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Melo-Guzmán G, Burgos-Sosa E, Granados-Hernández AC, Taveras R, Sanchez-García L, Espinosa-Lira F. A Case Series of Late Vascular Lesions of Traumatic Etiology: Endovascular and Surgical Approaches. Cureus 2023; 15:e39457. [PMID: 37362495 PMCID: PMC10290207 DOI: 10.7759/cureus.39457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
There is a broad spectrum of pathology in traumatic vascular injury. Arteriovenous fistula (AVF) is an abnormal communication between the high-flow arterial system and the low-flow venous network, directly connecting the afferent artery and nearby draining veins without the regular intervention of the capillary bed. Most of these fistulas occur due to incidental or iatrogenic injury. A retrospective review of procedures performed by an endovascular surgeon in a tertiary center identified 15 cases of vascular injuries that encompassed all these different clinical scenarios, including post-traumatic, iatrogenic, or spontaneous origin. The information collected, including patient age, sex, previous symptoms, and treatment, was gathered from medical records. In addition, information on procedural technique, endovascular devices used, and specific intraprocedural details were collected from procedure notes and angiographic images. A broad spectrum of injuries can present as late trauma complications (over three months); endovascular treatment is a safe and effective approach for intracranial and extracranial injuries. Endovascular treatment can be a sole option or adjuvant to other hybrid therapies and has emerged as essential for treating these lesions as a first option. We have described standard techniques to treat different vascular pathologies, sometimes with limited resources.
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Affiliation(s)
| | - Erik Burgos-Sosa
- Neurology Endovascular Therapy, Hospital Juárez de México, Mexico City, MEX
| | | | - Rossy Taveras
- Neurology Endovascular Therapy, Hospital Juárez de México, Mexico City, MEX
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2
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Lauzier D, Chatterjee A, Kansagra A. Neurointerventional management of cerebrovascular trauma. UKRAINIAN INTERVENTIONAL NEURORADIOLOGY AND SURGERY 2022. [DOI: 10.26683/2786-4855-2022-2(40)-41-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Traumatic cerebrovascular injuries following blunt or penetrating trauma are common and carry a high risk of permanent disability or death. Proper screening, diagnosis, and treatment of these lesions is essential to improve patient outcomes. Advances in imaging continue to improve the accuracy of non-invasive diagnosis of these injuries while new clinical data provide better evidence for optimal management, whether medical or invasive. Here, we review screening, diagnosis, and treatment of traumatic cerebrovascular injuries.
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Lauzier DC, Chatterjee AR, Kansagra AP. Neurointerventional management of cerebrovascular trauma. J Neurointerv Surg 2021; 14:718-722. [PMID: 34949708 DOI: 10.1136/neurintsurg-2021-017923] [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: 10/19/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Abstract
Traumatic cerebrovascular injuries following blunt or penetrating trauma are common and carry a high risk of permanent disability or death. Proper screening, diagnosis, and treatment of these lesions is essential to improve patient outcomes. Advances in imaging continue to improve the accuracy of non-invasive diagnosis of these injuries while new clinical data provide better evidence for optimal management, whether medical or invasive. Here, we review screening, diagnosis, and treatment of traumatic cerebrovascular injuries.
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Affiliation(s)
- David C Lauzier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Arindam R Chatterjee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.,Department of Neurological Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA .,Department of Neurological Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
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Lolli V, Pezzullo M, Delpierre I, Sadeghi N. MDCT imaging of traumatic brain injury. Br J Radiol 2016; 89:20150849. [PMID: 26607650 PMCID: PMC4985461 DOI: 10.1259/bjr.20150849] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 01/24/2023] Open
Abstract
The aim of emergency imaging is to detect treatable lesions before secondary neurological damage occurs. CT plays a primary role in the acute setting of head trauma, allowing accurate detection of lesions requiring immediate neurosurgical treatment. CT is also accurate in detecting secondary injuries and is therefore essential in follow-up. This review discusses the main characteristics of primary and secondary brain injuries.
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Affiliation(s)
- Valentina Lolli
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Martina Pezzullo
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
| | | | - Niloufar Sadeghi
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
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5
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Abstract
Imaging is an indispensable part of the initial assessment and subsequent management of patients with head trauma. Initially, it is important for diagnosing the extent of injury and the prompt recognition of treatable injuries to reduce mortality. Subsequently, imaging is useful in following the sequelae of trauma. In this chapter, we review indications for neuroimaging and typical computed tomography (CT) and magnetic resonance imaging (MRI) protocols used in the evaluation of a patient with head trauma. We review the role of CT), the imaging modality of choice in the acute setting, and the role of MRI in the evaluation of patients with head trauma. We describe an organized and consistent approach to the interpretation of imaging of these patients. Important topics in head trauma, including fundamental concepts related to skull fractures, intracranial hemorrhage, parenchymal injury, penetrating trauma, cerebrovascular injuries, and secondary effects of trauma, are reviewed. The chapter concludes with advanced neuroimaging techniques for the evaluation of traumatic brain injury, including use of diffusion tensor imaging (DTI), functional MRI (fMRI), and MR spectroscopy (MRS), techniques which are still under development.
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Affiliation(s)
- Sandra Rincon
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Rajiv Gupta
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Division of Neuroradiology and Cardiac Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Ptak
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Division of Emergency Radiology, Massachusetts General Hospital, Boston, MA, USA
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6
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Edaigbini SA, Delia IZ, Aminu MB, Bosan IB, Ibrahim A, Anumenechi N. Vascular surgeries in West Africa: challenges and prospects. Asian Cardiovasc Thorac Ann 2014; 23:552-7. [PMID: 25429087 DOI: 10.1177/0218492314561646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The field of vascular surgery is evolving in sub-Saharan Africa but the practice is bedeviled by lack of expertise and infrastructure challenges. The consequences are a low volume of operations and a dearth of data. Available data are not representative of the wider picture, therefore, this study was undertaken to evaluate the practice of vascular surgery in a tertiary institution, in the light of the prevailing challenges. METHODS Data from all patients with vascular-related pathologies managed in our surgical outpatient clinic and accident and emergency wards were obtained from the clinic and in-patient records from January 2008 to December 2012. Age, sex, diagnosis, treatment, and complications were noted. There were 73 patients comprising 45 (61.6%) males and 28 (38.4%) females. The age range was 1-90 years (mean 43.5 years). RESULTS The pathologies managed included end-stage renal disease (n = 36, 49.3%), nontraumatic and posttraumatic aneurysms (n = 13, 17.8%), vascular trauma (n = 12, 16.4%), peripheral vascular disease (n = 5, 6.9%), congenital vascular malformations (n = 4, 5.5%), and thrombotic diseases (n = 3, 4.1%). Fifty-four (74.0%) surgeries were performed, with a complication rate of 5.5% and 2.7% mortality. CONCLUSIONS The practice of vascular surgery in Zaria, Nigeria, is fraught with challenges. The gap created by the dearth of skilled vascular surgeons is filled by competent cardiothoracic surgeons. Infrastructure decay and lack of prostheses limit the number and variety of operable cases. These challenges result in preventable morbidity and mortality.
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Affiliation(s)
- Sunday A Edaigbini
- Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Ibrahim Z Delia
- Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Muhammad B Aminu
- Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Istifanus B Bosan
- Division of Nephrology, Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Abdulrasheed Ibrahim
- Division of Plastic and Reconstructive Surgery, Ahmadu Bello University, Zaria, Nigeria
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7
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Vessel injuries of the head and neck presenting in mandibular fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:267-70. [DOI: 10.1016/j.oooo.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/28/2014] [Accepted: 04/20/2014] [Indexed: 11/19/2022]
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8
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Kim SJ, Park IS. Urgent intracranial carotid artery decompression after penetrating head injury. J Korean Neurosurg Soc 2013; 53:180-2. [PMID: 23634269 PMCID: PMC3638272 DOI: 10.3340/jkns.2013.53.3.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/15/2012] [Accepted: 02/25/2013] [Indexed: 12/01/2022] Open
Abstract
We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient.
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Affiliation(s)
- Seong Joon Kim
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
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Kansagra AP, Cooke DL, English JD, Sincic RM, Amans MR, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Current trends in endovascular management of traumatic cerebrovascular injury. J Neurointerv Surg 2013; 6:47-50. [PMID: 23322749 DOI: 10.1136/neurintsurg-2012-010605] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of catheter angiography in the diagnosis and management of traumatic cerebrovascular injury has evolved rapidly with advances in CT and MR angiography and continued development of endovascular techniques. OBJECTIVE To identify the modern spectrum of traumatic arterial injury encountered during catheter neuroangiography and to examine current patterns of endovascular treatment. METHODS Records of trauma patients undergoing catheter neuroangiography over a 4 year period at two high volume centers were retrospectively reviewed. The sample comprised 100 separate arterial lesions that were classified according to mechanism, location, acuity, and endovascular treatment. Follow-up imaging and clinical notes were reviewed to identify procedural complications. RESULTS Of 100 arterial lesions, 81% were related to blunt trauma. Distribution of lesions by location was 42% intracranial, 39% cervical, and 19% extracranial. The most common injuries were pseudoaneurysm (38%), fistula (29%), and dissection (19%). In total, 41% of lesions underwent endovascular treatment, with trends favoring treatment of non-acute, penetrating, non-cervical, and high grade lesions. Therapy involved coil embolization for 89% of treated lesions. There were a total of two immediate neurovascular complications and one delayed neurovascular complication; one of these resulted in a permanent neurological deficit. CONCLUSIONS Our experience in a large cohort of patients suggests that a relatively high proportion of traumatic arterial lesions identified by catheter angiography are treated by endovascular means, with a low rate of immediate and delayed neurovascular complications.
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Affiliation(s)
- Akash P Kansagra
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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10
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Poster 102: Incidence of Major Blood Vessel Injuries Presenting in Mandibular Fractures. J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.joms.2012.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Van Waes OJ, Cheriex KCAL, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg 2012; 99 Suppl 1:149-54. [PMID: 22441870 DOI: 10.1002/bjs.7733] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI. METHODS Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations. RESULTS Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected. CONCLUSION FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.
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Affiliation(s)
- O J Van Waes
- Departments of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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12
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Herrera DA, Vargas SA, Dublin AB. Endovascular treatment of penetrating traumatic injuries of the extracranial carotid artery. J Vasc Interv Radiol 2010; 22:28-33. [PMID: 21109458 DOI: 10.1016/j.jvir.2010.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/29/2010] [Accepted: 09/15/2010] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. MATERIALS AND METHODS The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). RESULTS Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. CONCLUSIONS In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases.
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Affiliation(s)
- Diego A Herrera
- Department of Radiology, Neuroradiology Section, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, and CediMed, Medellin, Colombia.
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13
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Hjortoe S, Wagner A, Cortsen M. Endovascular embolization of intracranial iatrogenic pseudoaneurysms. A report of two cases and review of the literature. Neuroradiol J 2010; 23:479-83. [PMID: 24148643 DOI: 10.1177/197140091002300420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/27/2010] [Indexed: 11/17/2022] Open
Abstract
Iatrogenic pseudoaneurysm is a rare but severe complication of intracranial surgery. Treatment of the condition is difficult. The purpose of this report is to draw attention to the fact that endovascular embolization of pseudoaneurysms with parent artery preservation is possible. We describe two cases of endovascular embolization and review the literature. The conclusion is that endovascular treatment can be safe and curative.
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Affiliation(s)
- S Hjortoe
- Neuroradiology Department, Rigshospitalet; Copenhagen, Denmark -
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14
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Gaitini D, Beck-Razi N, Engel A, Dogra VS. Sonographic Evaluation of Vascular Injuries. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.cult.2007.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gaitini D, Razi NB, Ghersin E, Ofer A, Soudack M. Sonographic evaluation of vascular injuries. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:95-107. [PMID: 18096735 DOI: 10.7863/jum.2008.27.1.95] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this presentation is to highlight the color Doppler duplex sonographic features of procedure-related and blunt or penetrating trauma-related vascular injuries. METHODS Different kinds of vascular complications such as pseudoaneurysms, arteriovenous fistulas, dissection, and thrombosis are discussed. Cases of vascular injuries in the extremities, neck, and abdomen are presented to illustrate the spectrum of sonographic appearances. RESULTS Color Doppler duplex sonography is valuable in the diagnosis and monitoring of most vessel injuries and in the treatment of pseudoaneurysms. It is useful for flow analysis and for follow-up after treatment. However, because of limitations inherent to sonography, such as bones, air, casts, skin burns, and relatively slow performance of the test, magnetic resonance imaging, computed tomography, and angiography are necessary for further evaluation in selected cases. CONCLUSIONS Color Doppler duplex sonography is a widely available, noninvasive, and accurate technique for evaluating vascular injuries and should be the first-line imaging modality in most patients.
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Affiliation(s)
- Diana Gaitini
- Unit of Ultrasound, Department of Medical Imaging, Rambam Medical Center, Ha'aliya 8, 31096, Haifa, Israel.
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Ray CE, Spalding SC, Cothren CC, Wang WS, Moore EE, Johnson SP. State of the art: noninvasive imaging and management of neurovascular trauma. World J Emerg Surg 2007; 2:1. [PMID: 17212833 PMCID: PMC1796545 DOI: 10.1186/1749-7922-2-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 01/09/2007] [Indexed: 11/10/2022] Open
Abstract
Neurotrauma represents a significant public health problem, accounting for a significant proportion of the morbidity and mortality associated with all traumatic injuries. Both blunt and penetrating injuries to cervicocerebral vessels are significant and are likely more common than previously recognized. Imaging of such injuries is an important component in the evaluation of individuals presenting with such potential injuries, made all the more important since many of the vascular injuries are clinically silent. Management of injuries, particularly those caused by blunt trauma, is constantly evolving. This article addresses the current state of imaging and treatment of such injuries.
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Affiliation(s)
- Charles E Ray
- Diagnostic and Interventional Radiology, Denver Health Medical Center, 777 Bannock St, Denver, CO80204, USA
- Diagnostic and Interventional Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - Shaun C Spalding
- Diagnostic and Interventional Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - C Clay Cothren
- Surgery, Denver Health Medical Center, 777 Bannock St., Denver, CO80204, USA
- Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - Wei-Shin Wang
- University of Colorado School of Medicine, 4200 East Ninth Street, Denver, CO80220, USA
| | - Ernest E Moore
- Surgery, Denver Health Medical Center, 777 Bannock St., Denver, CO80204, USA
- Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
| | - Stephen P Johnson
- Diagnostic and Interventional Radiology, University of Colorado Health Sciences Center, 4200 East Ninth Street, Denver, CO80220, USA
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Nuñez DB, Berkmen T. Imaging of blunt cerebrovascular injuries. Eur J Radiol 2006; 59:317-26. [PMID: 16787729 DOI: 10.1016/j.ejrad.2006.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 04/14/2006] [Accepted: 04/14/2006] [Indexed: 10/24/2022]
Abstract
Arterial dissection, pseudoaneurysm, arteriovenous fistula, arterial laceration and occlusion are uncommon complications of blunt trauma. Angiography has been considered the primary method of evaluation to assess for vascular injuries but, due to the low frequency of these lesions, its screening role has been challenged. Non-invasive imaging, particularly CT angiography (CTA), offers definitive advantages and has emerged as a promising diagnostic screening method. Angiography is shifting to a rather therapeutic role and the endovascular management of these lesions is briefly discussed.
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Affiliation(s)
- Diego B Nuñez
- Department of Radiology, Hospital of St. Raphael, Yale University School of Medicine, 1450 Chapel St., New Haven, CT 06511, United States.
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18
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O'Shaughnessy BA, Bendok BR, Parkinson RJ, Shaibani A, Batjer HH. Transarterial coil embolization of a high-flow vertebrojugular fistula due to penetrating craniocervical trauma: case report. ACTA ACUST UNITED AC 2005; 64:335-40; discussion 340. [PMID: 16182005 DOI: 10.1016/j.surneu.2004.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Revised: 10/25/2004] [Accepted: 11/08/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vertebrojugular fistulas after penetrating cervical trauma (gunshot or stab wounds) are rarely reported. Successful endovascular coil embolization of an acute fistulizing vertebral artery pseudoaneurysm involving an obstructed internal jugular vein is presented and the various treatment strategies for such a lesion are described. CASE DESCRIPTION A 23-year-old man presented from an outside institution after sustaining 2 gunshot wounds in a civilian conflict. Neuroimaging revealed a right vertebral artery pseudoaneurysm, which formed a fistulous connection with the internal jugular vein. Because venous outflow obstruction was present just below the fistula, a high-flow shunt was directed intracranially. Both the pseudoaneurysm and arteriovenous fistula were accessed percutaneously via a transfemoral route and coil embolization was performed. Perfusion of the basilar artery circulation was assumed by the contralateral vertebral artery. The ipsilateral posteroinferior cerebellar artery filled through retrograde flow down the vertebral confluence. CONCLUSIONS Coil embolization is a safe and reliable strategy by which to obliterate an acute traumatic vertebrojugular fistula as well as pseudoaneurysm. Serial angiographic follow-up is mandatory to document a persistent cure.
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Affiliation(s)
- Brian A O'Shaughnessy
- Department of Neurological Surgery, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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19
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Ferguson E, Dennis JW, Vu JH, Frykberg ER. Redefining the role of arterial imaging in the management of penetrating zone 3 neck injuries. Vascular 2005; 13:158-63. [PMID: 15996373 DOI: 10.1258/rsmvasc.13.3.158] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to assess the role of arteriography (AG) in the diagnosis and treatment of vascular trauma in patients with zone 3 penetrating neck injuries. The records of all cases of penetrating neck trauma for the past 14 years at a level 1 trauma center were reviewed retrospectively. Eight hundred forty-four penetrating neck injuries were documented, of which 72 (8.5%) traversed zone 3 of the neck (gunshot, 35; stab, 32; shotgun, 5). Twenty patients (27%) had hard signs of vascular injury (hemorrhage, expanding hematoma, bruit, thrill, neurologic deficit). Twelve of these (60%) underwent immediate exploration, 1 had no significant injury, and 11 had successful surgical repair or ligation of the vascular injury. AG in the other eight patients with hard signs revealed injuries requiring embolization (three patients), urokinase infusion (one patient), and observation (three patients) and one normal examination. Fifty-two patients had no hard signs of vascular injury. Twenty-four of these underwent AG, of which 18 were negative. Positive findings included internal carotid artery narrowings (two patients), external compression of the internal carotid artery (one patient), vertebral artery intimal flap (one patient), and nonbleeding injuries to small, noncritical arteries (two patients), none of which required treatment. Twenty-four of the remaining 28 patients were observed clinically, and 4 patients had negative explorations. Nine patients had ultrasonography performed, but these examinations did not yield any useful information. The absence of hard signs reliably excludes surgically significant vascular injuries in penetrating zone 3 neck trauma, suggesting that AG is not necessary. Hard signs in stable patients should mandate AG because these vascular injuries may be amenable to endovascular therapy.
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Affiliation(s)
- Eric Ferguson
- Department of Surgery, University of Florida Health Science Center/Jacksonville, Jacksonville, FL, USA
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20
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Abstract
Traumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging also can be important in the chronic therapy of TBI, identifying chronic sequelae, determining prognosis, and guiding rehabilitation.
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Affiliation(s)
- Bruce Lee
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvani 19104, USA
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Kakizawa H, Toyota N, Naito A, Ito K. Endovascular Therapy for Management of Oral Hemorrhage in Malignant Head and Neck Tumors. Cardiovasc Intervent Radiol 2005; 28:722-9. [PMID: 16132394 DOI: 10.1007/s00270-004-0130-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of endovascular therapy in oral hemorrhage from malignant head and neck tumors. METHODS Ten patients (mean age 56 years) with oral hemorrhage caused by malignant head and neck tumors underwent a total of 13 emergency embolization procedures using gelatin sponge particles, steel and/or platinum coils, or a combination of these embolic materials. Angiographic abnormalities, technical success rate, clinical success rate, recurrence rate, complications, hemostatic period, hospital days, survival days, and patient outcome were all analyzed. RESULTS Angiographic abnormalities were identified during 85% of procedures (11/13). The technical success rate was 100% (13/13 procedures). The primary and secondary clinical success rates were 77% (10/13 procedures) and 67% (2/3 procedures), respectively. The overall clinical success rate was 92%, and the recurrence rate was 22% (2/9 procedures) in patients whom we were able to observe during the 1-month period after embolization. No major complications occurred. Several patients in whom gelatin sponge particles had been used complained of transient local pain after the procedure. The median hemostatic period was 71 days (range 0-518 days). Median hospital and survival days were 59 days (range 3-209 days) and 141 days (range 4-518 days), respectively. Three patients survived and 7 patients died during the observation period. Only 1 of these 7 patients died from hemorrhage. CONCLUSION In conclusion, our findings suggest that endovascular therapy is an effective, safe, and repeatable treatment for oral hemorrhage caused by malignant head and neck tumors.
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Affiliation(s)
- Hideaki Kakizawa
- Department of Radiology, Division of Medical Intelligence and Informatics Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, 734-8551, Japan.
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Lee B, Newberg A. Neuroimaging in traumatic brain imaging. Neurotherapeutics 2005. [DOI: 10.1007/bf03206678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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O'Shaughnessy BA, Getch CC, Bowman RM, Batjer HH. Ruptured traumatic vertebral artery pseudoaneurysm in a child treated with trapping and posterior inferior cerebellar artery reimplantation. J Neurosurg 2005; 102:231-7. [PMID: 16156237 DOI: 10.3171/jns.2005.102.2.0231] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case report of a pediatric patient with a ruptured traumatic pseudoaneurysm of the intracranial vertebral artery (VA) from which the posterior inferior cerebellar artery (PICA) emerged. After considering multiple therapeutic options, the patient was treated surgically by trapping of the aneurysm segment and direct reimplantation of the PICA distal to the rupture site. In addition to presenting this unique case, the authors discuss the treatment of VA pseudoaneurysms and the various techniques for PICA revascularization. A review of the literature on PICA reimplantation is provided as an adjunct in the treatment of complex VA aneurysms.
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Affiliation(s)
- Brian A O'Shaughnessy
- Department of Neurological Surgery, The Feinberg School of Medicine, McGaw Medical Center, Children's Memorial Hospital, Northwestern University, Chicago, Illinois 60611, USA
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Tenjin H, Kimura S, Sugawa N. Coil embolization of vertebro-vertebral arteriovenous fistula: a case report. ACTA ACUST UNITED AC 2005; 63:80-3; discussion 83. [PMID: 15639536 DOI: 10.1016/j.surneu.2004.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Accepted: 01/26/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vertebro-vertebral arteriovenous fistulas (VVFs) are not uncommon, but they usually present with benign symptoms such as neck murmur. We report a case of VVF presenting with myelopathy which was successfully treated by embolization with detachable coils. CASE PRESENTATION A 72-year-old woman was admitted with complaint of bilateral leg weakness. Cervical magnetic resonance image showed compression of the spinal cord by a large vascular lesion. Right vertebral angiogram showed a vertebro-vertebral fistula draining into ectatic epidural veins. From a transfemoral arterial approach, the fistula site was selected with a microcatheter, and embolization was performed by placement of several Guglielmi detachable coils until flow arrest was obtained. The patient made a full recovery, and long-term angiographic follow-up demonstrated complete cure. CONCLUSION We present a case of VVF treated using detachable coils with good long-term results.
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Affiliation(s)
- Hiroshi Tenjin
- Department of Neurosurgery, Kyoto Prefectural Yosanoumi Hospital, Kitashirakawa, Sakyoku, Kyoto 606-8264, Japan.
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Múnera F, Soto JA, Nunez D. Penetrating injuries of the neck and the increasing role of CTA. Emerg Radiol 2004; 10:303-9. [PMID: 15278711 DOI: 10.1007/s10140-004-0352-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 02/22/2004] [Indexed: 11/28/2022]
Abstract
Vascular injuries of the neck are most frequently the result of penetrating trauma. Diagnostic evaluation of hemodynamically stable patients who have suffered penetrating neck wounds is challenging and remains controversial. In order to reduce morbidity and mortality, prompt diagnosis and subsequent treatment of these injuries is critical. Traditionally, these patients undergo direct contrast angiography. However, this technique has limitations including its invasive nature and potential complications. The use of routine screening angiography has also been questioned because of the low rate of positive examinations. More recently, helical and multislice CT angiography (CTA) has emerged as a fast, minimally invasive accurate study to evaluate penetrating neck injuries. CTA is not operator-dependent and the results can be reproduced easily by using established technical parameters. It is readily available in most centers and allows the simultaneous evaluation of the extravascular soft tissues and bones.
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Affiliation(s)
- Felipe Múnera
- Department of Radiology, University of Miami / Jackson Memorial Hospital / Ryder Trauma Center, 1611 NW 12th Ave-West Wing 279, Miami, FL 33136, USA.
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Abstract
The role of radiological imaging modalities in the investigation of head trauma is reviewed with reference to the mechanisms of head injury, as well as the recent guidelines for investigation produced by the National Institute for Clinical Excellence (NICE), and the Royal College of Radiologists. Lesions resulting from head trauma and the associated radiological ndings are described.
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Affiliation(s)
- J Benham
- Department of Neuroradiology, Queen Elizabeth Hospital, Birmingham, UK
| | - SV Chavda
- Department of Neuroradiology, Queen Elizabeth Hospital, Birmingham, UK
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