1
|
Stafforini NA, Singh N. Management of Vascular Injuries in Penetrating Trauma. Surg Clin North Am 2023; 103:801-825. [PMID: 37455038 DOI: 10.1016/j.suc.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Management of vascular trauma remains a challenge and traumatic injuries result in significant morbidity and mortality. Vascular trauma can be broadly classified according to mechanism of injury (iatrogenic, blunt, penetrating, and combination injuries). In addition, this can be further classified by anatomical area (neck, thoracic, abdominal, pelvic, and extremities) or contextual circumstances (civilian and military).
Collapse
Affiliation(s)
- Nicolas A Stafforini
- Division of Vascular Surgery, Department of Surgery, University of Washington, 325 9th Avenue, Box 359908, Seattle, WA 98104, USA
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, 325 9th Avenue, Box 359908, Seattle, WA 98104, USA.
| |
Collapse
|
2
|
Kajtazi NI, Manzoor MU, Ghamdi JA, Zahrani HA, Suwaidan FA, Qahtani SA, Bafaquh M. Right cerebellar stroke with a right vertebral artery occlusion following an embolization of the right glomus tympanicum tumor: Case report with literature review. J Cerebrovasc Endovasc Neurosurg 2022; 24:386-392. [PMID: 35818687 PMCID: PMC9829557 DOI: 10.7461/jcen.2022.e2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 01/21/2023] Open
Abstract
A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist.
Collapse
Affiliation(s)
- Naim I. Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA,Correspondence to Naim I. Kajtazi Department of Neurology, National Neurosciences Institute, King Fahad Medical City, 59046, Riyadh 11525, Kingdom of Saudi Arabia Tel +966-50-234-3276 E-mail
| | - Muhammad Usman Manzoor
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Juman Al Ghamdi
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Hanadi Al Zahrani
- Physical Medicine, Audiology Department, King Fahad Medical City, Riyadh, KSA
| | - Faisal Al Suwaidan
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA,Critical Care Department, Neuro Critical Care Unit, King Fahad Medical City, Riyadh, KSA
| | - Sultan Al Qahtani
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Mohammad Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| |
Collapse
|
3
|
Role of Transarterial Embolization in the Treatment of Life-Threatening Hemorrhage in Patients With Maxillofacial Injury. Korean J Neurotrauma 2022; 18:178-187. [DOI: 10.13004/kjnt.2022.18.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 07/23/2022] [Indexed: 11/15/2022] Open
|
4
|
Kuzmenko AV, Shkvarko MG. [Surgical anatomy of extraorganic anastomoses of inferior vesical artery]. Khirurgiia (Mosk) 2021:44-48. [PMID: 34941208 DOI: 10.17116/hirurgia202112144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the variants of topography and quantity of extraorganic anastomoses of inferior vesical artery (IVA). MATERIAL AND METHODS The study included 186 corpses of males (age 22-82 years) and 109 females (age 32-93 years). All people died from accidental causes not associated with pelvic organ diseases. Dissection, vascular injection and statistical analysis were performed. RESULTS IVA forms anastomoses with other branches of internal iliac artery in 11.3% of cases on the right and in 12.4% of cases on the left in males. These collaterals in females are noted in 9.2% of cases on the right and in 7.3% of cases on the left. Mean length of extraorganic anastomoses of a. vesicalis inferior in males is 1.4 cm, mean diameter - 1.7 mm. Mean length of such collaterals in females is 1.7 cm, mean diameter - 1.7 mm. Extraorganic anastomoses are more common in proximal and middle thirds of IVA, rarely - in distal third. Linear correlation between diameters of a. vesicalis inferior and its extraorganic anastomoses was not detected in females but found in males. CONCLUSION Extraorganic anastomoses of IVA are characterized by certain pattern of origination in males and in females.
Collapse
|
5
|
Khurana A, Quencer K, Saini A, Sill A, Albadawi H, Jamal L, Naidu S, Patel I, Alzubaidi S, Oklu R. Endovascular interventions in the management of acute extremity trauma: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1197. [PMID: 34430638 PMCID: PMC8350664 DOI: 10.21037/atm-20-5428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/16/2021] [Indexed: 11/06/2022]
Abstract
Minimally invasive endovascular interventions including stenting and embolization have been widely adopted for the treatment of emergent and traumatic thoracoabdominal injuries. In recent years, these techniques have been utilized in the setting of extremity vascular trauma with promising outcomes. By allowing for the rapid diagnosis and subsequent treatment of penetrating or blunt vascular extremity trauma, these techniques can help to minimize blood loss, reduce operative complications, and potentially prevent limb amputation. Here, we present a narrative review of the ever-increasing role of minimally invasive interventions in the management of extremity trauma and compare its use and outcomes to open surgical repair. A special focus is placed on diagnostic imaging modalities in trauma and the role of interventional radiologists in the work-up and treatment of extremity trauma. We discuss diagnostic imaging modalities that aid in the triaging of extremity trauma, such as Doppler sonography, CT angiography, and catheter-based angiography. We present an overview on the literature related to endovascular interventions such as embolotherapy and stent grafting as well as the technical challenges associated with each technique. Finally, we present our own cases on the workup and endovascular treatment of extremity trauma, including CT angiography, particulate and coil embolization, and stent graft placement.
Collapse
Affiliation(s)
- Aditya Khurana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Keith Quencer
- University of Utah, Interventional Radiology, Salt Lake City, Utah, USA
| | - Aman Saini
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Andrew Sill
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Hassan Albadawi
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Leila Jamal
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Indravadan Patel
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
6
|
Kawai T, Pan CC, Okuzu Y, Shimizu T, Stahl AM, Matsuda S, Maloney WJ, Yang YP. Combining a Vascular Bundle and 3D Printed Scaffold with BMP-2 Improves Bone Repair and Angiogenesis. Tissue Eng Part A 2021; 27:1517-1525. [PMID: 33906392 DOI: 10.1089/ten.tea.2021.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Vascularization is currently considered the biggest challenge in bone tissue engineering due to necrosis in the center of large scaffolds. We established a new expendable vascular bundle model to vascularize a three-dimensional printed channeled scaffold with and without bone morphogenetic protein-2 (BMP-2) for improved healing of large segmental bone defects. Bone formation and angiogenesis in an 8 mm critical-sized bone defect in the rat femur were significantly promoted by inserting a bundle consisting of the superficial epigastric artery and vein into the central channel of a large porous polycaprolactone scaffold. Vessels were observed sprouting from the vascular bundle inserted in the central tunnel. Although the regenerated bone volume in the group receiving the scaffold and vascular bundle was similar to that of the healthy femur, the rate of union of the group was not satisfactory (25% at 8 weeks). BMP-2 delivery was found to promote not only bone formation but also angiogenesis in the critical-sized bone defects. Both insertion of the vascular bundle alone and BMP-2 loading alone induced comparable levels of angiogenesis and when used in combination, significantly greater vascular volume was observed. These findings suggest a promising new modality of treatment in large bone defects. Level of Evidence: Therapeutic level I.
Collapse
Affiliation(s)
- Toshiyuki Kawai
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Chi-Chun Pan
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | | | - Alexander M Stahl
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Chemistry, Stanford University, Stanford, California, USA
| | - Shuich Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Yunzhi P Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Materials Science and Engineering, and Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| |
Collapse
|
7
|
Weaver JJ, Chick JFB, Monroe EJ, Johnson GE. Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma. Semin Intervent Radiol 2021; 38:64-74. [PMID: 33883803 DOI: 10.1055/s-0041-1724011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Traumatic injury is the leading cause of death worldwide in younger patient populations and extremity trauma with associated vascular injury accounts for many trauma-related deaths. Iatrogenic injury is also a common cause of extremity vascular trauma and the incidence of iatrogenic injury will likely increase as endovascular techniques continue to become more ubiquitous. For many vascular injuries involving the extremities, surgical repair is viewed as the standard of care. Historically, endovascular techniques did not play a role in the treatment of these vascular injuries, rather they were utilized only as part of the diagnostic assessment; however, there is an increasing trend toward endovascular management of extremity vascular trauma. No validated, widely implemented algorithm to select patients for endovascular intervention exists. Transcatheter techniques, however, play an important role in the management of these patients. For arterial injuries, embolization can be used to rapidly achieve hemostasis if the vessel can be sacrificed. More advanced endovascular techniques such as stent-graft placement may be best employed in the context of isolated, proximal extremity injuries, although there is increasing literature supporting the use of advanced techniques for more distal arterial injuries. The management of peripheral venous trauma remains controversial; however, there is growing data describing successful endovascular management of some peripheral venous injuries. The purpose of this article is to review extremity vascular trauma, concepts of injury triage, endovascular techniques, and intraprocedural considerations.
Collapse
Affiliation(s)
- John J Weaver
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Jeffrey F B Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington.,Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Guy E Johnson
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| |
Collapse
|
8
|
Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma. Radiol Oncol 2020; 54:253-262. [PMID: 32463389 PMCID: PMC7409609 DOI: 10.2478/raon-2020-0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Severe bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce. Patients and methods PubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories. Results and conclusions Based on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.
Collapse
|
9
|
Perrucci L, Graziano M, Ferrante Z, Salviato E, Carnevale A, Galeotti R. Pitfalls in the embolisation of a thyrocervical trunk bleeding: a case report. Patient Saf Surg 2020; 14:19. [PMID: 32391083 PMCID: PMC7201948 DOI: 10.1186/s13037-020-00244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction An intrathoracic bleeding from the thyrocervical branch is not common in blunt trauma, but an interventional radiologist should be aware of the risks in order to prevent complications. Case presentation A 30-year-old male presented with a right pneumo-haemothorax due to active bleeding revealed at contrast-enhanced CT, as a consequence of a fall occurred in the previous week. The patient was treated with endovascular embolisation in an angiographic room with coils placement, since the right thyrocervical artery was found to be supplying the pneumo-haemothorax. A radiculo-medullary branch rose from the thyrocervical trunk, impeding the proximal embolization with microparticles and needing selective isolation of the bleeding artery with the catheter to avoid spinal cord injuries. The treatment had a successful result and the following CT control showed signs of recovering, without any complication. Conclusion Our paper presents a rare contingency, warning the operator to bear in mind the presence of arteries feeding the spinal cord. This crucial detail precludes the use of microparticles embolisation to prevent neurologic sequelae, whereas the use of endovascular coils for embolization should be mandatory. Moreover, this case reminds that the post-traumatic bleeding deriving from a cervical trauma may also occur later.
Collapse
Affiliation(s)
- Luca Perrucci
- 1Department of Interventional and Diagnostic Radiology, Arcispedale Sant'Anna, Ferrara, Italy.,2Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,3Azienda Ospedaliero-Universitaria - Nuovo Sant'Anna Hospital, via A. Moro 8, Cona, Ferrara, Italy
| | - Monica Graziano
- 1Department of Interventional and Diagnostic Radiology, Arcispedale Sant'Anna, Ferrara, Italy
| | - Zairo Ferrante
- 1Department of Interventional and Diagnostic Radiology, Arcispedale Sant'Anna, Ferrara, Italy
| | - Elisabetta Salviato
- 1Department of Interventional and Diagnostic Radiology, Arcispedale Sant'Anna, Ferrara, Italy
| | - Aldo Carnevale
- 4Radiology Department, University Radiology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - Roberto Galeotti
- 2Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
10
|
Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma. J Vasc Interv Radiol 2020; 31:363-369.e2. [PMID: 31948744 DOI: 10.1016/j.jvir.2019.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022] Open
|
11
|
Recurrent destabilising paediatric pelvic arterial haemorrhage: Choosing the embolisation technique that works – A case report. TRAUMA-ENGLAND 2019. [DOI: 10.1177/1460408618794211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
12
|
Srinivasan VM, Ghali MGZ, Kan P. John Allcock and a brief history of Allcock's test. J Neurointerv Surg 2017; 10:98. [PMID: 29146828 DOI: 10.1136/neurintsurg-2017-013578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
13
|
Peroneal arteriovenous fistula and pseudoaneurysm: an unusual presentation. Case Rep Vasc Med 2014; 2014:506067. [PMID: 25349770 PMCID: PMC4199079 DOI: 10.1155/2014/506067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022] Open
Abstract
Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome.
Collapse
|
14
|
Abstract
Trauma continues to be the leading cause of death in the young population. Uncontrolled bleeding is a major factor in early mortality after trauma, contributing to 30 to 40% of trauma-related deaths. Transcatheter embolization techniques play a significant role in the comprehensive modern treatment of traumatic vascular injuries to solid organs and extremities. The purpose of this article is to review current principles and techniques in the use of embolization for the treatment of traumatic arterial injuries of solid organs and extremities.
Collapse
Affiliation(s)
- Jorge E Lopera
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| |
Collapse
|
15
|
Sekhar LN, Biswas A, Hallam D, Kim LJ, Douglas J, Ghodke B. Neuroendovascular Management of Tumors and Vascular Malformations of the Head and Neck. Neurosurg Clin N Am 2009; 20:453-85. [DOI: 10.1016/j.nec.2009.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|