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Góes AMDO, Parreira JG, Kleinsorge GHD, Dalio MB, Alves PHF, Gomes FJSDDV, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian guidelines on diagnosis and management of traumatic vascular injuries. J Vasc Bras 2023; 22:e20230042. [PMID: 38021277 PMCID: PMC10647898 DOI: 10.1590/1677-5449.202300422] [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: 03/15/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Centro Universitário do Pará - CESUPA, Faculdade de Medicina, Belém, PA, Brasil.
- Universidade Federal do Pará - UFPA, Faculdade de Medicina, Belém, PA, Brasil.
| | - José Gustavo Parreira
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Gustavo Henrique Dumont Kleinsorge
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Fundação Hospitalar do Estado de Minas Gerais - FHEMIG, Clínica de Cirurgia Vascular, Hospital João XXIII, Belo Horizonte, MG, Brasil.
| | - Marcelo Bellini Dalio
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Pedro Henrique Ferreira Alves
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, III Clínica Cirúrgica, São Paulo, SP, Brasil.
| | - Francisco João Sahagoff de Deus Vieira Gomes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade do Estado do Rio de Janeiro - UERJ, Faculdade de Ciências Médicas, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
- Polícia Militar do Estado do Rio de Janeiro - PMERJ, Rio de Janeiro, RJ, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Paraná - UFPR, Hospital das Clínicas, Divisão de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
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Hazra D, Kota AA, Raj SP, Premkumar P, Selvaraj AD, Agarwal S, Thomas BP. Does endovascular repair of post-traumatic thoracic vascular injury of the subclavian/axillary arteries followed by brachial plexus injury improve outcome? Indian J Thorac Cardiovasc Surg 2021; 38:294-299. [PMID: 35528997 PMCID: PMC9023618 DOI: 10.1007/s12055-021-01278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022] Open
Abstract
Traumatic injuries to the axillary artery or subclavian artery along with a brachial plexus injury are infrequent. Although the traditional management has been conservative because of robust collaterals, the functional improvement of the limb depends on the degree of brachial plexus injury and on the revascularization status. We report three cases of endovascular repair post-traumatic axillo-subclavian artery injuries followed by brachial plexus injury with good functional outcomes. Endovascular repair of post-traumatic subclavian and axillary artery injuries followed by brachial plexus injury is safe and feasible, and improves limb outcomes.
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Affiliation(s)
- Darpanarayan Hazra
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Albert Abhinay Kota
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sam Pon Raj
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Prabhu Premkumar
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Andrew Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Binu Prathap Thomas
- Department of Hand and Leprosy Reconstructive Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
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Asmar S, Bible L, Obaid O, Tang A, Khurrum M, Castanon L, Ditillo M, Joseph B. Open vs Endovascular Treatment of Traumatic Peripheral Arterial Injury: Propensity Matched Analysis. J Am Coll Surg 2021; 233:131-138.e4. [PMID: 33771677 DOI: 10.1016/j.jamcollsurg.2021.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arterial injuries occur in the setting of blunt and penetrating trauma. Despite increasing use, there remains a paucity of data comparing long-term outcomes of endovascular vs open repair management of these injuries. The aim of our study was to compare outcomes and readmission rates of open vs endovascular repair of traumatic arterial injuries. STUDY DESIGN The National Readmission Database (2011-2014) was queried for all adult (age ≥ 18 y) patients presenting with peripheral arterial (axillary, brachial, femoral, and popliteal) injuries. Patients were stratified into 2 groups based on intervention: open vs endovascular approach. Propensity score matching (1:2 ratio) was performed. Outcomes measures were complications, length of stay (LOS), 30-day readmission, and cost of readmission. RESULTS A matched cohort of 786 patients was obtained (endovascular: 262, open: 524). Mean age was 45 ± 17 years, and 79% were males. Median LOS was 4 (range 2-6) days for the endovascular group vs 3 (range 2-5) days for the open group (p < 0.01). The endovascular group had higher rates of seroma (4% vs 2%; p = 0.04) and arterial thrombosis (13% vs 7%; p < 0.01) during index hospitalization. Patients who underwent endovascular repair had higher 30-day readmission (11% vs 7%; p = 0.03) and a higher 30-day open-reoperation rate (6% vs 2%; p < 0.01). On subanalysis of the patients who were readmitted, the median cost of each readmission was higher in the endovascular group $47,000 ($27,202-$56,763) compared with $21,000 ($11,889-$43,503) in the open group. CONCLUSIONS Endovascular repair for peripheral arterial injuries was associated with higher rates of in-hospital complications, readmissions, and costs. As this new technology continues to undergo refinement, a thorough re-evaluation of its indications, risks, and benefits is warranted.
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Affiliation(s)
- Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Omar Obaid
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
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Glaser JD, Kalapatapu VR. Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature. Vasc Endovascular Surg 2019; 53:477-487. [DOI: 10.1177/1538574419844073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To review the current use of endovascular techniques in trauma. Summary Background Data: Multiple studies have demonstrated that, despite current guidelines, endovascular therapies are used in instances of arterial trauma. Methods: The existing literature concerning arterial trauma was reviewed. Studies reviewed included case reports, single-center case series, large database studies, official industry publications and instructions for use, and society guidelines. Results: Endovascular therapies are used in arterial trauma in all systems. The use of thoracic endografts in blunt thoracic aortic trauma is accepted and endorsed by society guidelines. The use of endovascular therapies in other anatomic locations is largely limited to single-center studies. Advantages potentially include less morbidity due to smaller incisions as well as shorter operating room times. Many report using endovascular therapies even with hard signs of injury. Long-term results are limited by a lack of long-term follow-up but, in general, suggest that these techniques produce acceptable outcomes. The adoption of these techniques may be limited by resource and surgeon availability. Conclusions: The use of endovascular therapies in trauma has gained acceptance despite not yet having a place in official guidelines.
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Affiliation(s)
- Julia D. Glaser
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Venkat R. Kalapatapu
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
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Gilbert F, Schneemann C, Scholz CJ, Kickuth R, Meffert RH, Wildenauer R, Lorenz U, Kellersmann R, Busch A. Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma. BMC Musculoskelet Disord 2018; 19:404. [PMID: 30458745 PMCID: PMC6247697 DOI: 10.1186/s12891-018-2333-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. METHODS This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. RESULTS Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. CONCLUSION Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.
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Affiliation(s)
- F. Gilbert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
- Department of Trauma Hand Plastic and Reconstructive Surgery, University Munich Germany, Julius-Maximilians-University of Würzburg Oberdürrbacherstr, 6 D-, 97080 Würzburg, Germany
| | - C. Schneemann
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - C. J. Scholz
- Core Unit Systems Medicine IZKF, University Hospital Würzburg, Würzburg, Germany
| | - R. Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - R. H. Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
| | - R. Wildenauer
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - U. Lorenz
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - R. Kellersmann
- Department of Vascular Surgery, Klinikum Fulda, Fulda, Germany
| | - A. Busch
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Hull JE, Jennings WC, Cooper RI, Waheed U, Schaefer ME, Narayan R. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access. J Vasc Interv Radiol 2018; 29:149-158.e5. [DOI: 10.1016/j.jvir.2017.10.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022] Open
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Ganapathy A, Khouqeer AF, Todd SR, Mills JL, Gilani R. Endovascular management for peripheral arterial trauma: The new norm? Injury 2017; 48:1025-1030. [PMID: 28193445 DOI: 10.1016/j.injury.2017.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endovascular therapy is well studied in atraumatic conditions; and there appears to be a growing interest in its application to traumatic injuries. The objective of this study is to compare open and endovascular techniques in the management of peripheral arterial trauma. METHODS This is a retrospective review of patients admitted to a Level I Trauma Center sustaining injuries to the subclavian, axillary, superficial femoral, and popliteal arteries. Demographics, surgical interventions, complications, and clinical outcomes were evaluated in patients requiring open or endovascular repair between 2009 and 2015. RESULTS Sixty-eight patients with 70 total arterial injuries were identified. There were 10 subclavian, 14 axillary, 15 superficial femoral, and 31 popliteal artery injuries. Endovascular (n=20) compared to open repairs (n=50) were more commonly performed: by vascular surgeons (90% vs. 54%, p=0.01); in older patients (median age: 38 years vs. 25, p=0.01); primarily involving upper extremity injuries (60% vs. 24%, p=0.01). Furthermore, endovascular repairs less commonly required fasciotomy (15% vs. 46%, p=0.03) and trended towards lower transfusion requirements (50% vs. 77%, p=0.06). Patients undergoing open repair had lower pre-hospital systolic blood pressures (110 vs. 120, p=0.03) and lower initial hematocrit (31.5 vs. 36.2, p=0.02). However, outcomes between groups were trending higher in the endovascular group with respect to limb salvage rates at discharge (94% vs. 89%), median length of stay (14days vs. 9), and median follow-up (288days vs. 92) compared to the open group, but the data were not statistically significant. There was increasing utilization of endovascular repair over time (7% of total procedures in 2009; 50% in 2014). CONCLUSIONS Overall, endovascular and open techniques were not statistically different in early outcomes. Endovascular therapy appears to provide some advantage when it comes to: challenging anatomy, decreasing blood product utilization, and minimizing physiologic derangement. However, patients with injuries resulting in free hemorrhage or significant external blood loss may still be best served with open repair. Despite this, given the increasing use of endovascular techniques, close collaboration is needed between trauma and endovascular specialists to properly select the optimal management for patients with peripheral arterial trauma.
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Affiliation(s)
- Anand Ganapathy
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Ahmed F Khouqeer
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - S Robb Todd
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Joseph L Mills
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Ramyar Gilani
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Diaz-Gutierrez I, Rana MA, Ali B, Marek JM, Langsfeld M. Hybrid Repair of Complex Left Subclavian Artery Injury with Partial Transection and Complete Thrombosis in an Unstable Patient following Blunt Trauma. Ann Vasc Surg 2016; 40:298.e11-298.e14. [PMID: 27903481 DOI: 10.1016/j.avsg.2016.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
Abstract
Blunt subclavian artery injuries are rare and are associated with high morbidity and mortality. Several case reports have suggested that endovascular repair is safe with short operative times and minimal blood loss. We report a case of a 20-year-old male patient involved in a high-speed motor vehicle collision that resulted in partial transection of left subclavian artery with complete luminal thrombosis. Patient also had a left main-stem bronchus avulsion along with major intra-abdominal injuries and multiple spine and long bone fractures. He underwent emergent abdominal exploration due to multisystem trauma and hemodynamic instability. Following laparotomy and resuscitation, the subclavian artery injury was repaired using a hybrid technique geared at protecting the patent vertebral and axillary arteries from embolization. We used supraclavicular dissection and arterial control with endovascular stent-graft placement in retrograde fashion to repair the left subclavian artery injury. At 6-month follow-up, computed tomography scan confirmed patency of the left subclavian artery stent and there was no evidence of vertebrobasilar insufficiency or left upper extremity ischemia. In conclusion, stent-graft repair of blunt subclavian artery injuries is expedient and safe. Supraclavicular vascular dissection and control are effective in preventing distal embolization in rare cases complicated with luminal thrombosis.
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Affiliation(s)
- Ilitch Diaz-Gutierrez
- Department of Surgery, Division of Vascular Surgery, University of New Mexico, Albuquerque, NM
| | - Muhammad A Rana
- Department of Surgery, Division of Vascular Surgery, University of New Mexico, Albuquerque, NM.
| | - Barkat Ali
- Department of Surgery, Division of Vascular Surgery, University of New Mexico, Albuquerque, NM
| | - John M Marek
- Department of Surgery, Division of Vascular Surgery, University of New Mexico, Albuquerque, NM
| | - Mark Langsfeld
- Department of Surgery, Division of Vascular Surgery, University of New Mexico, Albuquerque, NM
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Matsagkas M, Kouvelos G, Peroulis M, Xanthopoulos D, Bouris V, Arnaoutoglou E. Endovascular repair of blunt axillo-subclavian arterial injuries as the first line treatment. Injury 2016; 47:1051-6. [PMID: 26905594 DOI: 10.1016/j.injury.2016.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/25/2016] [Accepted: 02/05/2016] [Indexed: 02/02/2023]
Abstract
AIM To report and analyse our results regarding the endovascular management of blunt axillo-subclavian arterial injuries as the first line treatment. METHODS During an eight-year period, seven patients (mean age 56.4±14.1 years, all males) with blunt traumatic axillo-subclavian arterial injuries were presented to the emergency department. All patients suffered also from concomitant other injuries and had a supraclavicular haematoma along with diminished or absent upper limb peripheral pulses, while computed tomography angiography set the diagnosis. RESULTS The endovascular procedure was technically successful in all patients. No procedure-related complication was encountered during the in-hospital stay, while none of the patients died. The median hospital stay was 22 days (range 12-46). During a follow-up period spanning an average of 27 months (range 6-44 months) there was one stent-graft thrombosis at 12 months in an otherwise asymptomatic patient that required no further intervention. CONCLUSION Endovascular technique seems to constitute a reliable approach for treating blunt axillo-subclavian arterial injuries in the emergent setting. Despite uncertainties in patient selection and optimal management algorithms, it seems that endovascular approach could be the first line treatment for such injuries. Accumulation of data on larger number of patients with longer follow-up is warranted to further define the value of this therapeutic modality in the trauma setting.
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Affiliation(s)
- Miltiadis Matsagkas
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - George Kouvelos
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Michalis Peroulis
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Xanthopoulos
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasilios Bouris
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, School of Medicine, University of Ioannina, Ioannina, Greece
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Endovascular management of traumatic peripheral arterial injuries. J Surg Res 2015; 199:557-63. [DOI: 10.1016/j.jss.2015.04.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/24/2015] [Accepted: 04/30/2015] [Indexed: 11/13/2022]
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