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SUEMATSU T, MURAKAMI T, TAKAMATSU J, SHIMIZU T, TOYOTA S, TAKI T. Crossbow Bolt Penetrating the Neck Removed with the Assistance of an Endovascular Approach: A Case Report and Literature Review. NMC Case Rep J 2022; 9:157-163. [PMID: 35836494 PMCID: PMC9239694 DOI: 10.2176/jns-nmc.2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Penetrating neck injury by a crossbow bolt is extremely rare and can be life-threatening. When removing a crossbow bolt from the neck, it is necessary to protect against fatal bleeding from the carotid vessels. We report removing a crossbow bolt penetrating the neck, with an endovascular approach. A 49-year-old woman was shot in the neck by a crossbow and was transferred to our hospital. On presentation, the crossbow bolt totally penetrated the neck from right to left. Her level of consciousness was clear, with no significant neurological deficits except for right peripheral facial palsy. Neck contrast-enhanced computed tomography revealed the crossbow bolt in contact with bilateral external and internal carotid arteries and that the bolt caused dissection of the left main trunk of the external carotid artery. Under general anesthesia, the crossbow bolt was removed under fluoroscopy with the assistance of an endovascular approach. First, we performed coil embolization for the dissected external carotid artery. Second, we prepared for fatal bleeding from the carotid arteries during crossbow bolt removal under protection using guiding catheters placed in bilateral common carotid arteries. The bolt was removed successfully without significant bleeding, and no complications occurred during the procedure. We report the successful removal of a crossbow bolt penetrating the neck. When removing a crossbow bolt penetrating the neck, endovascular assistance may be feasible to protect against fatal bleeding from the carotid arteries.
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Affiliation(s)
| | | | | | | | | | - Takuyu TAKI
- Department of Neurosurgery, Kansai Rosai Hospital
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2
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Choi KK, Cho J, Lee MA, Eun SM, Jeon YB. Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report. JOURNAL OF TRAUMA AND INJURY 2022. [DOI: 10.20408/jti.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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3
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Coleman KC, Hudnall A, Grabo DJ, Pillai L, Borgstrom DC, Wilson A, Bardes JM. Penetrating trauma to the neck: Using your vascular toolkit. J Trauma Acute Care Surg 2021; 91:e51-e54. [PMID: 34397958 PMCID: PMC8369043 DOI: 10.1097/ta.0000000000003159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kennith Conley Coleman
- From the Division of General Surgery, Department of Surgery (K.C.C., A.H., D.C.B.), Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (D.J.G., A.W., J.M.B.), and Division of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, (L.P.) West Virginia University, Morgantown, West Virginia
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Honda M, Tanioka T, Haruki S, Kamata Y, Hoshi H, Ryu K, Yagi K, Ueno K, Matsui S, Ohata Y, Hasegawa F, Kaito A, Arita K, Ito K, Takiguchi N. Thoracic esophageal injury due to a neck stab wound: a case report. Surg Case Rep 2021; 7:126. [PMID: 34014419 PMCID: PMC8137774 DOI: 10.1186/s40792-021-01208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic esophageal injury leads to severe complications such as mediastinitis, pyothorax, and tracheoesophageal fistula. Although prompt diagnosis and treatment are required, there are no established protocols to guide diagnosis or treatment. In particular, thoracic esophageal injury tends to be diagnosed later than cervical esophageal injury because it has few specific symptoms. We report a case of thoracic esophageal injury caused by a cervical stab wound; the patient was stabbed with a sharp blade. CASE PRESENTATION A 74-year-old woman was attacked with a knife while sleeping at home. The patient was taken to the emergency room with an injury localized to the left section of her neck. She was suspected of a left jugular vein and recurrent laryngeal nerve injury from cervical hematoma and hoarseness. On the day following the injury, computed tomography revealed a thoracic esophageal injury. Emergency surgery was performed for an esophageal perforation and mediastinal abscesses. Although delayed diagnosis resulted in suture failure, the patient was able to resume oral intake of food a month later following enteral feeding with a gastrostomy. Esophageal injuries due to sharp trauma are rare, and most are cervical esophageal injuries. There are very few reports on thoracic esophageal injuries. CONCLUSIONS The possibility of thoracic esophageal injury should always be considered when dealing with neck stab wounds, particularly those caused by an attack.
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Affiliation(s)
- Masaki Honda
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Toshiro Tanioka
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan.
| | - Shigeo Haruki
- Department of Esophageal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hokomagome, Bunkyo, Tokyo, Japan
| | - Yuko Kamata
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Hiromasa Hoshi
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Kyoko Ryu
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Kenta Yagi
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Kodai Ueno
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Satoshi Matsui
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Yoshiteru Ohata
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Fumi Hasegawa
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Akio Kaito
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Kaida Arita
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Koji Ito
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Noriaki Takiguchi
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
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Vellimana AK, Lavie J, Chatterjee AR. Endovascular Considerations in Traumatic Injury of the Carotid and Vertebral Arteries. Semin Intervent Radiol 2021; 38:53-63. [PMID: 33883802 DOI: 10.1055/s-0041-1724008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cervical carotid and vertebral artery traumatic injuries can have a devastating natural history. This article reviews the epidemiology, mechanisms of injury, clinical presentation, and classification systems pertinent to consideration of endovascular treatment. The growing role of modern endovascular techniques for the treatment of these diseases is presented to equip endovascular surgeons with a framework for critically assessing patients presenting with traumatic cervical cerebrovascular injury.
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Affiliation(s)
- Ananth K Vellimana
- Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jayson Lavie
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Arindam Rano Chatterjee
- Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Bazzout A, Lachkar A, Benfadil D, Tsen AA, El Ayoubi F, Ghailan R. About an unusual penetrating cervical wound:Iron bar. Ann Med Surg (Lond) 2021; 62:197-199. [PMID: 33537128 PMCID: PMC7843356 DOI: 10.1016/j.amsu.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The majority of cervical wounds are linked to aggressions and attempted autolysis by knives or firearms. Case presentation the story is about a 35 -year-old man admitted to the emergency room for a penetrating cervical wound following an accidental fall in the workplace. The extremely long iron bar (concrete)has penetrated its neck on the right side.upon admission, the patient was conscious,hemodynamically and respiratory stable without sensory-motor deficit. Surgical exploration is urgently decided under general anesthesia, from wich the foreign body is successfully removed.A follow -up examination at 4 months was without particularity. Discussion Penetrating neck injuries caused by objects such as rods or iron bars pose a significantly high risk of serious neurological damage. Penetrating neck injuries can be life-threatening and functional.the extent of the lesions must be assessed precisely before removing the foreign body. Conclusion we report an exceptional case of a penetrating neck wound caused by a concrete iron bar.treatment should always be multidisciplinary and giving priority to vital structures and function. The majority of cervical wounds are linked to aggressions and attempted autolysis by knives or firearms. The management of trauma to the penetrating neck has gone from compulsory exploration of the neck to selective management. The care is multidisciplinary because it calls upon several stakeholders to know: the surgeon of head and neck, vascular surgeon and anesthesiologist and only an early appropriate treatment can reduce the sequel.
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Affiliation(s)
- Asmae Bazzout
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Azzeddine Lachkar
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Drissia Benfadil
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Adil Abdenbi Tsen
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Fahd El Ayoubi
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Ghailan
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
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7
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Kochuba M, Rozycki GF, Feliciano D. Outcome after ligation of major veins for trauma. J Trauma Acute Care Surg 2021; 90:e40-e49. [PMID: 33502152 DOI: 10.1097/ta.0000000000003014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Kochuba
- From the Division of Acute Care Surgery, Department of Surgery, UF Health Jacksonville Medical Center (M.K.), University of Florida-Jacksonville, Jacksonville, Florida; Division of Acute Care and Adult Trauma Surgery, Department of Surgery, Johns Hopkins University School of Medicine (G.F.R.), Johns Hopkins University; and Division of Surgical Critical Care, Department of Shock Trauma Center, Shock Trauma Center (D.F.), University of Maryland Medical Center, University of Maryland, Baltimore, Maryland
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8
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Kansagra AP, Balasetti V, Huang MC. Neurovascular trauma: Diagnosis and therapy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:325-344. [PMID: 33272402 DOI: 10.1016/b978-0-444-64034-5.00012-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traumatic cerebrovascular injuries are common in both military and civilian populations. Whether such injuries occur in the aftermath of blunt or penetrating trauma has major implications for characteristics, classification, diagnosis, and optimal management of these lesions. Advances in screening methods, including particularly the dramatic rise of high-quality CT angiography, have facilitated early detection of these lesions. Fortunately, these diagnostic advances have occurred alongside improvements in pharmacological treatment and endovascular intervention, which now play an important role alongside surgical intervention in reducing the likelihood of adverse clinical outcomes. While the management of victims of trauma remains challenging, improved understanding of and ability to appropriately manage traumatic cerebrovascular lesions promises to yield better clinical outcomes for these vulnerable patients.
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Affiliation(s)
- Akash P Kansagra
- Departments of Radiology, Neurological Surgery, and Neurology, Washington University School of Medicine, St. Louis, MO, United States.
| | - Vamshi Balasetti
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael C Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
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9
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Blitzer DN, Ottochian M, O'Connor J, Feliciano DV, Morrison JJ, DuBose JJ, Scalea TM. Penetrating Injury to the Carotid Artery: Characterizing Presentation and Outcomes from the National Trauma Data Bank. Ann Vasc Surg 2020; 67:192-199. [PMID: 32217135 DOI: 10.1016/j.avsg.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penetrating injury to the neck can be devastating because of the multiple vital structures in close proximity. In the event of injury to the carotid artery, there is a significantly increased likelihood of morbidity or mortality. The purpose of this study was to assess presenting characteristics associated with penetrating injury to the carotid artery and directly compare approaches to surgical management. METHODS Data from the National Trauma Data Bank from 2002-2016 were accessed to evaluate adult patients sustaining penetrating injury to the common or internal carotid artery. Management (operative versus nonoperative) and surgical approach (open versus endovascular) were evaluated based on presentation characteristics, and outcomes were compared after propensity score matching. RESULTS Three thousand three hundred ninety-one patients fitting inclusion criteria and surviving past the emergency department were included in analyses (nonoperative: 1,976 [58.3%] patients and operative: 1,415 [41.7%] patients). The operative group was further classified by intervention as open = 1,192 patients and endovascular: 154 patients. On presentation, the nonoperative group demonstrated significantly higher prevalence of coma (Glasgow Coma Scale ≤8: nonoperative = 49.3% versus operative = 40.8%, P < 0.001), severe overall injury burden (Injury Severity Score ≥25: nonoperative = 42.3% versus operative = 33.3%, P < 0.001), and severe head injury (Abbreviated Injury Score ≥ 3: nonoperative = 44.9% versus operative = 22.0%, P < 0.001). After propensity score matching, the nonoperative group demonstrated higher mortality (nonoperative = 28.9% versus operative = 18.5%, P < 0.001), and lower rates of stroke (nonoperative = 6.6% versus operative - = 10.5%, P < 0.001). There were no differences in outcomes relating to surgical approach. CONCLUSIONS These results indicate that nonoperative patients often present with a more severe overall injury burden, particularly injury to the head, and not surprisingly, have higher rates of mortality. The lack of significant differences in outcomes relating to surgical approach indicates open versus endovascular invention should be individualized to the patient-for example, based on presenting characteristics and the location of the injury.
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Affiliation(s)
- David N Blitzer
- Department of Surgery, MedStar Health Baltimore, Baltimore, MD
| | - Marcus Ottochian
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - James O'Connor
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - David V Feliciano
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | | | - Joseph J DuBose
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
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10
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Wang D, Zhao Y, Cha B, Fang P, Liu Y. Penetrating neck trauma with common carotid artery injury caused by a percussive drill: A case report. Medicine (Baltimore) 2019; 98:e15750. [PMID: 31145290 PMCID: PMC6709122 DOI: 10.1097/md.0000000000015750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Penetrating neck traumas are dangerous and have a high mortality rate, particularly in patients with common carotid artery injuries. Advances in diagnostic imaging technology have shifted management of penetrating neck injuries from mandatory exploration to selective management. The question is now regarding optimal selection of auxiliary examinations to assess "stability" rapidly and guide clinics in managing such patients. PATIENT CONCERNS A 56-year-old man suffered neck trauma with the right common carotid artery caused by a percussive drill. The carotid artery could not be clearly displayed in computed tomography (CT) angiography imaging. DIAGNOSES Penetrating neck trauma due to percussive drill bit with common carotid artery injury. INTERVENTIONS X-ray and bedside duplex ultrasound with color Doppler flow imaging were used to assess the state of trauma and the foreign body was removed under general anesthesia. OUTCOMES The patient was discharged at postoperative day 10 with no complication. The patient had no sequelae from this injury at 6-month follow up. LESSONS X-ray provides a comprehensive assessment of damage, and can efficiently detect foreign bodies in the skull and cervical vertebrae. Duplex ultrasound to be a viable method to exclude macrovascular injury in unstable patients who are not eligible for computed tomography angiography (CTA) or catheter angiography imaging. Widely available duplex ultrasound and x-ray should be considered in emergency situations.
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Affiliation(s)
| | - Yi Zhao
- Department of Otorhinolaryngology
| | - Bingshan Cha
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Kovacević M, Kirin I, Vitezic D, Kolic Z, Martinovic G, Davor J. Traumatic avulsion of left common carotid and vertebral artery. ANZ J Surg 2012; 81:573-4. [PMID: 22295409 DOI: 10.1111/j.1445-2197.2011.05796.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Reva V, Pronchenko A, Samokhvalov I. Operative Management of Penetrating Carotid Artery Injuries. Eur J Vasc Endovasc Surg 2011; 42:16-20. [DOI: 10.1016/j.ejvs.2011.01.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/27/2011] [Indexed: 11/29/2022]
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Cruz C, Langberg J, Lerakis S, Veeraswamy R, Lloyd M. Internal Mammary Arterial Injury from Lead Extraction: A Clinically Subtle yet Important Complication of Implantable Device Removal. Cardiol Res Pract 2011; 2011:408640. [PMID: 21629794 PMCID: PMC3099199 DOI: 10.4061/2011/408640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/05/2011] [Indexed: 11/20/2022] Open
Abstract
Percutaneous implantable device extraction has increased in recent years and is associated with small but significant risk. Arteriovenous fistula formation is an uncommon complication of this procedure. We report two cases where lead extraction was complicated by an arteriovenous fistula between the left internal mammary artery and the left brachiocephalic vein. In both cases, the patients were asymptomatic and the presence of a continuous murmur in the left subclavicular region led to the appropriate diagnosis. These were successfully treated with coil embolization. Auscultation around prior extraction sites should be routinely done to aid in the diagnosis of this potentially harmful complication.
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Affiliation(s)
- Cesar Cruz
- Department of Cardiology, Division of Electrophysiology, Emory University, GA 30322, USA
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14
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Munera F, Danton G, Rivas LA, Henry RP, Ferrari MG. Multidetector row computed tomography in the management of penetrating neck injuries. Semin Ultrasound CT MR 2009; 30:195-204. [PMID: 19537052 DOI: 10.1053/j.sult.2009.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Penetrating neck trauma may occur from gun shots, stabbings, and accidental injury. Approximately 50% of gunshot and 10%-20% of stab-wound patients are reported as having severe injuries and the mortality from severe vascular injuries is reported as high as 50%. Penetrating traumatic neck injury is no longer best managed with exploratory surgery or conventional angiography in the stable patient. Computed tomography angiography has proven to be a useful, safe, and reliable means of diagnosis. Experience with interpreting and reconstructing computed tomography images, understanding the clinically important findings, and avoiding pitfalls is critical for successful patient care. Therefore, radiologists and clinicians who treat trauma patients need to familiarize themselves with the computed tomography angiography technique and appearances of vascular injury and know when to recommend further evaluation, such as interventional angiography or open surgery.
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Affiliation(s)
- Felipe Munera
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami, Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136, USA.
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15
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Abstract
The management of thoracic vascular injury has improved dramatically over the past two decades. The availability of multi-row detector CT has facilitated early diagnosis and incorporation of minimally invasive endograft repair for traumatic aortic injury has improved mortality and paraplegia rates. This review evaluates the available data on stent-graft repair of acute blunt traumatic aortic injury and traumatic great vessel injury with regard to safety and efficacy in comparison with conventional open surgical repair.
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Affiliation(s)
- Eric K Hoffer
- Department of Radiology, Section of Vascular and Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, United States.
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16
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Surgical and Endovascular Management of Penetrating Innominate Artery Injuries. Eur J Vasc Endovasc Surg 2008; 36:56-62. [DOI: 10.1016/j.ejvs.2008.01.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 01/26/2008] [Indexed: 11/22/2022]
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18
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Kumins NH, Tober JC, Love CJ, Culbertson TA, Gerhardt MA, Irwin RJ, Smead WL. Arteriovenous fistulae complicating cardiac pacemaker lead extraction: recognition, evaluation, and management. J Vasc Surg 2000; 32:1225-8. [PMID: 11107098 DOI: 10.1067/mva.2000.107994] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transvenous pacemaker lead extraction has become a commonly performed procedure that is associated with a small but significant risk. We report two cases where lead extraction was complicated by arteriovenous fistulae between branches of the aortic arch and the left brachiocephalic vein. Presenting signs and symptoms included severe chest or back pain, persistent or copious bleeding from the venous puncture site, unexplained hypotension or anemia, superior vena cava syndrome, and signs of central venous hypertension or acute heart failure. One patient whose injury was not recognized immediately and who did not undergo repair died rapidly, whereas the other patient who was diagnosed quickly underwent successful repair. Immediate diagnosis with arteriography and rapid intervention with surgery or percutaneous techniques are indicated and may prevent mortality.
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Affiliation(s)
- N H Kumins
- Department of Surgery, Division of Vascular Surgery, Ohio State University Medical Center, Columbus, OH 43210, USA
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19
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Gasparri MG, Lorelli DR, Kralovich KA, Patton JH. Physical examination plus chest radiography in penetrating periclavicular trauma: the appropriate trigger for angiography. THE JOURNAL OF TRAUMA 2000; 49:1029-33. [PMID: 11130484 DOI: 10.1097/00005373-200012000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the role of physical examination, chest radiography, and angiography in the management of periclavicular penetrating trauma. METHODS A retrospective review of the last 100 patients who suffered periclavicular penetrating trauma was performed. Patients with hard signs of vascular injury went either directly to the operating room or first to the angiography suite depending on their hemodynamic stability. All others underwent angiography and subsequent intervention if needed. The results were examined to determine the role of arteriography in the absence of hard signs of vascular injury. RESULTS Of the 100 patients in the study, there were 81 without hard signs of vascular injury. All underwent angiography, with 11 "occult" injuries discovered. Each of these patients exhibited some physical examination or chest radiographic finding that may have predicted the presence of vascular injury. Using clinical criteria, physical examination was found to have a sensitivity of 82%, a specificity of 91%, a positive predictive value of 60%, and a negative predictive value of 96%. When coupled with the chest radiographic findings, these numbers were 100%, 80%, 44%, and 100%, respectively. Using these criteria would have eliminated the need for angiography in 56 (69%) patients and would not have missed any injuries. CONCLUSIONS In patients with periclavicular penetrating trauma, a normal physical examination and chest radiographic excludes vascular injury. Proximity alone does not warrant angiography, although the test may be useful for therapeutic interventions or to plan operative approaches. A prospective study is essential to validate these findings.
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Affiliation(s)
- M G Gasparri
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Madoff DC, Brathwaite CE, Manzione JV, Bilaniuk JW, Giron F, Char D, Choi J, Bilfinger TV. Coexistent rupture of the proximal right subclavian and internal mammary arteries after blunt chest trauma. THE JOURNAL OF TRAUMA 2000; 48:521-4. [PMID: 10744296 DOI: 10.1097/00005373-200003000-00026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D C Madoff
- Department of Radiology, State University of New York at Stony Brook, 11794-8460, USA
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21
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Edwards JD, Sapienza P, Lefkowitz DM, Thorpe PE, McGregor PE, Agrawal DK, Samocha MS. Posttraumatic innominate artery aneurysm with occlusion of the common carotid artery at its origin by an intimal flap. Ann Vasc Surg 1993; 7:368-73. [PMID: 8268079 DOI: 10.1007/bf02002892] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Blunt trauma involving the innominate and carotid arteries is a rare occurrence that can be lethal or have serious neurologic sequelae. To our knowledge this is the first reported case in the international literature describing the association of posttraumatic innominate artery aneurysm with total occlusion and thrombosis of the common carotid artery at its origin by an intimal flap. The diagnostic problems created by this unusual injury are discussed. In this case the patency of the distal portion of the common and internal carotid arteries was demonstrated by magnetic resonance angiography (MRA), whereas color duplex and digital arteriographic studies were unsuccessful. This demonstration was crucial to patient management. Since no studies are available comparing color duplex imaging, conventional arteriography, and MRA in the evaluation of blunt carotid trauma, this case study is presented to demonstrate the utility of MRA in emergency situations. In addition, we analyze the possible pathogenesis and discuss the surgical treatment.
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Affiliation(s)
- J D Edwards
- Department of Surgery, Creighton University School of Medicine, Omaha, Neb. 68131
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Abstract
Penetrating trauma involving the innominate artery is uncommon. Few surgeons have experience with this injury. A successfully managed case of penetrating innominate artery trauma is summarized and the literature reviewed.
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Affiliation(s)
- T R McLean
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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