery was placed. The patient tolerated the procedure well and was discharged 4 days after the procedure. At the sixth month follow-up, Doppler ultrasound showed patent stent and resolution of the muscular hematoma. CONCLUSIONS Penetrating trauma-related vascular injuries are complex cases to handle within an acute setting. POCUS and POCDUS are increasingly being used for the workup and decision-making process of gunshot-related vascular injuries to the neck and are a fundamental part of the follow-up after definitive therapy.
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Affiliation(s)
| | - Marianna Sarkissyan
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina
| | - Matthew Wolfers
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Federico Rodríguez
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina
| | - Fernando Pla
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina
| | - Miguel Montorfano
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina.
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Ikeda K, Ikeda T, Tani N, Shida A, Aoki Y, Morioka F, Ishikawa T. Inferior mesenteric artery laceration associated with blunt abdominal trauma with Casper's sign in a physically abused child: An autopsy case and literature review. J Forensic Leg Med 2020; 74:102001. [PMID: 33012316 DOI: 10.1016/j.jflm.2020.102001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022]
Abstract
There have been few studies of the death of children secondary to child abuse-related abdominal compression, and the detailed pathophysiology of such deaths is therefore unknown. The autopsy findings of a 3-year-old boy who died of hemorrhagic shock due to non-accidental severe blunt abdominal trauma were compared to those of children who died of other non-accidental abdominal injuries. Old and acute subcutaneous hemorrhages, abrasions, and scars were present all over the subject's body. No superficial injuries were found on the ventral midline, but a minor hemorrhage was found in the subcutaneous fat tissue, as well as in the rectus abdominis muscle. The intraperitoneal space contained 450 mL of blood, including coagulated blood. There was a tear in the transverse mesocolon and a crush injury in the small bowel mesentery. The inferior mesenteric artery was transected 0.5 cm from the aortic root. The transverse colon was necrotic, with hemorrhages in the mucosa. Since various organs were ischemic, the cause of death was determined to be blood loss from the inferior mesenteric artery injuries. Blunt abdominal trauma in children usually causes organ damage and intestinal injury, but because it is caused on the posterior surface of the mesentery, vascular injury should also be considered, and an autopsy should be performed. In the case of child abuse-related deaths, damage to the skin surface may not always be present; therefore, imaging tests, histopathological examinations, and biochemical tests should be performed with a focus on the gross anatomy to determine the cause of death and pathology.
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Alarhayem AQ, Rasmussen TE, Farivar B, Lim S, Braverman M, Hardy D, Jenkins DJ, Eastridge BJ, Cestero RF. Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era. J Vasc Surg 2020; 73:896-902. [PMID: 32682070 DOI: 10.1016/j.jvs.2020.05.079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) is the preferred operative treatment of blunt thoracic aortic injuries (BTAIs). Its use is associated with improved outcomes compared with open surgical repair and nonoperative management. However, the optimal time from injury to repair is unknown and remains a subject of debate across different societal practice guidelines. The purpose of this study was to evaluate national trends in the management of BTAI, with a specific focus on the impact of timing of repair on outcomes. METHODS Using the National Trauma Data Bank, we identified adult patients with BTAI between 2012 and 2017. Patients with prehospital or emergency department cardiac arrest or incomplete data sets were excluded from analysis. Patients were classified according to timing of repair: group 1, <24 hours; and group 2, ≥24 hours. The primary outcome evaluated was in-hospital mortality; secondary outcomes included overall hospital and intensive care unit length of stay. Multivariable logistic regression was performed to identify independent predictors of mortality. RESULTS The analysis was completed for 2821 patients who underwent TEVAR for BTAI with known operative times. The overall mortality in the patient cohort was 8.4% (238/2821); 75% of patients undergoing TEVAR were repaired within 24 hours. Mortality was more than twofold greater in group 1 compared with group 2 (9.8% [207/2118] vs 4.4% [31/703]; P = .001). This mortality benefit persisted across injury severity groups and was independent of the presence of serious extrathoracic injuries. Logistic regression analysis, adjusting for age ≥65 years, Glasgow Coma Scale score ≤8, systolic blood pressure ≤90 mm Hg at admission, and serious extrathoracic injuries, showed a higher adjusted mortality in group 1 (odds ratio, 2.54; 95% confidence interval, 1.66-3.91; P = .001). CONCLUSIONS The majority of patients with BTAI undergo endovascular repair within 24 hours of injury. Patients undergoing delayed repair have improved survival compared with those repaired within the first 24 hours of injury in spite of similar injury patterns and severity. In patients with BTAIs without signs of imminent rupture, delaying endovascular repair beyond 24 hours after injury should be considered.
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Affiliation(s)
| | - Todd E Rasmussen
- Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Md.
| | - Behzad Farivar
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sungho Lim
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Max Braverman
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - David Hardy
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Donald J Jenkins
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Brian J Eastridge
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Ramon F Cestero
- University of Texas Health Science Center at San Antonio, San Antonio, Tex
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Sonnenschein K, Fiedler J, Pfanne A, Just A, Mitzka S, Geffers R, Pich A, Bauersachs J, Thum T. Therapeutic modulation of RNA-binding protein Rbm38 facilitates re-endothelialization after arterial injury. Cardiovasc Res 2020; 115:1804-1810. [PMID: 30843048 PMCID: PMC6755352 DOI: 10.1093/cvr/cvz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/13/2018] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Aims Delayed re-endothelialization after balloon angioplasty in patients with coronary or peripheral artery disease impairs vascular healing and leads to neointimal proliferation. In the present study, we examined the effect of RNA-binding motif protein 38 (Rbm38) during re-endothelialization in a murine model of experimental vascular injury. Methods and results Left common carotid arteries of C57BL/6 mice were electrically denudated and endothelial regeneration was evaluated. Profiling of RNA-binding proteins revealed dysregulated expression of Rbm38 in the denudated and regenerated areas. We next tested the importance of Rbm38 in human umbilical vein endothelial cells (HUVECS) and analysed its effects on cellular proliferation, migration and apoptosis. Rbm38 silencing in vitro demonstrated important beneficial functional effects on migratory capacity and proliferation of endothelial cells. In vivo, local silencing of Rbm38 also improved re-endothelialization of denuded carotid arteries. Luciferase reporter assay identified miR-98 and let-7f to regulate Rbm38 and the positive proliferative properties of Rbm38 silencing in vitro and in vivo were mimicked by therapeutic overexpression of these miRNAs. Conclusion The present data identified Rbm38 as an important factor of the regulation of various endothelial cell functions. Local inhibition of Rbm38 as well as overexpression of the upstream regulators miR-98 and let-7f improved endothelial regeneration in vivo and thus may be a novel therapeutic entry point to avoid endothelial damage after balloon angioplasty.
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Affiliation(s)
- Kristina Sonnenschein
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan Fiedler
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | - Angelika Pfanne
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | - Annette Just
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | - Saskia Mitzka
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | - Robert Geffers
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Andreas Pich
- Institute of Toxicology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Excellence Cluster REBIRTH, Hannover Medical School, Hannover, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.,Excellence Cluster REBIRTH, Hannover Medical School, Hannover, Germany.,National Heart and Lung Institute, Imperial College London, London, UK
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Glanz L. Pseudaneurysm of the superolateral genicular artery following an anterior cruciate ligament reconstruction. Int J Surg Case Rep 2020; 72:628-631. [PMID: 32611535 PMCID: PMC7365774 DOI: 10.1016/j.ijscr.2020.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
Pseudoaneurysm of the superolateral genicular artery is a risk in arthroscopic knee procedure. Pseudoaneurysms risk increase due to minimal invasive procedure. Ultrasound-guided percutaneous thrombin injection for iatrogenic pseudoaneurysms is a valuable option.
Introduction Arthroscopic procedures are a safe way nowadays to do anterior cruciate ligament reconstruction. Rare complications involve injuries to popliteal vessels or one of its branches. Presentation of case We present a case of a young patient who undergone an anterior cruciate ligament reconstruction. This procedure was associated with a meniscal suture. The follow-up was marked by pseudoaneurysm of the supero-lateral genicular artery. Discussion This is the first time a pseudoaneurysm of this branch is described in the literature as we discovered it. The treatment by an ultrasonography-guided embolization with thrombin was proceeded and suceeded. Conclusion We stress the fact with new arthroscopic procedures and techniques, new complications can occur, and we should be attentive to them and new symptoms consequently, as a painless mass on the lateral side of the knee, to ensure a fast and optimal treatment.
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Affiliation(s)
- L Glanz
- Department of Orthopedic Surgery and Musculoskeletal Trauma Care, University Hospitals Geneva, Geneva, Switzerland; Civil Hospices of Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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Fernandes PX, Medeiros DM, Teixeira RC, Nunes AM, Seco AS, Caetano AC. Injury to the Superior Gluteal Artery during Intramedullary Fixation of a Proximal Femoral Fracture - A Case Report. J Orthop Case Rep 2020; 9:27-31. [PMID: 32548023 PMCID: PMC7276602 DOI: 10.13107/jocr.2019.v09.i06.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Proximal femoral fractures represent a health problem of global proportions. Iatrogenic vascular lesion in the treatment of these fractures is an unusual potentially lethal complication, reported in only 0.2% of trochanteric fractures treated with intramedullary implants. Superior gluteal artery injury is extremely rare, with only two cases reported in literature. Case Report A 66-year-old Caucasian woman, with metastatic disease, was admitted with a right pertrochanteric fracture. She underwent closed reduction and long intramedullary nail fixation. Five days post-operatively, a sudden hemoglobin drop occurred. A computed tomography demonstrated an extensive hematoma. Angiography confirmed an arterial bleeding from the superior gluteal artery and subsequent selective embolization was successfully performed. Conclusion The presence of anemia and thigh hematoma that progressively worsens post-operatively should raise the diagnostic suspicion of an iatrogenic vascular injury. To the best of our knowledge, this is only the third case reported of superior gluteal artery injury after intramedullary fixation of a proximal femoral fracture. We describe the post-operative course and management strategy and hope this will contribute to the global knowledge and increase awareness of these rare injuries.
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Affiliation(s)
- Pedro Xavier Fernandes
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
| | - Duarte Manuel Medeiros
- Department of Vascular Surgery, Hospital de Egas Moniz,Centro Hospitalar de Lisboa Ocidental, R. da Junqueira 126, 1349-019 Lisbon, Portugal
| | - Raquel C Teixeira
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
| | - Andreia Mercier Nunes
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
| | - Antonio Sousa Seco
- Department of Orthopaedic Surgery, Hospital Lusiadas, R. Abílio Mendes 12, 1500-458 Lisbon, Portugal
| | - Afonso Cevadinha Caetano
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
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Harada M, Fujii K, Yamada Y, Tsukada W, Tsukada M, Hashimoto K, Kamijo Y. Relationship between serum uric acid level and vascular injury markers in hemodialysis patients. Int Urol Nephrol 2020; 52:1581-1591. [PMID: 32557375 DOI: 10.1007/s11255-020-02531-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE It has been reported that hyperuricemia causes vascular endothelial injury. Most hemodialysis patients present with hyperuricemia and also with vascular injury, resulting in cardiovascular diseases (CVD). However, the association of serum uric acid (sUA) with vascular injury markers in hemodialysis patients remains unclear. This study aimed to investigate this and discuss the mechanism by which uric acid causes vascular injury. METHODS We enrolled 48 Japanese maintenance hemodialysis patients without any history of CVD. The association between sUA level and three vascular injury markers (reactive hyperemia index [RHI], ankle-brachial index [ABI], and cardio ankle vascular index [CAVI]) was investigated by linear- and logistic regression analyses. RESULTS The median natural logarithm RHI (LnRHI) was 0.36. Linear regression analysis revealed a significant positive correlation between sUA level and LnRHI (β = 0.42, p = 0.001) in all patients. Moreover, a significant, strongly positive correlation was observed between sUA and LnRHI in patients who were treated with xanthine oxidase inhibitors (XOIs) (β = 0.75, p = 0.001). Further, the linear analysis showed a significant negative correlation between sUA level and CAVI in patients who were treated with XOIs (β = - 0.52, p = 0.049). sUA level was not significantly associated with ABI abnormality. CONCLUSIONS It is possible that a high level of sUA is significantly associated with better vascular endothelial function and condition of vascular tone in hemodialysis patients who were treated with XOIs. The findings suggest a significant paradox between sUA level and vascular endothelial function in hemodialysis patients; however, the opposite has been reported in patients without hemodialysis.
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Affiliation(s)
- Makoto Harada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan. .,Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan.
| | - Kazuaki Fujii
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.,Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.,Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Wataru Tsukada
- Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Manabu Tsukada
- Department of Nephrology and Urology, Jisyukai Ueda Kidney Clinic, 322 Sumiyoshi, Ueda, 386-0002, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
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Al-Faham FSM, Al-Hakkak SMM, Akpinar MB. Trauma-induced large true superficial femoral artery aneurysm: A case report. Ann Med Surg (Lond) 2020; 55:234-7. [PMID: 32518648 DOI: 10.1016/j.amsu.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background A femoral aneurysm is a weakness and bulging in the femoral artery wall located in the thigh. Femoral aneurysms can burst, which may cause uncontrolled bleeding and life-threatening conditions. The aneurysm may also cause a blood clot, showering emboli, potentially resulting in leg ischemia and amputation. Case report A 49-year-old man with hypertension presented significant swelling in his right thigh. The patient had a history of surgery for arteriovenous fistula repair. The arteriovenous fistula in the thigh was caused by a bullet injury during the war. Diagnosis of the superficial femoral artery aneurysm was determined using magnetic resonance angiogram. The aneurysm was surgically excised and a prosthetic vascular graft was inserted. Discussion The exact cause of femoral aneurysms is unknown, although atherosclerosis and hypertension may play a key role. Trauma to the artery may also be a contributing factor. Long-standing occult arteriovenous fistula plays a significant role in the cause of distal aneurysms. Conclusion Femoral aneurysms are usually treated surgically. A surgeon will replace the artery with a graft or create a bypass around the area of the artery where the aneurysm is present.
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Soriano Sánchez JA, de Zavalía M, Soto García ME, Rodríguez García M, Soriano Solís S, Castañeda Gaxiola R, Guerrero Hernández M, Flores Soria ER, Romero Rangel JAI. Segmental T12 Vertebral Artery Injury Treated by Endovascular Coil Placement after Kyphoplasty for Symptomatic Spinal Angioma. Case Report of a Minimal Invasive Solution for a Complication of a Minimally Invasive Spine Procedure. World Neurosurg 2020; 141:137-141. [PMID: 32497848 DOI: 10.1016/j.wneu.2020.05.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vertebral angioma is a tumor defined as an abnormality of vascular tissue development. It usually has an asymptomatic behavior, being present in 10%-12% of autopsies and imaging studies. CASE DESCRIPTION A 70-year-old man consulted because of a long history of low back pain. Imaging studies were compatible with vertebral angioma at T12; we decided to perform a minimally invasive surgical procedure, such as kyphoplasty. During surgery, there was a sharp decrease in pulmonary saturation, and the patient underwent a computed tomography scan evaluation confirming a left hemothorax due to segmental branch vascular injury at T12. Given the patient's poor medical condition and the complexity of an emergent open procedure in the thoracic spine, we decided to undertake a minimally invasive endovascular coil placement to repair the vascular injury. Due to a favorable outcome, we discharged the patient after 72 hours of surveillance. CONCLUSIONS Even in the case of a complication to occur, we should always consider a minimally invasive solution to solve the problem because patients undergoing these procedures correspond to elderly patients with poor medical conditions or comorbidities.
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Affiliation(s)
| | | | | | - Manuel Rodríguez García
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Sergio Soriano Solís
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Roberto Castañeda Gaxiola
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Manuel Guerrero Hernández
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Enrique Raúl Flores Soria
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
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Tosun B. Medial approach for the treatment of femur fractures in association with vascular injury. Injury 2020; 51:1367-1372. [PMID: 32336478 DOI: 10.1016/j.injury.2020.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To highlight an alternative method of treatment for femoral fractures associated with vascular injury, allowing both fracture fixation and vascular repair from the same surgical approach. DESIGN Retrospective case series. METHODS Twelve patients with arterial injury as a consequence of femoral fracture were treated by internal fixation. There were five femoral diaphysis, seven distal femoral including supracondylar and intercondylar fractures. Four patients had injury to the popliteal artery, whereas eight to the superficial femoral artery. Seven patients had a nerve injury. Medial femoral approach was used both for the fixation of the fracture and vascular repair. Fracture fixation was done by plate-screw in all patients, whereas vascular injuries were treated using saphenous vein interposition graft in ten patients and end-to-end repair in two patients. Nerve injuries were not dealt by exploration during the vascular repair. RESULTS All of the limbs were ultimately survived. Clinical and radiological union was observed in all patients at the last follow-up radiographs. Of the 4 total sciatic nerve palsies, 2 had developed total, one had tibial nerve recovery. One patient had no motor recovery. Of the 3 peroneal nerve palsies, 1 patient had recovery, 2 patients had no motor improvement. CONCLUSIONS A midlateral approach is traditionally used for fractures of femur when plates and screws are used for fixation. In association with vascular injury, this procedure requires two separate incisions. The added soft tissue disruption associated with open reduction and internal fixation by lateral incision can be reduced with the use of single medial approach, which allows bony stabilization under direct visualization of the repaired vessels.
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Affiliation(s)
- Bilgehan Tosun
- Kocaeli University, School of Medicine, Department of Orthopaedics and Traumatology, Uctepeler Mevkii Umuttepe Kampusu, 41380 Izmit, Turkey.
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Akhaddar A, Alaoui M, Turgut M, Hall W. Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review. Neurosurg Rev 2021; 44:821-42. [PMID: 32399729 DOI: 10.1007/s10143-020-01311-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/14/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4-L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4-L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients.
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Musolino V, Gliozzi M, Bombardelli E, Nucera S, Carresi C, Maiuolo J, Mollace R, Paone S, Bosco F, Scarano F, Scicchitano M, Macrì R, Ruga S, Zito MC, Palma E, Gratteri S, Ragusa M, Volterrani M, Fini M, Mollace V. The synergistic effect of Citrus bergamia and Cynara cardunculus extracts on vascular inflammation and oxidative stress in non-alcoholic fatty liver disease. J Tradit Complement Med 2020; 10:268-274. [PMID: 32670822 PMCID: PMC7340872 DOI: 10.1016/j.jtcme.2020.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIM Non-Alcoholic Fatty Liver Disease (NAFLD) represents a risk factor for cardiovascular diseases. NAFLD is worsened by the simultaneous occurrence of type 2 diabetes mellitus (T2DM) causing an enhancement of inflammatory and fibrotic processes. Although insulin resistance appears the link between NAFLD and T2DM, current pharmacological treatments of T2DM failed to produce relevant benefits in preventing T2DM-related liver dysfunction. In this randomized, double blind, placebo-controlled clinical study, we evaluated the effect of Bergacyn, an innovative formulation originating from the combination of Bergamot Polyphenolic Fraction (BPF) and Cynara cardunculus (CyC). EXPERIMENTAL PROCEDURE 80 adult patients with a history of at least 12 months of T2DM and NAFLD received orally BPF (300 mg/daily) Cyc (300 mg/daily), separately or formulated in combination 50/50% (Bergacyn; 300 mg/daily), or placebo all containing 300 mg of bergamot albedo fibers micronized and co-grinded as excipients. RESULTS AND CONCLUSION Serum measurements and liver ultrasound analyses showed that concomitant administration of BPF and CyC produced significant improvement of NAFLD biomarkers in patients with T2DM. This effect was associated with a substantial reduction of oxidative stress/inflammatory biomarkers, thus contributing to a significant improvement of NO-mediated reactive vasodilation. Furthermore, the effect of Bergacyn showed a synergistic effect of both extracts, thus suggesting that this peculiar formulation represents a novel therapeutic strategy to counteract vascular inflammation and endothelial dysfunction in patients suffering from T2DM and NAFLD. Further studies in larger cohort of diabetic patients are required to better identify the potential of Bergacyn on metabolic disorders accompanying T2DM and NAFLD.
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Affiliation(s)
- Vincenzo Musolino
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Micaela Gliozzi
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Ezio Bombardelli
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Saverio Nucera
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Cristina Carresi
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Jessica Maiuolo
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Rocco Mollace
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Sara Paone
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Francesca Bosco
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Federica Scarano
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Miriam Scicchitano
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Roberta Macrì
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Stefano Ruga
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Maria Caterina Zito
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Ernesto Palma
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Santo Gratteri
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | - Monica Ragusa
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
| | | | | | - Vincenzo Mollace
- Institute of Research for Food Safety & Health, Department of Health Sciences, University “Magna Graecia” of Catanzaro, Nutramed Scarl and, Italy
- San Raffaele IRCCS, Rome, Italy
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Choi CH, Lee WS, Jung M, Moon HS, Lee YH, Oh J, Kim SJ, Kim SH. Adequate protection rather than knee flexion prevents popliteal vascular injury during high tibial osteotomy: analysis of three-dimensional knee models in relation to knee flexion and osteotomy techniques. Knee Surg Sports Traumatol Arthrosc 2020; 28:1425-35. [PMID: 31119339 DOI: 10.1007/s00167-019-05515-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE (1) To analyse popliteal artery (PA) movement in a three-dimensional (3D) coordinate system in relation to knee flexion and high tibial osteotomy (HTO) techniques (lateral closed wedge HTO [LCHTO], uniplane medial open wedge HTO [UP-MOHTO], biplane medial open wedge HTO [BP-MOHTO]) and (2) to identify safe zones of the PA in each osteotomy plane. METHODS Sixteen knees of patients who underwent magnetic resonance imaging with extension and 90° flexion were used to develop subject-specific 3D knee flexion models. Displacement of the PA during knee flexion was measured along the X- and Y-axis, as was the distance between the posterior tibial cortex and PA parallel to the Y-axis (d-PCA). Frontal plane safety index (FPSI) and maximal axial safe angles (MASA) of osteotomy, which represented safe zones for the osteotomy from the PA injury, were analysed. All measurements were performed along virtual osteotomy planes. Differences among the three osteotomy methods were analysed for each flexion angle using a linear mixed model. RESULTS The average increments in d-PCA during knee flexion were 1.3 ± 2.3 mm in LCHTO (n.s.), 1.4 ± 1.2 mm in UP-MOHTO (P < 0.0001), and 1.7 ± 2.0 mm in BP-MOHTO (P = 0.015). The mean FPSIs in knee extension were 37.6 ± 5.9%, 46.4 ± 5.8%, and 45.1 ± 8.1% for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. The mean MASA values in knee extension were 45.8° ± 4.4°, 37.3° ± 6.1°, and 38.9° ± 6.5° for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. CONCLUSION Although the PA moved posteriorly during knee flexion, the small (1.7 mm) increment thereof and inconsistent movements in subjects would not be of clinical relevance to PA safety during HTO. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Wang Z, Liu L, Xu XH, Cao MD, Lu H, Zhang KB. The OLIF working corridor based on magnetic resonance imaging: a retrospective research. J Orthop Surg Res 2020; 15:141. [PMID: 32293492 PMCID: PMC7158069 DOI: 10.1186/s13018-020-01654-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To provide an anatomical basis for the development of oblique lumbar interbody fusion (OLIF) in Chinese patients. METHODS Between November 2018 and June 2019, 300 patients' lumbar MRI data were reviewed. According to the Moro system and zone method described by us, the axial view was vertically divided into 6 zones (A, I II, III, IV, P) and was horizontally divided into 4 zones (R, a, b, c, L). The locations of left psoas muscle and the major artery at L2/3, L3/4, and L4/5 levels were evaluated by the grid system. The aortic bifurcation segments will also be evaluated at the level of the vertebral body or the disc. RESULTS At the L2/3 level, left psoas muscle and the major artery in zone Ib were found in 28.0% of subjects, in zone IIb in 20.3%, and in zone Ic in 20.0%; at the L3/4 level, in zone Ab in 20.7% of subjects, in zone Ac in 26.0%, and in zone Ic in 11.0%; and at the L4/5 level, areas in zone Ab in 31.0% of subjects, in zone Ac in 26.0%, and in zone Ib in 11.7%. The aortic bifurcation segments were mainly at the L4 level. The zone of the left psoas muscle at all levels, the zone of the major artery at L4/5 level, and the zone of the aortic bifurcation segments had significant correlation with gender difference (P < 0.05). CONCLUSION The left-sided OLIF at L2-L5 disc levels can be a feasible type of surgery for lumbar interbody fusion in the majority of Chinese patients. Before the operation, in order to screen out the appropriate surgical approach, routine lumbar magnetic resonance imaging is recommended to analyze the patient's local anatomical features.
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Affiliation(s)
- Zhe Wang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Lei Liu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiang-He Xu
- Department of Orthopaedics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ming-de Cao
- Department of Orthopaedics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hai Lu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Kui-Bo Zhang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
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141
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Scheu M, Espinoza GF, Mellado CA, Díaz PA, Garín AF, O'Connell LA. Varus mechanism is associated with high incidence of popliteal artery lesions in multiligament knee injuries. Int Orthop 2020; 44:1195-200. [PMID: 32162037 DOI: 10.1007/s00264-020-04517-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aims to identify multiple ligament knee injury patterns that possess a high-risk of vascular lesion. METHODS We retrospectively compared torn ligament patterns and the presence of vascular lesions confirmed by magnetic resonance imaging and computed tomography angiography from 122 consecutive patients with diagnoses of multiple ligament knee injury made at the emergency department between January 2012 and December 2017. Patients were not eligible if they had an ipsilateral lower extremity lesion (dislocations or fractures at another level), initial evaluation at another hospital, or follow-up for less than 12 months. The primary outcomes were the comparison between the imaging findings of torn structures patterns and the presence of a vascular lesion. RESULTS We identified 48 eligible patients (50 knees) with multiligamentary knee lesions, of whom eight had popliteal artery damage, yielding an incidence of 16%. Our clinical examination detected six of these patients that were classified, according to the Schenck system, as KD-IIIL (6 knees) and KD-IIIM (2 knees). The odds of having a popliteal artery injury is 4.69 to 1 with a KD-IIIL injury that with any other type of injury on that classification (95% CI 0.960-22.98). CONCLUSIONS This data suggests that varus forces causing enough energy to produce a KD-IIIL lesion possess a higher popliteal artery injury risk, making recommendable a thorough examination of the vascular integrity when diagnosing a KD-IIIL lesion.
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Chen JY, Zhu XL, Liu WH, Xie Y, Zhang HF, Wang X, Ying R, Chen ZT, Wu MX, Qiu Q, Wang JF, Chen YX. C-reactive protein derived from perivascular adipose tissue accelerates injury-induced neointimal hyperplasia. J Transl Med 2020; 18:68. [PMID: 32046736 PMCID: PMC7011279 DOI: 10.1186/s12967-020-02226-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/12/2020] [Indexed: 01/24/2023] Open
Abstract
AIM Inflammation within the perivascular adipose tissue (PVAT) in obesity plays an important role in cardiovascular disorders. C-reactive protein (CRP) level in obesity patients is significantly increased and associated with the occurrence and progression of cardiovascular disease. We tested the hypothesis CRP derived from PVAT in obesity contributes to vascular remodeling after injury. METHODS A high-fat diet (HFD) significantly increased CRP expression in PVAT. We transplanted thoracic aortic PVAT from wild-type (WT) or transgenic CRP-expressing (CRPTG) mice to the injured femoral artery in WT mice. RESULTS At 4 weeks after femoral artery injury, the neointimal/media ratio was increased significantly in WT mice that received PVAT from CRPTG mice compared with that in WT mice that received WT PVAT. Transplanted CRPTG PVAT also significantly accelerated adventitial macrophage infiltration and vasa vasorum proliferation. It was revealed greater macrophage infiltration in CRPTG adipose tissue than in WT adipose tissue and CRP significantly increased the adhesion rate of monocytes through receptor Fcγ RI. Proteome profiling showed CRP over-expression promoted the expression of chemokine (C-X-C motif) ligand 7 (CXCL7) in adipose tissue, transwell assay showed CRP increased monocyte migration indirectly via the induction of CXCL7 expression in adipocytes. CONCLUSION CRP derived from PVAT was significantly increased in HFD mice and promoted neointimal hyperplasia after vascular injury.
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Affiliation(s)
- Jia-Yuan Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China.,Department of Cardiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, People's Republic of China
| | - Xiao-Lin Zhu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - Wen-Hao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - Yong Xie
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - XiaoQiao Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, People's Republic of China
| | - Ru Ying
- Department of Cardiology, The First Affiliated Hospital of NanChang University, Nanchang, 330006, People's Republic of China
| | - Zhi-Teng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - Mao-Xiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - Qiong Qiu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China.
| | - Yang-Xin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, People's Republic of China.
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Shahi N, Phillips R, Meier M, Nehler M, Jacobs D, Recicar J, Bensard D, Moulton S. Anti-coagulation management in pediatric traumatic vascular injuries. J Pediatr Surg 2020; 55:324-330. [PMID: 31732119 DOI: 10.1016/j.jpedsurg.2019.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric traumatic vascular injuries are rare. Given the paucity of data to guide anti-coagulation (AC) management of these injuries in children, who have a lower overall risk for thrombosis compared to their adult counterparts, we sought to examine and summarize our recent experience. METHOD We conducted a retrospective review of all patients (<18 years old) who sustained traumatic vascular injuries between 2010-2018 at a Level 1 and Level 2 Pediatric Trauma Center. RESULTS Ninety-nine patients had traumatic vascular injuries. Eighty-four patients sustained a major arterial injury, 26 had a major venous injury, and 11 had both arterial and venous injuries. The arterial injury cohort had a median age of 13.3 years. Most of the arterial injury patients (65/84, 77%) required vascular repair. In-hospital AC management for the arterial injury patients consisted of a post-operative heparin drip (18%, 15/84), aspirin (39%, 26/84), enoxaparin (23%, 19/84), or none (42%, 43/84). Approximately one-half of the patients with arterial injuries (54%, 45/84) were discharged home on AC therapy, most commonly aspirin. Fifty-six patients (66%) followed up post-injury, of which 25% (14/56) had experienced complications. CONCLUSION Pediatric traumatic arterial injuries that require surgical intervention other than ligation should be considered for discharge AC - most commonly aspirin - in the absence of contraindications. Pediatric patients with vascular injuries to the aorta, carotid artery, inferior vena cava, portal vein, or lower extremities that are managed non-operatively should also be considered for AC. The preferred AC for pediatric venous injuries is enoxaparin, in the absence of contraindications. STUDY TYPE Treatment Study LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Niti Shahi
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ryan Phillips
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark Nehler
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Donald Jacobs
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - John Recicar
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Denis Bensard
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Steven Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Chowdhry M, Burchette D, Whelan D, Nathens A, Marks P, Wasserstein D. Knee dislocation and associated injuries: an analysis of the American College of Surgeons National Trauma Data Bank. Knee Surg Sports Traumatol Arthrosc 2020; 28:568-575. [PMID: 31559462 DOI: 10.1007/s00167-019-05712-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Knee dislocations (KDs) are potentially devastating injuries, leading to loss of function or limb in often young patients. This retrospective database review aims to determine the relative incidence and risk factors for KDs presenting to North American Level I and II trauma centers. METHODS The National Trauma Data Bank (NTDB) was retrospectively interrogated using ICD-9-CM codes to identify KDs between 2010 and 2014 to derive KD incidence. KDs were stratified by age, sex, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), drug and alcohol use, injury mechanism, open vs. closed KD, vascular injury and fracture. Each co-variate was tested against different mechanisms of injury, using Chi-squared tests and risk adjusted analyses to derive risk factors for KD. The same calculations were done for secondary outcomes (vascular and neurological injuries, compartment syndrome, amputation, and mortality). RESULTS A total of 6454 KDs met the inclusion criteria (18/10,000 admissions). KDs occurred most commonly amongst men, aged 20-39, with an ISS score 1-14 and following motor vehicle collision (MVC). A vascular investigation was performed in 29%, with injury documented in 15% of KDs and 10.8% receiving a vascular procedure. Associated fractures were observed in 41.4% of KDs. Open injuries in 13.6%. Neurological injury documented in 6.2%, compartment syndrome in 2.7%, amputation in 3.8% (> 50% had vascular injury) and 2.8% died. MVC was the most common mechanism of injury (p < 0.001), significantly more common in young, male patients, associated with higher ISS and lower GCS, especially when drugs or alcohol were involved (p < 0.0001). Being male, having a vascular injury or open KD were all risk factors for compartment syndrome, amputation and neurological injuries. CONCLUSIONS KDs are rare injuries, but their relative incidence may be increasing. Young, male patients involved in MVCs are risk factors for KDs and their associated injuries, such as neurological injuries, amputations and compartment syndrome. Vascular injury occurs at a frequency of around 15%. The findings of the current study may guide future research and help to inform clinicians on the expected rates of associated injuries in patients identified to have KD in a trauma center population. It informs regarding risk factors for KD, which may improve diagnosis rates of spontaneously reduced knee dislocations by increasing index of suspicion in high-risk patients and identifies specific links with impaired driving. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Majid Chowdhry
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, Brighton, East Sussex, UK.
| | - Daniel Burchette
- Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, Brighton, East Sussex, UK
| | - Danny Whelan
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Avery Nathens
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Paul Marks
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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145
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Ali RO, Moon MS, Townsend EC, Hill K, Zhang GY, Bradshaw A, Guan H, Hamilton D, Kleiner DE, Auh S, Koh C, Heller T. Exploring the Link Between Platelet Numbers and Vascular Homeostasis Across Early and Late Stages of Fibrosis in Hepatitis C. Dig Dis Sci 2020; 65:524-533. [PMID: 31407130 PMCID: PMC7988415 DOI: 10.1007/s10620-019-05760-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Thrombocytopenia is a hallmark of advanced liver disease. Platelets, growth factors (GFs), and vascular integrity are closely linked factors in disease pathogenesis, and their relationship, particularly in early disease stages, is not entirely understood. The aim was to compare circulating platelets, growth factors, and vascular injury markers (VIMs) in hepatitis C-infected (HCV) patients with early fibrosis and cirrhosis. METHODS Retrospective evaluation of serum GFs and VIMs by ELISA were evaluated from twenty-six HCV patients. Analytes from an earlier time-point were correlated with MELD at a later time-point. RESULTS Platelets and GFs decreased, and VIMs increased with fibrosis. Platelets correlated positively with PDGF-AA, PDGF-BB, TGFB1, EGF, and P-selectin, and negatively with ICAM-3 and VCAM-1. P-selectin showed no correlations with VIMs but positively correlated with PDGF-AA, PDGF-BB, TGFB1, and EGF. Soluble VCAM-1 and ICAM-3 were linked to increasing fibrosis, liver enzymes, and synthetic dysfunction. Higher VCAM-1 and ICAM-3 and lower P-selectin at an earlier time-point were linked to higher MELD score at a later time-point. CONCLUSION In chronic HCV, progressive decline in platelets and growth factors with fibrosis and their associations suggest that platelets are an important source of circulating GFs and influence GF decline with fibrosis. Enhanced markers of vascular injury in patients with early fibrosis suggest an earlier onset of endothelial dysfunction preceding cirrhosis. Associations of VIMs with platelets suggest a critical link between platelets and vascular homeostasis. Circulating markers of vascular injury may not only have prognostic importance but emphasize the role of vascular dysfunction in liver disease pathogenesis (NCT00001971).
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Affiliation(s)
- Rabab O Ali
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA.
| | - Mi Sun Moon
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Elizabeth C Townsend
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Kareen Hill
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Grace Y Zhang
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Alyson Bradshaw
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Hannah Guan
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Destanee Hamilton
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Koh
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA
| | - Theo Heller
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B16, 10 Center Dr. MSC 1800, Bethesda, MD, 20892-1800, USA.
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Taghavi S, Jones G, Duchesne J, McGrew P, Guidry C, Schroll R, Harris C, Nkansah R, Jacome T, Tatum D. Impact of trauma center volume on major vascular injury: An analysis of the National Trauma Data Bank (NTDB). Am J Surg 2020; 220:787-92. [PMID: 32061398 DOI: 10.1016/j.amjsurg.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/11/2019] [Accepted: 01/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The association of procedure volume and improved outcomes has been established with infrequently performed elective operations. However, effect of trauma center volume on outcomes in emergency surgery has not been defined. We hypothesized that high volume centers (HVC) would provide better outcomes for operative major vascular injuries (MVI) than low volume centers (LVC). METHODS The NTDB was queried from 2010 to 2014. Patients with MVI were identified and HVC were compared to LVC. HVC were defined as >480 patients per year with ISS≥15. RESULTS There were 37,125 patients with MVI, with 16,461 (44.3%) managed operatively. Of these, 15,965 (97%) underwent surgery at HVC and 496 (3%) at LVC. There was no difference in shunt utilization, however, HVC were more likely to utilize endovascular repair (31.0% vs. 21.9%, p < 0.001). Rates of death, amputation, and compartment syndrome were similar. HVC were more likely to develop pneumonia or sepsis. On logistic regression, HVC was not associated with survival (OR: 0.90, 95%CI: 0.60-1.34, p = 0.60). Variables associated with mortality for HVC and LVC included thoracic arterial injury (OR: 1.57, 95%CI: 1.27-1.94, p < 0.001), penetrating mechanism (OR:1.84, 95%CI: 1.57-2.15, p < 0.001), and open repair (OR: 1.95, 95%CI: 1.69-2.26, p < 0.001). Lower ISS (OR: 0.29, 95%CI: 0.24-0.34, p < 0.001) and higher presenting blood pressure (OR: 0.99, 95%CI: 0.99-1.00, p < 0.001) were associated with survival. CONCLUSIONS Although LVC may have less proficiency with endovascular techniques, trauma center volume does not influence survival in emergency surgery for MVI.
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147
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Lim IR, Kim C, Jung JW, Kim JH, Hong SJ. Inhibition of Smooth Muscle Cell Proliferation and Migration by a Talin Modulator Attenuates Neointimal Formation after Femoral Arterial Injury. Korean Circ J 2020; 50:613-624. [PMID: 32588569 PMCID: PMC7321761 DOI: 10.4070/kcj.2019.0421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 03/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Vascular smooth muscle cell (SMC) proliferation and migration play a critical role in neointimal formation. Focal adhesion is involved in cell proliferation and migration, and talin is known to be a key regulator of these processes. We synthesized a new talin modulator that binds to the talin protein, and investigated its effects on SMCs and neointimal formation after vascular injury. Methods Human aortic SMCs (HAoSMCs) were treated with a newly synthesized talin modulator. Apolipoprotein E knockout (ApoE KO) mice were subjected to left femoral arterial injury and orally administered with the talin modulator daily. Laser Doppler imager was used to compare the blood flow, and injured femoral arteries and blood serum were analyzed after 28 days. Results The talin modulator significantly inhibited cell proliferation in a concentration-dependent manner and suppressed the migration of HAoSMCs. Treatment with a talin modulator resulted in a significant reduction in the phosphorylation of focal adhesion molecules and downstream signaling molecules related to cell proliferation and migration. The effects of the talin modulator in HAoSMCs were found to be reversible, as evidenced by the reactivation of signaling pathways upon its removal. After 28 days of administration of the talin modulator, an improvement in the blood flow and reduction in neointimal formation in the injured femoral arteries were observed. Conclusions We demonstrated the inhibitory effects of a talin modulator on SMC proliferation and migration, and that were associated with downregulation of signaling pathways, resulting in the attenuation of neointimal formation in ApoE KO mice.
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Affiliation(s)
- I Rang Lim
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul, Korea
| | - Chungho Kim
- Department of Life Sciences, Korea University College of Life Sciences and Biotechnology, Seoul, Korea
| | - Jong Wha Jung
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu, Korea
| | - Jong Ho Kim
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul, Korea.
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul, Korea
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148
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Nordin A, Shi J, Kenney B, Xiang H, Samora JB. Pediatric supracondylar humerus fractures and vascular injuries: A cross-sectional study based on the National Trauma Data Bank. J Clin Orthop Trauma 2020; 11:264-268. [PMID: 32099291 PMCID: PMC7026563 DOI: 10.1016/j.jcot.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/08/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Supracondylar humerus (SCH) fractures represent one of the most commonly treated fractures. We sought to determine: 1) how often SCH fractures are associated with vascular injury; 2) mechanism of injuries; 3) where cases are treated 4) time to operating room (OR); and 5) length of stay (LOS). METHODS The 2007-2014 National Trauma Data Bank (NTDB) data were analyzed for all patients <18 years of age who presented with an isolated supracondylar humerus fracture, with or without an associated vascular injury. Both non-operative and operative management were included. Main outcome measures were demographics, mechanism of injury, presence of vascular injury, time to OR, number of OR procedures, type of treating facility, and LOS. Comparisons were performed using Chi square test for categorical variables and Student's t-test for continuous variables. RESULTS We identified a total of 53,571 pediatric patients over eight years with SCH fractures. Vascular injuries occurred in 149 patients (0.3%), which were significantly more common with open fractures (p < 0.001). Patients with vascular injuries had significantly longer LOS (3.5 days v 1.4 days; p < 0.001) and shorter times to the OR (4.7 h v 10.4 h; p < 0.001), and were more likely to be treated in teaching hospitals and pediatric level 1 trauma centers (p = 0.037). CONCLUSION The percentage of vascular injuries associated with SCH fractures in pediatric patients remains low (0.3%). The majority of pediatric patients with these injuries are treated at level 1 pediatric trauma centers. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Andrew Nordin
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Brian Kenney
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie Balch Samora
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA,Corresponding author. Nationwide Children’s Hospital, Department of Orthopaedics, 700 Children’s Drive, T2E-A2700, Columbus, OH, 43205, USA.
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149
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Cao M, Yuan W, Peng M, Mao Z, Zhao Q, Sun X, Yan J. Role of CyPA in cardiac hypertrophy and remodeling. Biosci Rep 2019; 39:BSR20193190. [PMID: 31825469 PMCID: PMC6928530 DOI: 10.1042/bsr20193190] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022] Open
Abstract
Pathological cardiac hypertrophy is a complex process and eventually develops into heart failure, in which the heart responds to various intrinsic or external stress, involving increased interstitial fibrosis, cell death and cardiac dysfunction. Studies have shown that oxidative stress is an important mechanism for this maladaptation. Cyclophilin A (CyPA) is a member of the cyclophilin (CyPs) family. Many cells secrete CyPA to the outside of the cells in response to oxidative stress. CyPA from blood vessels and the heart itself participate in a variety of signaling pathways to regulate the production of reactive oxygen species (ROS) and mediate inflammation, promote cardiomyocyte hypertrophy and proliferation of cardiac fibroblasts, stimulate endothelial injury and vascular smooth muscle hyperplasia, and promote the dissolution of extracellular matrix (ECM) by activating matrix metalloproteinases (MMPs). The events triggered by CyPA cause a decline of diastolic and systolic function and finally lead to the occurrence of heart failure. This article aims to introduce the role and mechanism of CyPA in cardiac hypertrophy and remodeling, and highlights its potential role as a disease biomarker and therapeutic target.
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Affiliation(s)
- Mengfei Cao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Wei Yuan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Meiling Peng
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Ziqi Mao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Qianru Zhao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Xia Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
| | - Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China
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Huang AE, Noland SS, Spinner RJ, Bishop AT, Shin AY. Outcomes of Reconstructive Surgery in Traumatic Brachial Plexus Injury with Concomitant Vascular Injury. World Neurosurg 2019; 135:e350-e357. [PMID: 31837496 DOI: 10.1016/j.wneu.2019.11.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate functional outcome from reconstructive surgery in adult traumatic brachial plexus injury (AT-BPI) with associated vascular lesions. METHODS A retrospective review was performed of 325 patients with AT-BPI who underwent reconstructive surgery between 2001 and 2012. Patients with (vascular group) and without (control group) vascular injuries were identified by review of medical documentation. Patient presentation, characteristics of nerve and associated lesions, and surgical management were evaluated to identify prognostic variables. Postoperative muscle strength, range of motion, and patient-reported disability scores were analyzed to determine long-term outcome. RESULTS Sixty-eight patients had a concomitant vascular injury. There were no significant differences in age or sex between the control and vascular groups. The vascular group was more likely to have pan-plexus lesions (P < 0.0001), with significantly more associated upper extremity injuries (P < 0.0001). The control group underwent more nerve transfers, whereas the vascular group underwent more nerve grafting (P = 0.003). Complete outcome data were obtained in 139 patients, which included 111 control (43% of all control subjects) and 28 vascular patients (41%). There was no significant difference in patient-reported disability scores between the 2 groups. However, 73% of control subjects had grade 3 or greater postoperative elbow flexion, whereas only 43% of vascular patients achieved this strength (P = 0.003). Control patients demonstrated a greater increase in strength of shoulder abduction as well (P = 0.004). Shoulder external rotation strength was grade 0 in most patients, with no difference between the 2 groups. CONCLUSIONS Concomitant vascular injury leads to worse functional outcome after reconstructive surgery of traumatic brachial plexus injury.
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Affiliation(s)
- Alice E Huang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Shelley S Noland
- Department of Plastic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Robert J Spinner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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