Management of traumatic peripheral artery pseudoaneurysm: A 10-year experience at a single center

Carbon dioxide angiography during angioembolization for trauma patients increases the detection of active bleeding and leads to reliable hemostasis: a retrospective, observational study

BACKGROUND

Angiography with carbon dioxide (CO2) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO2 angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO2 angiography in angioembolization (AE) for trauma patients.

METHODS

This was a single-center, retrospective, observational study of trauma patients who underwent AE at our facility between January 2012 and April 2023.

RESULTS

Within this period, 335 AEs were performed. CO2 angiography was performed in 102 patients (30.4%), and in 113 procedures. CO2angiography was used to provoke active bleeding which went undetected using ICM in 83 procedures, and to confirm hemostasis after embolization in 30 procedures. Of the 80 procedures wherein, active bleeding was not detected on ICM, 35 procedures (43.8%) were detected using CO2. The spleen had the highest detection rate of active bleeding by CO2 angiography among the organs. There were 4/102 (1.9%) patients with CO2 contrast who underwent some form of reintervention. Two patients were re-embolized with n-butyl-2-cyanoacrylate because of recanalization after embolization with gelatin sponge. The other two patients had pseudoaneurysm formation which required reintervention, and CO2 angiography was not used. Vomiting was the most common complication of CO2 angiography in 10 patients (9.8%), whereas all were transient and did not require treatment.

CONCLUSIONS

CO2 angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.

The Third Hand of Neurosurgeons - a novel intraoperative malleable adjustable continuous suction tube

Objective

We designed a novel intraoperative malleable adjustable continuous suction tube to obtain clear surgical fields, reduce intracranial pressure, and lower the temperature of the surgical area.

Methods

This device consists of six parts: continuous suction tube head and cotton patty, suction tube, fixed wire position, fixed clip, spiral plastic pressure regulating valve, and tail. It can continuously extract blood, cerebrospinal fluid, and rinsing solution from surgical fields, with minimal contact and trauma to tissues, nerves, and blood vessels, while also having a negligible impact on the surgeon's focus and procedure.

Result

The excellent and safe performance (simple, malleable, adjustable, space-saving, inexpensive, safe, and effective) of this device in clearing the operating field has been proven in more than 2000 neurosurgical operative procedures. We encountered no complications associated with this device, such as cerebral hematoma, postoperative low intracranial pressure, or vascular and nerve injuries.

Conclusion

The newly innovated intraoperative malleable adjustable continuous suction tube is effective and safe for microneurosurgery.