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Robbins JM, Crayton C, Koloditch I, Walk C, Gramajo L, Shugar S, Ekeh P, DuBose J, Wong Y, Layba C. In-Hospital Risk Factors for Reintervention and Amputation in Brachial Arterial Trauma. J Surg Res 2024; 300:318-324. [PMID: 38838429 DOI: 10.1016/j.jss.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Brachial artery trauma is a rare but potentially devastating injury. There is little data regarding risk factors for reintervention and amputation prevention in this population, as well as anticoagulant (AC) and antiplatelet (AP) regimens and outcomes after discharge in trauma patients with vascular injuries requiring repair. This study aims to identify in-hospital risk factors for reintervention and amputation and stratify outcomes of follow-up by discharge AC or AP regimen. METHODS The AAST Prospective Observational Vascular Injury Trial database was queried for all patients who underwent traumatic brachial arterial repair from 2013 to 2022. Patients were evaluated by need for reintervention, amputation, and outcomes at follow-up by AC or AP regimen. RESULTS Three hundred and eleven patients required brachial repair, 28 (9%) required reoperation, and 8 (2.6%) required amputation. High injury severity score and an increased number of packed red blood cells and platelets showed a significant increase for reoperation and amputation. Damage control and shunt use were significant for the need to reoperate. Seventy-four percent (221/298) of patients were discharged with postoperative AC or AP regimens. There was no significant difference of short-term follow-up by type of AC or AP regimen. CONCLUSIONS Damage control and temporary shunt may lead to additional operations but not an increase in amputations. However, anticoagulation intraoperatively and postoperatively does not appear to play a significant role in reducing reintervention. It also suggests that there is no increase in short-term follow-up complications with or without AC or AP therapy.
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Affiliation(s)
| | | | | | - Casey Walk
- Wright State University Department of Surgery, Dayton, Ohio
| | - Limayre Gramajo
- Oklahoma State University College of Osteopathic Medicine, Tulsa, Oklahoma
| | | | - Peter Ekeh
- Wright State University Department of Surgery, Dayton, Ohio
| | - Joseph DuBose
- University of Texas Department of Surgery, Austin, Texas
| | - Yee Wong
- Wright State University Department of Surgery, Dayton, Ohio
| | - Cathline Layba
- Wright State University Department of Surgery, Dayton, Ohio
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2
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Harutyunyan M, Hnath JC, Jacobson X, Le J, Shah MD, Kleene J, Darling RC. Trauma bypass performed by vascular surgeons demonstrate excellent long-term outcomes and limb preservation. J Vasc Surg 2023; 78:779-787. [PMID: 37330703 DOI: 10.1016/j.jvs.2023.05.046] [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: 04/27/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Long-term outcomes in civilian trauma patients requiring upper or lower extremity revascularization is poorly studied secondary to limitations of certain large databases and the nature of the patients in this specific vascular subset. This study reports on the experience and outcomes of a Level 1 trauma center that serves both an urban and a large rural population over a 20-year period to identify bypass outcomes and surveillance protocols. METHODS Database of a single vascular group at an academic center was queried for trauma patients requiring upper or lower extremity revascularization between January 1, 2002, and June 30, 2022. Patient demographics, indications, operative details, operative mortality, 30-day nonoperative morbidity, revisions, subsequent major amputations, and follow-up data were analyzed. RESULTS A total of 223 revascularizations were performed, 161 (72%) lower and 62 (28%) upper extremities. One hundred sixty-seven patients (74.9%) were male, with a mean age of 39 years (range, 3-89 years). Comorbidities included hypertension (n = 34; 15.3%), diabetes (n = 6; 2.7%), and tobacco use (n = 40; 17.9%). Mean follow-up time was 23 months (range, 1-234 months), with 90 patients (40.4%) lost to follow-up. Mechanisms included blunt trauma (n = 106; 47.5%), penetrating trauma (n = 83; 37.2%), and operative trauma (n = 34; 15.3%). Bypass conduit was reversed vein (n= 171; 76.7%), prosthetic (n = 34; 15.2%), and orthograde vein (n = 11; 4.9%). Bypass inflow artery was superficial femoral (n = 66; 41.0%), above-knee popliteal (n = 28; 17.4%), and common femoral (n = 20; 12.4%) in the lower extremity, and brachial (n = 41; 66.1%), axillary (n = 10; 16.1%), and radial (n = 6; 9.7%) in the upper extremity. Lower extremity outflow artery was posterior tibial (n = 47; 29.2%), below-knee popliteal (n = 41; 25.5%), superficial femoral (n = 16; 9.9%), dorsalis pedis (n = 10; 6.2%), common femoral (n = 9; 5.6%), and above-knee popliteal (n = 10; 6.2%). Upper extremity outflow artery was brachial (n = 34; 54.8%), radial (n = 13; 21.0%), and ulnar (n = 13; 21.0%). Total operative mortality was nine patients (4.0%), all involving lower extremity revascularization. Thirty-day non-fatal complications included immediate bypass occlusion (n = 11; 4.9%), wound infection (n = 8; 3.6%), graft infection (n = 4; 1.8%), and lymphocele/seroma (n = 7; 3.1%). All major amputations (n = 13; 5.8%) were early and in the lower extremity bypass group. Late revisions in the lower and upper extremity groups were 14 (8.7%) and four (6.4%), respectively. CONCLUSIONS Revascularization for extremity trauma can be performed with excellent limb salvage rates and has demonstrated long-term durability with low limb loss and bypass revision rates. The poor compliance with long-term surveillance is concerning and may require adjustment in patient retention protocols; however, emergent returns for bypass failure are extremely low in our experience.
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Affiliation(s)
- Misak Harutyunyan
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY
| | - Jeffrey C Hnath
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY
| | - Xander Jacobson
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY
| | - Jeremy Le
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY
| | - Melissa D Shah
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY
| | - Julia Kleene
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY
| | - R Clement Darling
- Division of Vascular Surgery, Department of Surgery, Albany Medical Center Hospital, Albany, NY.
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Chipman AM, Ottochian M, Ricaurte D, Gunter G, DuBose JJ, Stonko DP, Feliciano DV, Scalea TM, Morrison J. Contemporary management and time to revascularization in upper extremity arterial injury. Vascular 2023; 31:284-291. [PMID: 35418267 DOI: 10.1177/17085381211062726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Upper extremity arterial injury is associated with significant morbidity and mortality for trauma patients, but there is a paucity of data to guide the clinician in the management of these injuries. The goals of this review were to characterize the demographics, presentation, clinical management, and outcomes, and to evaluate how time to intervention associates with outcomes in trauma patients with upper extremity vascular injuries. METHODS The National Trauma Data Bank (NTDB) Research Data Set for the years 2007-2016 was queried in order to identify adult patients (age ≥ 18) with an upper extremity arterial injury. Patients with brachiocephalic, subclavian, axillary, or brachial artery injury using the 1998 and 2005 versions of the Abbreviated Injury Scale were included. Patients with non-survivable injuries to the brain, traumatic amputation, or other major arterial injuries to the torso or lower extremities were excluded. RESULTS The data from 7908 patients with upper extremity arterial injuries was reviewed. Of those, 5407 (68.4%) underwent repair of the injured artery. The median Injury Severity Score (ISS) was 10 (IQR = 7-18), and 7.7% of patients had a severe ISS (≥ 25). Median time to repair was 120 min (IQR = 60-240 min). Management was open repair in 52.3%, endovascular repair in 7.3%, and combined open and endovascular repairs in 8.8%; amputation occurred in 1.8% and non-operative management was used in 31.6% of patients. Blunt mechanism of injury, crush injury, concomitant fractures/dislocations, and nerve injuries were associated with amputation, whereas simultaneous venous injury was not. There was a significant decrease in the rate of amputation when patients undergoing surgical revascularization did so within 90 min of injury (P = 0.007). CONCLUSION Injuries to arteries of the upper extremity are managed with open repair, endovascular repair, and, rarely, amputation. Expeditious transport to the operating room for revascularization is the key for limb salvage.
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Affiliation(s)
- Amanda M Chipman
- 12264University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marcus Ottochian
- 137889R. Adams Cowley Shock Trauma Center, 12264University of Maryland Medical System, Baltimore, Maryland, USA
| | - Daniel Ricaurte
- 12264University of Maryland School of Medicine, Baltimore, MD, United States
| | - Grahya Gunter
- 12264University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joseph J DuBose
- 137889R. Adams Cowley Shock Trauma Center, 12264University of Maryland Medical System, Baltimore, Maryland, USA
| | - David P Stonko
- Department of Surgery, 160877Johns Hopkins Hospital, Baltimore, MD, United States
| | - David V Feliciano
- 12264University of Maryland School of Medicine, Baltimore, MD, United States
| | - Thomas M Scalea
- 137889R. Adams Cowley Shock Trauma Center, 12264University of Maryland Medical System, Baltimore, Maryland, USA
| | - Jonathan Morrison
- 137889R. Adams Cowley Shock Trauma Center, 12264University of Maryland Medical System, Baltimore, Maryland, USA
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Hussain SA, Walters S, Ahluwalia A, Trompeter A. Diagnosis and management of arterial injuries associated with limb fracture or dislocation. Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2021.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
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Affiliation(s)
- SA Hussain
- Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK
| | - S Walters
- Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK
| | - A Ahluwalia
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - A Trompeter
- Orthopaedic Trauma/Limb Reconstruction Unit, St George's University Hospital, London, UK
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Kawatani Y, Hori T. Rare brachial artery injury caused by blunt trauma; a case of the brachial artery laceration in an amateur volleyball player. Trauma Case Rep 2021; 37:100570. [PMID: 34917737 PMCID: PMC8669432 DOI: 10.1016/j.tcr.2021.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/16/2022] Open
Abstract
Low-energy blunt brachial artery injury is very rare and can be easily missed. Moreover, brachial artery injury in an amateur volleyball player is extremely rare. A 33-year-old woman was referred to our emergency department with swelling on her left upper arm after playing volleyball. Paresis or paralysis was not observed. The pulse of the left brachial artery was palpable, but relatively weak. An ultrasound examination and a computed tomography, both, revealed a pseudoaneurysm on the posterior wall of the left brachial artery in the antecubital fossa. A massive hematoma was also observed beneath the artery. The examination ruled out any concomitant injuries such as fracture and dislocation of the joints. An emergency surgery was performed. A hockey stick skin incision was made from the distal brachium to the antecubital fossa. The left brachial artery was detected in the hematoma. A 15 mm-long laceration was observed on the posterior wall of the artery. The condition of the vessel wall around laceration was poor. Therefore, we resected the injured lesions. The defect was so long that the lesion was interposed by a reversed saphenous vein graft. Heparin was administered one day after the surgery, which was later changed to apixaban on the sixth day after the surgery. Apixaban was discontinued after a month post-surgery. During the follow-up period, the patient did not report any complications and the graft was unobstructed.
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Affiliation(s)
- Yohei Kawatani
- Department of Cardiovascular Surgery, Kamagaya General Hospital 929, Hatsutomi, Kamagaya-Shi, Chiba-Ken, Japan
| | - Takaki Hori
- Department of Cardiovascular Surgery, Kamagaya General Hospital 929, Hatsutomi, Kamagaya-Shi, Chiba-Ken, Japan
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Tanmit P, Angkasith P, Teeratakulpisarn P, Thanapaisal C, Wongkonkitsin N, Prasertcharoensuk S, Panich C. Treatment Outcome of Traumatic Subclavian Artery Injuries. Vasc Health Risk Manag 2021; 17:481-487. [PMID: 34429608 PMCID: PMC8379483 DOI: 10.2147/vhrm.s322127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic subclavian artery injuries are associated with high morbidity and mortality. Thoracic cage and clavicle provide a well protection of the underlying subclavian vessels and nerves and also cause a very limited operation space during open surgery. The endovascular modality is less invasive and alternative to conventional open surgical reconstruction. PURPOSE The purpose of this study was to analyze the different therapeutic effects on limb salvage. METHODS A retrospective review of patients who presented with blunt or penetrating injuries to the subclavian arteries between March 2012 and March 2021. RESULTS Endovascular and open repairs were both effective for traumatic subclavian artery injury. There was no statistical difference in the limb salvage, mortality, procedure-related complication, reintervention rate and in-hospital medical complications. Intraoperative blood loss, red blood cell transfusion requirement and length of hospital stay were significantly lower in the endovascular intervention group. CONCLUSION Endovascular treatment represents an attractive alternative to the traditional surgical approach for the treatment of traumatic injuries in the subclavian.
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Affiliation(s)
- Parichat Tanmit
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Phati Angkasith
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panu Teeratakulpisarn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chaiyut Thanapaisal
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Chaiwat Panich
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries. J Trauma Acute Care Surg 2021; 89:1183-1196. [PMID: 33230048 DOI: 10.1097/ta.0000000000002967] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
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Haney LJ, Bae E, Pugh MJV, Copeland LA, Wang CP, MacCarthy DJ, Amuan ME, Shireman PK. Patency of arterial repairs from wartime extremity vascular injuries. Trauma Surg Acute Care Open 2020; 5:e000616. [PMID: 33409373 PMCID: PMC7768973 DOI: 10.1136/tsaco-2020-000616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability. METHODS Service members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency. RESULTS The cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1-Q3: 3-58; range: 1-175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24-32). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency. CONCLUSIONS Arterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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Affiliation(s)
- Lauren J Haney
- Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA,South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Esther Bae
- South Texas Veterans Health Care System, San Antonio, Texas, USA,Surgery, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Mary Jo V Pugh
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA,Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chen-Pin Wang
- South Texas Veterans Health Care System, San Antonio, Texas, USA,Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Daniel J MacCarthy
- South Texas Veterans Health Care System, San Antonio, Texas, USA,Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Megan E Amuan
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Paula K Shireman
- Surgery, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA,Surgery, South Texas Veterans Health Care System, San Antonio, Texas, USA
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Karachentsev S. Blunt vascular trauma in a patient with peripheral arterial disease: a case report and review of the literature. J Surg Case Rep 2020; 2020:rjaa412. [PMID: 33133507 PMCID: PMC7587504 DOI: 10.1093/jscr/rjaa412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022] Open
Abstract
Blunt vascular trauma is rare and challenging in management. Trauma victims who are elderly and have medical comorbidities are still uncommon, but their proportion is expected to increase, as life expectancy has been rising worldwide. A case of blunt vascular trauma to the lower extremity in a 70-year-old patient is reported. During the procedure, a contusion of the superficial femoral artery with thrombosis was identified. Besides, the artery was found to be affected by atherosclerosis. Thrombectomy with resection of the artery and end-to-end anastomosis was performed. Good early clinical outcome was achieved. Nonsystematic review of the available literature is also presented.
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Asensio JA, Kessler JJ, Miljkovic SS, Kotaru TR, Dabestani PJ, Kalamchi LD, Wenzl FA, Sanford AP, Rowe VL. Brachial Artery Injuries Operative Management and Predictors of Outcome. Ann Vasc Surg 2020; 69:146-157. [DOI: 10.1016/j.avsg.2020.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
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Masood A, Danawar NA, Mekaiel A, Raut S, Malik BH. The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries. Cureus 2020; 12:e8473. [PMID: 32642377 PMCID: PMC7336685 DOI: 10.7759/cureus.8473] [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] [Indexed: 11/27/2022] Open
Abstract
Extremity vascular trauma is a challenging surgical emergency in both civilian population and combat environment. It requires vigilant diagnosis and prompt treatment to minimize limb loss and mortality. A multidisciplinary team approach is required to deal with shock states, concomitant abdominal injuries, head injuries, and fractures with significant tissue loss and psychological stress. Anticoagulation is frequently used during traumatic vascular repair to avoid repair site thrombosis, postoperative deep venous thrombosis, and pulmonary embolism (PE). In this review article, we are going to search about how frequent is the use of anticoagulation in terms of limb salvage rates, and mortality rates or side effects of anticoagulation in terms of risk of bleeding episodes, and the need for future prospective studies. Extremity vascular trauma is managed by a variety of methods including open repairs, endovascular repairs, and nonoperative management. Most of the literature demonstrates the use of systemic or regional anticoagulation in the management of vascular injuries with the improvement in limb salvage rates and reduced morbidities but confounding factors lead to variable results. Some studies show an increased risk of bleeding in trauma patients with the use of anticoagulants in trauma settings without any significant effect on repair site thrombosis. More comprehensive studies and randomized controlled trials are needed to confirm the importance of perioperative anticoagulation while avoiding the confounding factors in terms of injury severity scores, ischemia time, demographics of patients, modes of injury, comorbidities, grades of shock, concomitant injuries that need anticoagulation like venous injuries or intracranial injuries that are contraindications to the use of anticoagulation, type of anticoagulation and expertise available as well as the experience level of the operating surgeon. Literature also reveals the use of new oral anticoagulants (e.g., dabigatran) to be associated with lesser bleeding episodes when compared to warfarin, so in future, we can check the feasibility of these agents to reduce the bleeding episodes and at the same time improve the limb salvage rates.
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Affiliation(s)
- Ayesha Masood
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nuaman A Danawar
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Andrew Mekaiel
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sumit Raut
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Abubakar A, Okpechi S. Bilateral vascular repair in a patient with multiple upper extremity injury presenting at a teaching hospital—Case report and literature review. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:30-35. [PMID: 35814970 PMCID: PMC9267045 DOI: 10.4103/jwas.jwas_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Penetrating trauma to the upper extremity will usually result in vascular injuries, which mostly also involves nerves and tendons. Morbidity related to upper extremity vascular injuries usually occurs due to the associated injuries of the nerves, tendons, and bone. Early presentation to a trauma centre and prompt intervention will reduce morbidity associated with upper extremity vascular injuries.
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Contemporary management of subclavian and axillary artery injuries-A Western Trauma Association multicenter review. J Trauma Acute Care Surg 2017; 83:1023-1031. [PMID: 28715360 DOI: 10.1097/ta.0000000000001645] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. METHODS A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. RESULTS Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients. CONCLUSION The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for pseudoaneurysms. Low early complication rates and limb salvage rates of 97% were observed after open and endovascular repairs. LEVEL OF EVIDENCE Prognostic/epidemiologic, level IV.
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Chan J, Han D, Gallo RA. Acute Occlusion of Brachial Artery Caused by Blunt Trauma in Football Player: Case Report and Review of the Literature. Curr Sports Med Rep 2017; 16:386-390. [PMID: 29135635 DOI: 10.1249/jsr.0000000000000415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- John Chan
- 1Bone and Joint Institute, Department of Orthopaedics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA; and 2Division of Vascular Surgery, Department of General Surgery, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA
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Frech A, Pellegrini L, Fraedrich G, Goebel G, Klocker J. Long-term Clinical Outcome and Functional Status After Arterial Reconstruction in Upper Extremity Injury. Eur J Vasc Endovasc Surg 2016; 52:119-23. [DOI: 10.1016/j.ejvs.2016.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
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Lannau B, Bliley J, James IB, Wang S, Sivak W, Kim K, Fowler J, Spiess AM. Long-term Patency of Primary Arterial Repair and the Modified Cold Intolerance Symptom Severity Questionnaire. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e551. [PMID: 26893976 PMCID: PMC4727703 DOI: 10.1097/gox.0000000000000522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of this study was to assess the long-term arterial patency of repaired arteries in the upper extremity and any morbidity resulting from the subsequent occlusion of these vessels. Concurrently, a new questionnaire, the modified Cold Intolerance Symptom Severity (mod CISS) questionnaire, was developed to allow for better assessment of cold intolerance. METHODS Thirteen patients who had undergone repair of the radial (4 patients), ulnar (6 patients), brachial (1 patient), digital (1), and an undefined lower arm artery (1) were examined using questionnaires, physical examination, and high-resolution ultrasound. RESULTS Outcome measures that were statistically significantly worse in the group of patients who presented with nerve injuries included cold intolerance symptoms, Disabilities of the Arm, Shoulder, and Hand score, Michigan Hand Questionnaire, and grip strength (middle setting on dynamometer). The results from the mod CISS correlated with high statistical significance with the results of the CISS score for the injured hand. Of note, wrist extension was significantly better with patent arteries. CONCLUSIONS Sixty-seven percent of arterial repairs remained patent at 6 years (mean) follow-up. The presence of nerve injury has a higher impact on the outcome metrics assessed in this study than arterial patency. Our modification of the CISS score enhances its utility as a survey of cold intolerance.
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Affiliation(s)
- Bernd Lannau
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Jacqueline Bliley
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Isaac B. James
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Sheri Wang
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Wesley Sivak
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Kang Kim
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - John Fowler
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
| | - Alexander M. Spiess
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Department of Plastic Surgery, UPMC, Pittsburgh, Pa.; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine and Heart and Vascular Institute, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pa.; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pa.; Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pa.; and Department of Plastic Surgery, UPMC Mercy Center for Nerve Disorder, Pittsburgh, Pa
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Chon SH, Yie K, Kang JG. Traumatic Subclavian Artery Dissection in Clavicle Fracture Due to Blunt Injury: Surgery or Stent in Long Segment Occlusion? JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.3.219] [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
Affiliation(s)
- Soon-Ho Chon
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, S. Korea
| | - Kilsoo Yie
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, S. Korea
| | - Jae Gul Kang
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, S. Korea
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Khan FH, Yousuf KM, Bagwani AR. Vascular injuries of the extremities are a major challenge in a third world country. J Trauma Manag Outcomes 2015; 9:5. [PMID: 26229550 PMCID: PMC4520131 DOI: 10.1186/s13032-015-0027-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Traumatic vascular injuries of the extremities are a major challenge especially in the third world countries. These injuries are mostly due to poor traffic laws, street crimes, firearms and blast associated injuries. We therefore would like to share our 10 years of experience in dealing with vascular injuries in Pakistan. METHODS This was a retrospective observational study conducted in the department of vascular surgery of Liaquat National Hospital, Karachi, Pakistan. Patients' records were retrieved from the department and were reviewed. Cases with vascular injuries of upper and lower limb that presented with signs of salvageable limb and presented within 12 hours of injury were included in the study. Patients with more than 12 hours of presentation and in whom primary amputation was done, were excluded from the study. RESULTS There were 328 patients who presented with vascular injuries of the extremities that fell in the inclusion criteria. Limb salvage rate was 41 %, whereas 30-days perioperative mortality was 5.48 %. The major cause of limb loss was delay in presentation of more than 8 h of injury. Major vessels involved were popliteal artery (41.76 %), followed by femoral artery (27.43 %). CONCLUSION Vascular injuries are becoming a major contributor of limb loss in third world countries due to violence, terrorism and unavailability of vascular facilities. This morbidity can be reduced by improving law and order situation, evolving an effective emergency ambulatory system and with better training and provision of vascular services in remote areas so that the delay factor can be reduced.
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Affiliation(s)
- Fahad H Khan
- General Surgery, Civil Hospital, Baba-e-Urdu Road, Karachi, 75200 Pakistan
| | - Kamal M Yousuf
- Vascular Surgery, Liaquat National Hospital, Stadium Road, Karachi, 74800 Pakistan
| | - Anel R Bagwani
- General Surgery, Liaquat National Hospital, Stadium Road, Karachi, 74800 Pakistan
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Muckart DJJ, Pillay B, Hardcastle TC, Skinner DL. Vascular injuries following blunt polytrauma. Eur J Trauma Emerg Surg 2014; 40:315-22. [DOI: 10.1007/s00068-014-0382-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
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Sinha S, Patterson BO, Ma J, Holt PJ, Thompson MM, Carrell T, Tai N, Loosemore TM. Systematic review and meta-analysis of open surgical and endovascular management of thoracic outlet vascular injuries. J Vasc Surg 2013; 57:547-567.e8. [DOI: 10.1016/j.jvs.2012.10.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/26/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
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A Five-Year Review of Management of Upper-Extremity Arterial Injuries at an Urban Level I Trauma Center. Ann Vasc Surg 2012; 26:655-64. [DOI: 10.1016/j.avsg.2011.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/07/2011] [Indexed: 11/24/2022]
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22
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Patterson BO, Holt PJ, Cleanthis M, Tai N, Carrell T, Loosemore TM. Imaging vascular trauma. Br J Surg 2011; 99:494-505. [DOI: 10.1002/bjs.7763] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2011] [Indexed: 01/06/2023]
Abstract
Abstract
Background
Over the past 50 years the management of vascular trauma has changed from mandatory surgical exploration to selective non-operative treatment, where possible. Accurate, non-invasive, diagnostic imaging techniques are the key to this strategy. The purpose of this review was to define optimal first-line imaging in patients with suspected vascular injury in different anatomical regions.
Methods
A systematic review was performed of literature relating to radiological diagnosis of vascular trauma over the past decade (2000–2010). Studies were included if the main focus was initial diagnosis of blunt or penetrating vascular injury and more than ten patients were included.
Results
Of 1511 titles identified, 58 articles were incorporated in the systematic review. Most described the use of computed tomography angiography (CTA). The application of duplex ultrasonography, magnetic resonance imaging/angiography and transoesophageal echocardiography was described, but significant drawbacks were highlighted for each. CTA displayed acceptable sensitivity and specificity for diagnosing vascular trauma in blunt and penetrating vascular injury within the neck and extremity, as well as for blunt aortic injury.
Conclusion
Based on the evidence available, CTA should be the first-line investigation for all patients with suspected vascular trauma and no indication for immediate operative intervention.
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Affiliation(s)
- B O Patterson
- St George's Vascular Institute, St George's University of London, London, UK
| | - P J Holt
- St George's Vascular Institute, St George's University of London, London, UK
| | - M Cleanthis
- Imperial College Regional Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - N Tai
- Trauma Clinical Academic Unit, Barts and the London NHS Trust, London, UK
| | - T Carrell
- National Institute for Health Research Comprehensive Biomedical Research Centre of Guy's and St Thomas' NHS Foundation Trust and Department of Vascular Surgery, King's College London, London, UK
| | - T M Loosemore
- St George's Vascular Institute, St George's University of London, London, UK
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Repair of Blunt Thoracic Outlet Arterial Injuries: An Evolution From Open to Endovascular Approach. ACTA ACUST UNITED AC 2011; 71:E114-21. [DOI: 10.1097/ta.0b013e31822cf359] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brachial vessel injuries: high morbidity and low mortality injuries. Eur J Trauma Emerg Surg 2011; 37:459. [PMID: 26815416 DOI: 10.1007/s00068-011-0143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Reports of arterial injuries from both the civilian and military arenas report the brachial artery as the most frequently injured vessel, accounting for approximately 25-33% of all peripheral arterial injuries. The brachial artery is surrounded by important peripheral nerves -the median, ulnar and radial, and also parallels the humerus and associated veins. Due to its close proximity to these structures, associated nerve and osseous injuries are frequent with residual neuropathy from such nerve injuries, often the main sources of permanent disability. MATERIALS AND METHODS Systematic review of the literature, with emphasis in the diagnosis, treatment and outcomes of these injuries, incorporating the authors experience. CONCLUSIONS The morbidity and mortality rates associated with brachial artery injuries depend on the cause of the injury itself, which vein or tendon is injured, and whether musculoskeletal and nerve injuries are also present. During the last 20 years, amputation associated with upper extremity arterial injuries has decreased to a rate of 3% because of advances in the treatment of shock, the use of antibiotic therapy, and increased surgical experience.
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Shalhub S, Starnes BW, Tran NT. Endovascular treatment of axillosubclavian arterial transection in patients with blunt traumatic injury. J Vasc Surg 2011; 53:1141-4. [PMID: 21276694 DOI: 10.1016/j.jvs.2010.10.129] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/29/2010] [Accepted: 10/30/2010] [Indexed: 11/28/2022]
Abstract
Axillosubclavian arterial transection due to blunt traumatic injury poses a treatment challenge in the multiply injured patient. Endovascular repair can be technically successful if the injury is focal. We describe an endovascular technique utilizing combined brachial and femoral access to create a through-and-through brachial-femoral wire and repair the arterial injury with a covered stent.
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Affiliation(s)
- Sherene Shalhub
- University of Washington, Harborview Medical Center, Department of Surgery, Division of Vascular Surgery, 325 9th Ave, Box 359796, Seattle, WA 98104, USA
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