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Cheraghali R, Salimi J, Omrani Z. Endovascular treatment of penetrating vascular injuries. J Surg Case Rep 2021; 2021:rjab486. [PMID: 34804479 PMCID: PMC8599047 DOI: 10.1093/jscr/rjab486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Endovascular treatment of vascular injuries has resulted in reduced operating time, blood loss, hospital mortality and sepsis. The purpose of this study was to evaluate the success and complication rate of the endovascular management of penetrating peripheral vascular injuries during 5 years. In this observational study, the clinical records and imaging features of 22 penetrating trauma injuries of 276 penetrating vascular trauma patients (8%), which were repaired using endovascular stent-grafts or coil embolization, between April 2013 and August 2018, included in the study. The median age of patients was 43 years (Range, 20–78 years). There were 17 stab wounds (77.3%), 2 shotgun war remnants (9.1%) and 2 iatrogenic post-surgical lesions. Eleven stent-grafts (50%) and nine coil embolizations (40.9%) were deployed. Endovascular interventions in the management of peripheral vascular injuries can be efficient in definitive repair, damage control and hemorrhage control in severely ill trauma patients.
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Affiliation(s)
- Roozbeh Cheraghali
- Vascular and Endovascular Surgery, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Javad Salimi
- Vascular and Endovascular Surgery, Liver Transplantation Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Omrani
- Department of Surgery, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Kelemen JA, Kaserer A, Jensen KO, Stein P, Seifert B, Simmen HP, Spahn DR, Pape HC, Neuhaus V. Prevalence and outcome of contrast-induced nephropathy in major trauma patients. Eur J Trauma Emerg Surg 2020; 48:907-913. [PMID: 32948886 PMCID: PMC7500990 DOI: 10.1007/s00068-020-01496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.
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Affiliation(s)
- Julian Alexander Kelemen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Philipp Stein
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute of Anesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland
| | - Burkhardt Seifert
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
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Abstract
Traumatic pelvic injuries are associated with high injury severity scores and significant morbidity and mortality. As fractures and ligamentous disruption result in increased pelvic volume, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Due to the extensive collateral supply and limitations of surgery for pelvic hematomas, angiographic treatment is at the forefront of pelvic trauma management. This article will discuss typical injuries seen in pelvic trauma, treatment modalities available to the interventional radiologist, and common angiographic treatment strategies and techniques.
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Affiliation(s)
- Derek F. Franco
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Steven M. Zangan
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
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Hsieh TM, Tsai TH, Lin CC, Hsieh CH. Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan. BMJ Open 2016; 6:e012205. [PMID: 27798008 PMCID: PMC5093687 DOI: 10.1136/bmjopen-2016-012205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of the present study was to assess whether angiography after contrast-enhanced CT (CECT) as per the policy of non-operative management would add to the risk of acute kidney injury in patients with blunt splenic injuries (BSIs). DESIGN Cross-sectional study. SETTING Taiwan. PARTICIPANTS Patients with BSI aged >16 years, admitted to a level I trauma centre during the period of January 2004 to December 2014, were retrospectively reviewed. A total of 326 patients with BSI with CECT were included in the study, of whom 100 underwent subsequent angiography and 226 did not. MAIN OUTCOME MEASURES Incidence of contrast-induced nephropathy (CIN) and renal function as measured by the 48-hour serum creatinine (SCr) levels. RESULTS No significant difference between the patients who underwent angiography and those who did not in terms of the initial haemoglobin (Hb), SCr or estimated glomerular filtration rate (eGFR) level on arrival at the emergency department, 48 hours later, or at discharge. No significant difference in the incidence of CIN was found between these two groups of patients regardless of the criteria for identifying CIN. In the group of patients aged ≥55 years, those who underwent angiography had a significantly worse 48-hour SCr level than those who did not undergo the treatment. In addition, there was no significant difference in the 48-hour SCr level between the two groups of patients when subgrouping the patients according to sex, large haemoperitoneum revealed on CT, systolic blood pressure, initial Hb, initial SCr and initial eGFR levels. CONCLUSIONS This study demonstrated that angiography does not increase the incidence of CIN, and was not a risk factor to renal function impairment in patients with BSI who had undergone CECT.
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Affiliation(s)
- Ting-Min Hsieh
- Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Hsieh TM, Tsai TH, Liu YW, Hsieh CH. Risk factors for contrast-induced nephropathy and their association with mortality in patients with blunt splenic injuries. Int J Surg 2016; 35:69-75. [PMID: 27622729 DOI: 10.1016/j.ijsu.2016.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/25/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI. METHOD We retrospectively studied the complete data on 377 trauma patients with BSI who survived more than 48 h between July 2003 and June 2015. CIN was defined as the relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 48 h after contrast administration. A multivariate logistic regression analysis was conducted to identify the independent predictors of CIN and mortality. RESULTS CIN was independently associated with body mass index (BMI) ≥ 30 kg/m2 (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.20-8.76), injury severity score (ISS) ≥ 25 (OR: 6.08, 95% CI: 2.76-13.53), and 24-h hemoglobin (Hb) < 10 g/dL (OR: 3.16, 95% CI: 1.46-6.81). CIN (OR: 19.04, 95% CI: 6.15-58.94) and diabetes (OR: 3.43, 95% CI: 1.04-11.26) were also identified as independent predictors for mortality. CONCLUSION In this study, we found that BMI ≥ 30 kg/m2, ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI.
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Affiliation(s)
- Ting-Min Hsieh
- Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Yueh-Wei Liu
- Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
| | - Ching-Hua Hsieh
- Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan.
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Pelvic trauma and vascular emergencies. Diagn Interv Imaging 2015; 96:717-29. [DOI: 10.1016/j.diii.2015.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 04/22/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022]
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Saour M, Charbit J, Millet I, Monnin V, Taourel P, Klouche K, Capdevila X. Effect of renal angioembolization on post-traumatic acute kidney injury after high-grade renal trauma: a comparative study of 52 consecutive cases. Injury 2014; 45:894-901. [PMID: 24456608 DOI: 10.1016/j.injury.2013.11.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 11/14/2013] [Accepted: 11/24/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with unfavourable outcomes and higher mortality after trauma. Renal angioembolization (RAE) has proved efficiency in the management of high-grade renal trauma (HGRT), but inevitably expose to unavoidable ischaemic areas or contrast medium nephrotoxicity which may impair renal function in the following hours. The aim of this study was to assess the potential acute impact of RAE on renal function in a consecutive series of HGRTs treated nonoperatively. MATERIALS AND METHODS Of 101 cases of renal trauma admitted to our Regional Trauma Center between January 2005 and January 2010, 52 cases of HGRT were treated nonoperatively; they were retrospectively classified into 2 groups according to whether RAE was used. Incidence and progression of AKI (RIFLE classification), maximum increase in serum creatinine (SCr), level since admission and recovery of renal function at discharge were compared between the groups. Multivariable analysis was performed to determine the role of RAE as an independent risk factor of AKI. RESULTS RAE was performed in 10 patients within the first 48h. The RAE and no RAE groups were comparable in terms of severity score, renal injury grade, and level of SCr on admission. AKI incidence (RIFLE score Risk or worse) after 48 and 96h was 33% and 10%, respectively and did not differ significantly between groups at 48h (p=1.00) or 96h (p=1.00). The median maximum increase in SCr was significantly higher in no RAE than RAE group (30.4% vs. 6.9%, p=0.04). RAE was not found to be a significant variable in a multiple linear regression analysis predicting maximum SCr rise (p=0.34). SCr at discharge was >120% of baseline in only 5 patients, with no difference according to RAE (p=0.24). CONCLUSION In a population of nonoperatively treated HGRT, the incidence of AKI decreased from almost 30% to 10% at 48h and 96h. RAE proceeding did not seem to affect significantly the occurrence and course of AKI or renal recovery. The decision to use RAE should probably not be restricted by fear of worsening renal function.
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Affiliation(s)
- M Saour
- Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France
| | - J Charbit
- Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France.
| | - I Millet
- Department of Radiology, Lapeyronie Hospital, Montpellier I University, Montpellier, France
| | - V Monnin
- Department of Interventional Radiology, Arnaud de Villeneuve Hospital, Montpellier I University, Montpellier, France
| | - P Taourel
- Department of Radiology, Lapeyronie Hospital, Montpellier I University, Montpellier, France
| | - K Klouche
- Department of Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France
| | - X Capdevila
- Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Equipe Inserm U1046, Montpellier F-34295 Cedex 5, France
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Harvey J, West A. The right scan, for the right patient, at the right time: The reorganization of major trauma service provision in England and its implications for radiologists. Clin Radiol 2013; 68:871-86. [DOI: 10.1016/j.crad.2013.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 01/02/2013] [Accepted: 01/08/2013] [Indexed: 12/30/2022]
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Abstract
Significant advancements in nonsurgical and surgical approaches to control bleeding in severely injured patients have also improved the treatment of critical trauma-related coagulopathy. Nonsurgical procedures such as angiographic embolization are progressively considered to terminate arterial bleeding from pelvic fractures. The disturbance of coagulation may aggravate bleeding and hamper surgical procedures. The administration of coagulation factors and factor concentrates may be useful for correcting systemic coagulopathy and reducing the need for fresh frozen plasma, platelet, and red blood cell transfusions, which are associated with various adverse outcomes. In this review, nonsurgical management of critical trauma bleeding is discussed.
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Affiliation(s)
- Christian Zentai
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany.
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Abstract
This article outlines the clinical and radiological approach to patients with pelvic trauma. It reviews the clinical descriptions and classifications of pelvic trauma as well as the management of patients with stable and unstable fractures. A review of embolization techniques in these types of patients is provided.
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Affiliation(s)
- Scott R Broadwell
- Department of Diagnostic Radiology, University of Colorado Health Sciences Center, Denver, Colorado
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Aberrant Obturator Artery Is a Common Arterial Variant That May Be a Source of Unidentified Hemorrhage in Pelvic Fracture Patients. ACTA ACUST UNITED AC 2011; 70:366-72. [DOI: 10.1097/ta.0b013e3182050613] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beitland S, Moen H, Os I. Acute kidney injury with renal replacement therapy in trauma patients. Acta Anaesthesiol Scand 2010; 54:833-40. [PMID: 20528778 DOI: 10.1111/j.1399-6576.2010.02253.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) with renal replacement therapy (RRT) is rare in trauma patients. The primary aim of the study was to assess incidence, mortality and chronic RRT dependency in this patient group. METHODS Adult trauma patients with AKI receiving RRT at a regional trauma referral center over a 12-year period were retrospectively reviewed. RESULTS Population-based incidence of post-traumatic AKI with RRT was 1.8 persons per million inhabitants per year (p.p.m./year) [95% confidence the interval (CI) 1.5-2.1 p.p.m./year]. In trauma patients admitted to hospital, incidence was 0.5 per thousand (95% CI 0.3-0.7 per thousand) of those treated in intensive care unit (ICU), it was 8.3% (95% CI 5.9-10.8%). The median age was 46 years. Odds ratio (OR) for post-traumatic AKI requiring RRT was higher in males than in females in general population (OR 5.6, 95% CI 2.2-14.0), and in trauma patients admitted to hospital (OR 4.4, 95% CI 1.9-10.3) and ICU (OR 4.5, 95% CI 1.9-10.7). The in-hospital mortality rate was 24% (95% CI 11-37%), 3-month mortality 36% (95% CI 21-51%) and 1-year mortality 40% (95% CI 25-55%). Age was a risk factor for death after 1 year, with 57% (95% CI 7-109%) increased risk for each 10 years added. None of the survivors was dialysis-dependent 3 months or 1 year after trauma. CONCLUSION AKI in trauma patients requiring RRT was rare in this single-center study. More males than females were affected. Mortality was modest, and renal recovery was excellent as none of the survivors became dependent on chronic RRT.
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Affiliation(s)
- S Beitland
- Department of Anaesthesiology, Oslo University Hospital Ullevaal, Oslo, Norway.
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Tan L, Venkatesh SK, Consigliere D, Heng CT. Treatment of a patient with post-TURP hemorrhage using bilateral SAPE. Nat Rev Urol 2009; 6:680-5. [DOI: 10.1038/nrurol.2009.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Spaniolas K, Velmahos GC, Kwolek C, Gervasini A, De Moya M, Alam HB. Bedside placement of removable vena cava filters guided by intravascular ultrasound in the critically injured. World J Surg 2008; 32:1438-43. [PMID: 18330626 DOI: 10.1007/s00268-008-9523-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bedside placement of removable inferior vena cava filters (RVCF) is increasingly used in critically injured patients. The need for fluoroscopic equipment and specialized intensive care unit beds presents major challenges. Intravascular ultrasound (IVUS) eliminates such problems. The objective of the present study was to analyze the safety and feasibility of IVUS-guided bedside RVCF placement in critically injured patients. METHODS Between October 2004 and July 2006 47 IVUS-guided RVCF were placed at the bedside. Medical and trauma registry records were reviewed. Primary outcome was RVCF-related complications. RESULTS The mean patient age was 41 +/- 19 years, and the mean Injury Severity Score was 30 +/- 12. The right common femoral vein was chosen as the site of access in 40 patients, and the left common femoral vein was the access site in 7 patients. The insertion was performed 3.7 +/- 2.5 days after admission. Four patients (8.5%) developed common femoral deep vein thrombosis (DVT) and three (6%) developed a peripheral pulmonary embolism (PE). Complications related to technique were recorded in two patients (4%) and included one misplacement and one access site bleeding with no further associated morbidity. Five patients died during the hospital stay from issues unrelated to RVCF. Forty-one patients were eligible for follow-up. Removal of RVCF was offered only to 8 patients and was performed successfully in 4 (10%) at a mean of 130 days (range: 44-183 days). CONCLUSIONS In this study IVUS-guided bedside placement of RVCF was feasible but was also associated with complications. Follow-up was poor, and the rate of removal disappointingly low, underscoring the need for further exploration of the role of RVCF.
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Affiliation(s)
- Konstantinos Spaniolas
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA
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Abstract
PURPOSE Iodinated contrast medium is commonly used in diagnostic or interventional procedures in uroradiology. Procedures requiring the intravascular administration of iodinated contrast medium are becoming a great source of an iatrogenic disease known as contrast induced nephropathy. Identifying patients at high risk is the first step to minimize the overall risk of contrast induced nephropathy. This review describes conflicting and new risk factors for contrast induced nephropathy. MATERIALS AND METHODS A MEDLINE/PubMed search from 1966 to 2006 was performed. All articles related to the use of contrast medium and the risk factors for contrast induced nephropathy were reviewed. RESULTS The classic risk factors for contrast induced nephropathy are preexisting renal failure, diabetes mellitus, advanced age, nephrotoxic agent administration, hypovolemia, use of a large amount of contrast medium or an ionic hyperosmolar contrast medium and congestive heart failure. Metabolic syndrome, prediabetes and hyperuricemia have been identified as new risk factors for contrast induced nephropathy. The use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, renal transplantation, diabetes mellitus with normal renal function, low osmolar contrast medium in patients at high risk for contrast induced nephropathy, multiple myeloma, female gender and cirrhosis have been classified as conflicting risk factors for contrast induced nephropathy. CONCLUSIONS Patients at risk for contrast induced nephropathy should be identified before urological procedures requiring contrast administration. In addition to the classic risk factors for contrast induced nephropathy, determining the metabolic syndrome, hyperuricemia and prediabetes as well as the use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers before performing procedures using contrast medium seems to be a useful guide to assess the risk of contrast induced nephropathy.
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Plurad D, Brown C, Chan L, Demetriades D, Rhee P. Emergency Department Hypotension is not an Independent Risk Factor for Post-Traumatic Acute Renal Dysfunction. ACTA ACUST UNITED AC 2006; 61:1120-7; discussion 1127-8. [PMID: 17099517 DOI: 10.1097/01.ta.0000244737.54032.98] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypotension has been considered to be associated with renal dysfunction. The purpose of this study was to characterize the association of Emergency Department Hypotension (EDHypo) with post-traumatic renal insufficiency (RI) and renal failure (RF). METHODS A Level I center Intensive Care Unit database was analyzed. We reviewed all adult trauma patients surviving for more than 24 hours. EDHypo was defined as admission systolic blood pressure of less than 90 mm Hg, RI was defined as a peak serum creatine of > or = 2.0 mg/dL, RF was defined as requiring dialysis. RESULTS There were 2,574 admissions studied and RI occurred in 8.3% (213) of these patients whereas RF occurred in 1.1% (28). The mortality rate with RI was 41.0% (89) and 50.0% (14) with RF. There was no significant change in the incidence of RI, RF, or RI associated mortality during the study period. EDHypo was present in 7.9% (203) of patients and the incidence of RI was significantly higher than that of non-EDHypo patients (12.2% vs. 7.9%, p = 0.028). The incidence of RF was not different (1.0% vs. 1.1%). EDHypo was not independently associated with RI or RF but Injury Severity Score > 16, renal injury, age > 55, Body Mass Index > 30, male gender, and Intensive Care Unit (ICU) admission creatine kinase > or = 5,000 U/L had an independent association with RI. No risk factor in patients with RI could reliably predict RF. CONCLUSIONS EDhypo is not independently associated with post-traumatic RI or RF but severity of injury, renal injury, age, Body Mass Index, male gender, and elevated creatinine kinase are independently associated with RI. In critically ill trauma patients the incidence of RI and RF and the associated mortality rate has not changed significantly during a 6-year period despite, presumably, better understanding of resuscitative strategies.
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Affiliation(s)
- David Plurad
- Division of Trauma/Surgical Critical Care, LAC + USC Medical Center, Los Angeles, California 90033, USA.
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Abstract
With the wider use of imaging and interventional techniques that require the use of iodinated contrast media in seriously ill patients, many clinical situations occur where patients may be at increased risk for contrast-induced nephropathy (CIN). There is little guidance for clinicians in these areas. The aim of this review is to assess the available literature. Acute renal failure is a common complication following coronary artery bypass surgery, and exposure to contrast medium may increase the risk for this condition, although there is insufficient evidence to make a definitive statement. Evidence is also limited for patients with liver disease: in those undergoing transarterial chemoembolization, cirrhosis may be a risk factor for renal failure. There is some evidence that periprocedural hypotension may be a risk factor for CIN after percutaneous coronary intervention, but no published information was identified on the significance of shock or hypotension in other groups of patients. The published evidence on the risk of CIN in renal transplant recipients is inconsistent. In emergency situations, the course of action is usually dictated by clinical circumstances; the renal status of a patient is likely to be unknown and it is important to ensure adequate volume expansion, especially after the procedure. In all clinical situations that are potentially associated with a high risk for CIN, the decision to administer contrast medium is a matter for clinical judgment, based on the clinical status of the patient and the expected benefits of the investigation or procedure.
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Affiliation(s)
- Christoph R Becker
- Department of Clinical Radiology, University Hospital Grosshadern, Munich, Germany.
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Tremblay LN, Tien H, Hamilton P, Brenneman FD, Rizoli SB, Sharkey PW, Chu P, Rozycki GS. Risk and benefit of intravenous contrast in trauma patients with an elevated serum creatinine. ACTA ACUST UNITED AC 2006; 59:1162-6; discussion 1166-7. [PMID: 16385295 DOI: 10.1097/01.ta.0000194694.71607.0c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess if the benefits outweigh the risks of intravenous (iv) contrast in trauma patients who present with an elevated serum creatinine (Cr). BACKGROUND Radiologic investigations with iv contrast are often used in trauma patients to rapidly assess for life threatening injuries. However, contrast nephropathy (CNP) is associated with increased morbidity and mortality. This poses a dilemma for the physician who must weigh the risks and benefits of proceeding with iv contrast versus the risks of missed injuries/delayed diagnosis. METHODS A 2 year (2002-2003) retrospective chart review of all trauma patients presenting with an elevated Cr(> or =1.3 mg/dL or > or =115 micromol/L). Results are mean +/- sd (p < 0.05 significant). RESULTS Ninety-five patients (age 51 +/- 23 years; ISS 31.7 +/- 15.6; hospital stay 29 +/- 32 days; mortality 9%) presented with a Cr > or = 1.3 mg/dL (31 with Cr > or =1.7; 3 dialysis dependent). Fifty-six (59%) were given iv contrast (C+), of which only 2 (3%) had a transient rise of 25% in Cr within 48 hours versus 6 (16%) patients not exposed to contrast (C-). No C+ patient developed CNP requiring longterm dialysis. Of the 56 undergoing C+ tests, 16 had injuries requiring urgent intervention identified; 16 had injuries that were managed nonoperatively, and 24 had serious injuries ruled out. Of the 39 C- patients, 9 had indeterminate CT's; 2 had missed injuries; and 2 had no intraabdominal injuries found at celiotomy. CONCLUSION This study suggests the benefits may outweight the risks for proceeding prn with iv contrast in trauma patients with an elevated creatinine. A larger study is needed to confirm these findings.
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Affiliation(s)
- Lorraine N Tremblay
- Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5.
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Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Intervent Radiol 2004; 21:11-22. [PMID: 21331105 PMCID: PMC3036209 DOI: 10.1055/s-2004-831401] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Blunt and penetrating traumatic injuries may result in acute or subacute vascular injuries. These injuries to solid organs and extremity vessels are often managed in a conservative fashion. Acuity and hemodynamic compromise may dictate a surgical course; however, interventional techniques first popularized in the early 1970s now offer a wide range of solutions principally using transcatheter arterial embolization. There are a wide range of materials and clinical scenarios for which embolization is appropriate. Embolic agents such as coils, Gelfoam, and particles may be used individually or in combination to stop or control bleeding. In this way, embolotherapy may prove to be the safest and most effective form of therapy. The purpose of this article is to review the indications for embolization in the trauma patient and to provide guidelines regarding techniques and material selection.
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Affiliation(s)
- Jason R. Bauer
- Radiology Resident, Department of Radiology, University of Colorado Health Sciences Center, Denver, Colorado
| | - Charles E. Ray
- Division of Interventional Radiology, Denver Health Medical Center, Denver, Colorado
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