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Chen J, Zheng W, Liu T, Li X, Xin Z, Han Z, Wu Y. Successfully saving a child with destuctive iliac artery damage by hybrid surgery. J Cardiothorac Surg 2024; 19:470. [PMID: 39068409 PMCID: PMC11282611 DOI: 10.1186/s13019-024-02851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/14/2024] [Indexed: 07/30/2024] Open
Abstract
Non-iatrogenic trauma of the iliac artery is rarely reported but is always life-threatening. In this report, we describe the case of a child with complete transection and partial disappearance of the iliac artery caused by bicycle handlebar impalement. He experienced catastrophic hemorrhage, malignant arrhythmia, and difficulty in exploring transected vessel stumps. Aggressive infusion, blood transfusion in time, and pediatric vascular characteristics help delay the deterioration during anesthesia induction. Eventually he was successfully rescued by performing interventional balloon occlusion and open revascularization after more than 7 h post-trauma. A series of interventions and precautionary methods may benefit such severely injured patients; thus, these methods should be highlighted.
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Affiliation(s)
- Jianfeng Chen
- Department of Vascular Surgery, XuanWu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Wei Zheng
- Department of Vascular Surgery, XuanWu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Tingting Liu
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xianling Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhong Xin
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhonglong Han
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yingfeng Wu
- Department of Vascular Surgery, XuanWu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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Al Tannir AH, Biesboer EA, Pokrzywa C, Golestani S, Kukushliev V, Jean X, Harding E, de Moya MA, Morris R, Kugler N, Schellenberg M, Murphy PB. Open versus endovascular repair of penetrating non-aortic arterial injuries: A systematic review and meta analysis. Injury 2024; 55:111368. [PMID: 38309083 DOI: 10.1016/j.injury.2024.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Non-aortic arterial injuries are common and are associated with high morbidity and mortality. Historically, open surgical repair (OSR) was the conventional method of repair. With recent advancements in minimally invasive techniques, endovascular repair (ER) has gained popularity. We sought to compare outcomes in patients undergoing endovascular and open repairs of traumatic non-aortic penetrating arterial injuries. METHODS A systematic review and meta-analysis was conducted using MEDLINE (OVID), Web of Science, Cochrane Library, and Scopus Database from January 1st, 1990, to March 20th, 2023. Titles and abstracts were screened, followed by full text review. Articles assessing clinically important outcomes between OSR and ER in penetrating arterial injuries were included. Exclusion criteria included blunt injuries, aortic injuries, pediatric populations, review articles, and non-English articles. Odds ratios (OR) and Cohen's d ratios were used to quantify differences in morbidity and mortality. RESULTS A total of 3770 articles were identified, of which 8 met inclusion criteria and were included in the review. The articles comprised a total of 8369 patients of whom 90 % were male with a median age of 28 years. 85 % of patients were treated with OSR while 15 % underwent ER. With regards to injury characteristics, those who underwent ER were less likely to present with concurrent venous injuries (OR: 0.41; 95 %CI: 0.18, 0.94; p = 0.03). Regarding hospital outcomes, patients who underwent ER had a lower likelihood of in-hospital or 30-day mortality (OR: 0.72; 95 %CI: 0.55, 0.95; p = 0.02) and compartment syndrome (OR: 0.29, 95 %CI: 0.12, 0.71; p = 0.007). The overall risk of bias was moderate. CONCLUSION Endovascular repair of non-aortic penetrating arterial injuries is increasingly common, however open repair remains the most common approach. Compared to ER, OSR was associated with higher odds of compartment syndrome and mortality. Further prospective research is warranted to determine the patient populations and injury patterns that most significantly benefit from an endovascular approach. LEVEL OF EVIDENCE Level III, Systematic Reviews & Meta-Analyses.
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Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elise A Biesboer
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Courtney Pokrzywa
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Simin Golestani
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vasil Kukushliev
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xavier Jean
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Harding
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marc A de Moya
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Morris
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Kugler
- Department of Surgery, Division of Vascular & Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan Schellenberg
- Department of Surgery, Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Patrick B Murphy
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Balakrishnan S. CT angiography of non-aortic thoracic arterial trauma. Emerg Radiol 2023; 30:667-681. [PMID: 37704920 DOI: 10.1007/s10140-023-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma.
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Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency and Trauma Imaging, Emory University School of Medicine, Atlanta, GA, USA.
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Davidovic LB, Koncar IB, Dragas MV, Markovic MD, Bogavac-Stanojevic N, Vujcic AD, Mitrovic AC, Ilic NS, Trailovic RD, Kostic DM. Treatment of vascular non-iatrogenic injuries of upper and lower extremities in tertiary vascular center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:74-81. [PMID: 36168950 DOI: 10.23736/s0021-9509.22.12243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to examine demographic and baseline characteristics of patients with vascular injuries of extremities and to define the most relevant factors which influenced an early outcome, as well as limb salvage after the management of vascular trauma. METHODS This study used the database that included 395 patients with peripheral arterial injuries, who were treated in the tertiary vascular university center in the period between 2005-2020. Exclusion criteria were isolated thoracic, abdominal and neck injuries as well as iatrogenic injuries and injuries of intravenous addicts. Univariate binary logistic regression analysis and multiple logistic regression were used to determine risk factors for lomb loss (after vascular reconstruction) or mortality. Decision to perform primary amputation (without vascular reconstruction) was based on surgeons' preference and experience. RESULTS Out of 395 vascular injuries treated in the period 2005-2020, 210 (53.2%) presented with non-iatrogenic vascular injuries of upper and lower extremities were analyzed. According to the univariate regression analysis, hemorrhage as the main clinical manifestation on admission (P=0.035) and early reintervention (P=0.048) increased, while an early patency of repaired artery (0.010) significantly decreased a 30-day amputation rate. Multivariate logistic regression analysis of these three variables showed that only early patency of repaired artery significantly decreased the early amputation rate (P=0.009). CONCLUSIONS Based on presented experience, the patency of vascular reconstruction plays a crucial role in limb salvage in patients with non-iatrogenic peripheral vascular injuries. All factors that might influence the patency should be in focus of improvement.
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Affiliation(s)
- Lazar B Davidovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor B Koncar
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia - .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko V Dragas
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav D Markovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Aleksandra D Vujcic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandar C Mitrovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola S Ilic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ranko D Trailovic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan M Kostic
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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