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Warner D, Holmes KW, Afifi R, Russo ML, Shalhub S. Emergency vascular surgical care in populations with unique physiologic characteristics: Pediatric, pregnant, and frail populations. Semin Vasc Surg 2023; 36:340-354. [PMID: 37330246 DOI: 10.1053/j.semvascsurg.2023.04.015] [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: 03/08/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
Vascular surgical emergencies are common in vascular surgical care and require complex decision making and multidisciplinary care. They are especially challenging when they occur in patients with unique physiological characteristics, such as pediatric, pregnant, and frail patients. Among the pediatric and pregnant population, vascular emergencies are rare. This rarity challenges accurate and timely diagnosis of the vascular emergency. This landscape review summarizes these three unique populations' epidemiology and emergency vascular considerations. Understanding the epidemiology is the foundation for accurate diagnosis and subsequent management. Considering each population's unique characteristics is crucial to the emergent vascular surgical interventions decision making. Collaborative and multidisciplinary care is vital in gaining expertise in managing these special populations and achieving optimal patient outcomes.
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Affiliation(s)
- David Warner
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239
| | - Kathryn W Holmes
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Melissa L Russo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239.
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Sharma V, Dahiya R, Ansar MJ, Kumar R, Chintamani C. Acute Upper Limb Ischemia and Amputation Post Antecubital Fossa Cannulation: A Report of Two Postpartum Patients. Cureus 2023; 15:e37575. [PMID: 37193482 PMCID: PMC10183221 DOI: 10.7759/cureus.37575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
Upper extremity arterial thrombosis is less common than that in the lower extremity. Upper extremity arterial thrombosis, when present, is more likely to occur on the ulnar side of the circulation. Severe ischemia resulting from radial artery thrombosis is rare, but iatrogenic cannulation is the most common etiology when it occurs. The risk factors underlying this dreadful presentation are numerous and still under investigation. Pregnancy and the immediate postpartum period are physiological hypercoagulable states. Here we present unusual cases of acute limb ischemia post iatrogenic cannulation in two patients within six weeks postpartum. At four weeks postpartum, a 26-year-old para-1 live-1 female presented to the emergency department with swelling in her right upper limb for four weeks and its blackish discoloration for one week. A 24-year-old primigravida female who had a termination of a blighted ovum 12 days ago presented to the emergency department with gangrenous changes in her right hand and forearm. Both patients reported recent antecubital fossa cannulation within six weeks postpartum, triggering gangrenous hand changes. Both patients had to undergo amputation of the digits and hand ultimately. Thus we postulate the need for extra care and education of healthcare workers in the cannulation of pregnant and post-pregnancy patients to prevent limb-threatening complications.
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Affiliation(s)
- Vagisha Sharma
- Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Rockey Dahiya
- Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Mohd Junaid Ansar
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Rishikesh Kumar
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Chintamani Chintamani
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
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Govsyeyev N, Malgor RD, Hoffman C, Harroun N, Sturman E, Al-Musawi M, Malgor EA, Jacobs DL, Nehler M. A systematic review and meta-analysis of outcomes after acute limb ischemia in patients with cancer. J Vasc Surg 2021; 74:1033-1040.e1. [PMID: 33905869 DOI: 10.1016/j.jvs.2021.03.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer results in a hypercoagulable state that is associated with both venous and arterial thromboses. However, little is known about the effects of acute limb ischemia (ALI) in this cohort of patients. In the present systematic review and meta-analysis, we analyzed the available clinical data on cancer and its association with ALI and evaluated the outcomes in these patients after a diagnosis of ALI. METHODS Three databases, including PubMed, EMBASE, and the Cochrane Library, were queried. Studies that met the inclusion criteria were included regardless of the publication year, language, sample size, or follow-up length. All the steps of the meta-analysis were conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) and MOOSE (meta-analysis of observational studies in epidemiology) guidelines. RESULTS Seven studies from 6222 references with a total of 2899 patients were included. Of the 2899 patients, 1195 (41%) had had a diagnosis of ALI before their cancer diagnosis, and 1704 (59%) had presented with ALI after a cancer diagnosis. Nearly three quarters of ALI events were among patients with cancer of the skin and soft tissue (19%), genitourinary (18%), lung (17%), and gastrointestinal (16%) systems. ALI recurrence was similar between the two groups, and major amputation was more likely in patients with a diagnosis of ALI after a cancer diagnosis (7.4% vs 4.6%; P < .01). The incidence of mortality at 1 year was significantly greater for patients with established cancer who had presented with ALI compared with the patients who had presented with ALI before a cancer diagnosis (50.6% vs 29.9%; P < .01). After adjusting for study variability using the random effects model, the mortality at 1 year for all patients was 52.3% (95% confidence interval, 37.7%-66.5%). No significant heterogeneity (P = .73) was found between the two groups of patients, which varied by the timing of the ALI diagnosis in relation to the cancer diagnosis. CONCLUSIONS The 1-year mortality after the development of ALI in patients with cancer was >50%. For patients presenting with ALI of unclear etiology, the presence of an underlying cancer should be considered.
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Affiliation(s)
- Nicholas Govsyeyev
- Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; CPC Clinical Research, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Rafael D Malgor
- Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo.
| | - Clayton Hoffman
- Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Nikolai Harroun
- Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Erin Sturman
- Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Mohammed Al-Musawi
- Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Emily A Malgor
- Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Donald L Jacobs
- Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Mark Nehler
- Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; CPC Clinical Research, University of Colorado, Anschutz Medical Center, Aurora, Colo; Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo
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