1
|
Góes AMDO, Parreira JG, Kleinsorge GHD, Dalio MB, Alves PHF, Gomes FJSDDV, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian guidelines on diagnosis and management of traumatic vascular injuries. J Vasc Bras 2023; 22:e20230042. [PMID: 38021277 PMCID: PMC10647898 DOI: 10.1590/1677-5449.202300422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.
Collapse
Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Centro Universitário do Pará - CESUPA, Faculdade de Medicina, Belém, PA, Brasil.
- Universidade Federal do Pará - UFPA, Faculdade de Medicina, Belém, PA, Brasil.
| | - José Gustavo Parreira
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Gustavo Henrique Dumont Kleinsorge
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Fundação Hospitalar do Estado de Minas Gerais - FHEMIG, Clínica de Cirurgia Vascular, Hospital João XXIII, Belo Horizonte, MG, Brasil.
| | - Marcelo Bellini Dalio
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Pedro Henrique Ferreira Alves
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, III Clínica Cirúrgica, São Paulo, SP, Brasil.
| | - Francisco João Sahagoff de Deus Vieira Gomes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade do Estado do Rio de Janeiro - UERJ, Faculdade de Ciências Médicas, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
- Polícia Militar do Estado do Rio de Janeiro - PMERJ, Rio de Janeiro, RJ, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Paraná - UFPR, Hospital das Clínicas, Divisão de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
| |
Collapse
|
2
|
American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries. J Trauma Acute Care Surg 2021; 89:1183-1196. [PMID: 33230048 DOI: 10.1097/ta.0000000000002967] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
Collapse
|
3
|
Blum AG, Gillet R, Athlani L, Prestat A, Zuily S, Wahl D, Dautel G, Gondim Teixeira P. CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings. Insights Imaging 2021; 12:16. [PMID: 33576888 PMCID: PMC7881081 DOI: 10.1186/s13244-020-00958-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.
Collapse
Affiliation(s)
- Alain G Blum
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France.
| | - Romain Gillet
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
| | | | - Stéphane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
| | | |
Collapse
|
4
|
Pinto A, Russo A, Reginelli A, Iacobellis F, Di Serafino M, Giovine S, Romano L. Gunshot Wounds: Ballistics and Imaging Findings. Semin Ultrasound CT MR 2019; 40:25-35. [DOI: 10.1053/j.sult.2018.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
5
|
Masi Z, Gussman K, Hazelton JP, Gefen R. Evaluation of the diagnostic value of a venous phase in CT angiography of the extremities in the setting of trauma: is vein imaging in vain? Emerg Radiol 2017; 24:335-340. [PMID: 28150047 DOI: 10.1007/s10140-017-1480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE This study examined the value of including a venous phase in addition to the initial arterial phase in the CT angiography evaluation of extremity trauma. METHODS CT studies from 157 patients (average age 38 years, age range 18-89 years, male 83%, female 17%) were obtained for trauma to the upper or lower extremity with both arterial and venous phases and retrospectively reviewed. The detection rate and type of vascular injury were evaluated by using the arterial phase alone and compared to the detection rate when interpreting the arterial and venous phases together. RESULTS Arterial injury was identified in 35 cases (22%), and venous injury was identified in seven cases (5%). Four cases of discrepant diagnoses were identified between image interpretation of the arterial phase alone and interpretation using both phases, all of which were venous injuries that were visible only on the venous phase. None of the four cases of venous injury required a change in surgical management. Overall, no significant difference in diagnosis between the two methods of image interpretation (arterial phase alone, arterial and venous phases) was discovered (p > 0.125; CI 95%). CONCLUSIONS The use of a venous phase in the CT angiography evaluation of extremity trauma does not add significant arterial diagnostic or clinical management value despite its potential of increasing the diagnostic detection rate of venous injury.
Collapse
Affiliation(s)
- Zachary Masi
- Department of Radiology, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Kathryn Gussman
- Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Joshua P Hazelton
- Department of Surgery, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Ron Gefen
- Department of Radiology, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA.
| |
Collapse
|
6
|
Colip CG, Gorantla V, LeBedis CA, Soto JA, Anderson SW. Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner. Emerg Radiol 2016; 24:223-232. [DOI: 10.1007/s10140-016-1469-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
|
7
|
Contemporary outcomes of lower extremity vascular repairs extending below the knee. J Trauma Acute Care Surg 2016; 81:63-70. [DOI: 10.1097/ta.0000000000000996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Hsu MJ, Gupta A, Soto JA, LeBedis CA. Imaging of Torso and Extremity Vascular Trauma. Semin Roentgenol 2016; 51:165-79. [DOI: 10.1053/j.ro.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
9
|
|
10
|
Branco BC, Linnebur M, Boutrous ML, Leake SS, Inaba K, Charlton-Ouw KM, Azizzadeh A, Fortuna G, DuBose JJ. The predictive value of multidetector CTA on outcomes in patients with below-the-knee vascular injury. Injury 2015; 46:1520-6. [PMID: 26105130 DOI: 10.1016/j.injury.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/25/2015] [Accepted: 06/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Multidetector computed tomographic angiography (MDCTA) has become the gold standard for the early assessment of lower extremity vascular injury. The objective of this study was to evaluate the predictive value of MDCTA documented vessel run-off to the foot on limb salvage rates after lower extremity vascular injury. METHODS All trauma patients undergoing lower extremity MDCTA for suspected vascular injury assessed at 2 high-volume Level I trauma centers between January 2009 and December 2012. Demographics, clinical data and outcomes (compartment syndrome requiring fasciotomy and limb salvage) were extracted. The predictive value of MDCTA vessel run-off was tested against an aggregate gold standard of operative intervention, clinical follow-up and all imaging obtained. RESULTS During the 4-year study period, 398 patients sustained lower extremity trauma and were screened for inclusion into this study. Of those, 166 (41.7%) patients (72.9% at MHH and 27.1% at LAC+USC Medical Center) underwent initial evaluation with MDCTA, 86 (51.8%) had vascular injury below the knee identified by MDCTA. Among these, the average age was 38.0±15.8 years, 80.2% were men and 83.7% sustained a blunt injury mechanism. On admission, 8.1% were hypotensive and the median ISS was 10 (range 1-57). There was a direct correlation between the number of patent vessels to the foot and the need for operative intervention (86.4% with no patent vessels, 56.0% with 1 patent vessel, 33.3% with 2 and 0.0% with 3, p<0.001). When outcomes were analysed, the rates of fasciotomy for compartment syndrome decreased in a stepwise fashion as the number of patent vessels to the foot increased (63.6% with no patent vessels; 44.0% with 1; 21.2% with 2; and 0.0% with 3; p=0.003). No amputations occurred in patients with 2 or more patent vessels to the foot (68.2% for no patent vessel; 16.0% for 1; 0.0% for 2; and 0.0% for 3; p<0.001). CONCLUSIONS In this multicenter evaluation of patients undergoing MDCTA for suspected below-the-knee vascular injury, there was a stepwise increase in the need for operative intervention, fasciotomy and amputation as the number of patent vessels to the foot decreased.
Collapse
Affiliation(s)
| | - Megan Linnebur
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Mina L Boutrous
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Herman Memorial Hospital, 6400 Fannin St, Suite 2850, Houston, TX 77030, USA
| | - Samuel S Leake
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Herman Memorial Hospital, 6400 Fannin St, Suite 2850, Houston, TX 77030, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Kristofer M Charlton-Ouw
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Herman Memorial Hospital, 6400 Fannin St, Suite 2850, Houston, TX 77030, USA
| | - Ali Azizzadeh
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Herman Memorial Hospital, 6400 Fannin St, Suite 2850, Houston, TX 77030, USA
| | - Gerald Fortuna
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Herman Memorial Hospital, 6400 Fannin St, Suite 2850, Houston, TX 77030, USA
| | - Joseph J DuBose
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Herman Memorial Hospital, 6400 Fannin St, Suite 2850, Houston, TX 77030, USA.
| |
Collapse
|
11
|
Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology 2015; 273:S45-74. [PMID: 25340438 DOI: 10.1148/radiol.14141356] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) has had a profound effect on the practice of medicine. Both the spectrum of clinical applications and the role that CT has played in enhancing the depth of our understanding of disease have been profound. Although almost 90 000 articles on CT have been published in peer-reviewed journals over the past 40 years, fewer than 5% of these have been published in Radiology. Nevertheless, these almost 4000 articles have provided a basis for many important medical advances. By enabling a deepened understanding of anatomy, physiology, and pathology, CT has facilitated key advances in the detection and management of disease. This article celebrates this breadth of scientific discovery and development by examining the impact that CT has had on the diagnosis, characterization, and management of a sampling of major health challenges, including stroke, vascular diseases, cancer, trauma, acute abdominal pain, and diffuse lung diseases, as related to key technical advances in CT and manifested in Radiology.
Collapse
Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute and Department of Radiology, Duke University School of Medicine, PO Box 17969, 2400 Pratt St, Durham, NC 27715
| |
Collapse
|
12
|
Multidetector CT and three-dimensional CT angiography of upper extremity arterial injury. Emerg Radiol 2014; 22:269-82. [DOI: 10.1007/s10140-014-1288-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023]
|
13
|
Adibi A, Krishnam MS, Dissanayake S, Plotnik AN, Mohajer K, Arellano C, Ruehm SG. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds. Eur Radiol 2014; 24:1586-93. [DOI: 10.1007/s00330-014-3174-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 11/27/2022]
|
14
|
CT angiography of the upper extremity arterial system: Part 1-Anatomy, technique, and use in trauma patients. AJR Am J Roentgenol 2013; 201:745-52. [PMID: 24059363 DOI: 10.2214/ajr.13.11207] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In this article, we focus on the arterial anatomy of the upper extremities, the technical aspects of upper extremity CT angiography (CTA), and CTA use in trauma patients. CONCLUSION CTA using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with abnormalities of the upper extremity arterial system.
Collapse
|
15
|
Jens S, Kerstens M, Legemate D, Reekers J, Bipat S, Koelemay M. Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Injury due to Trauma: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2013; 46:329-37. [DOI: 10.1016/j.ejvs.2013.04.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/26/2013] [Indexed: 11/30/2022]
|
16
|
Almazedi B, Lyall H, Bhatnagar P, Kessel D, McPherson S, Patel JV, Puppala S. Endovascular Management of Extra-cranial Supra-aortic Vascular Injuries. Cardiovasc Intervent Radiol 2013; 37:55-68. [DOI: 10.1007/s00270-013-0555-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
|
17
|
Suárez Poveda T, Morales Uribe CH, Cruz Vásquez R, Montoya Arango MDP, Ochoa Escudero M. [Efficacy of multidetector computed angiotomography in the diagnosis of limb arterial injuries]. Cir Esp 2012; 91:257-62. [PMID: 23063204 DOI: 10.1016/j.ciresp.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/22/2012] [Accepted: 07/11/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. METHODS Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on 99 limbs suspected of having a traumatic vascular injury over a 44-month period between August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Inter-observer variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. RESULTS MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI: 77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97% (95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869. CONCLUSION Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate therapeutic approach, and could be considered as new gold standard for the diagnosis of arterial injuries of the limbs.
Collapse
|
18
|
Patterson BO, Holt PJ, Cleanthis M, Tai N, Carrell T, Loosemore TM. Imaging vascular trauma. Br J Surg 2011; 99:494-505. [DOI: 10.1002/bjs.7763] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2011] [Indexed: 01/06/2023]
Abstract
Abstract
Background
Over the past 50 years the management of vascular trauma has changed from mandatory surgical exploration to selective non-operative treatment, where possible. Accurate, non-invasive, diagnostic imaging techniques are the key to this strategy. The purpose of this review was to define optimal first-line imaging in patients with suspected vascular injury in different anatomical regions.
Methods
A systematic review was performed of literature relating to radiological diagnosis of vascular trauma over the past decade (2000–2010). Studies were included if the main focus was initial diagnosis of blunt or penetrating vascular injury and more than ten patients were included.
Results
Of 1511 titles identified, 58 articles were incorporated in the systematic review. Most described the use of computed tomography angiography (CTA). The application of duplex ultrasonography, magnetic resonance imaging/angiography and transoesophageal echocardiography was described, but significant drawbacks were highlighted for each. CTA displayed acceptable sensitivity and specificity for diagnosing vascular trauma in blunt and penetrating vascular injury within the neck and extremity, as well as for blunt aortic injury.
Conclusion
Based on the evidence available, CTA should be the first-line investigation for all patients with suspected vascular trauma and no indication for immediate operative intervention.
Collapse
Affiliation(s)
- B O Patterson
- St George's Vascular Institute, St George's University of London, London, UK
| | - P J Holt
- St George's Vascular Institute, St George's University of London, London, UK
| | - M Cleanthis
- Imperial College Regional Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - N Tai
- Trauma Clinical Academic Unit, Barts and the London NHS Trust, London, UK
| | - T Carrell
- National Institute for Health Research Comprehensive Biomedical Research Centre of Guy's and St Thomas' NHS Foundation Trust and Department of Vascular Surgery, King's College London, London, UK
| | - T M Loosemore
- St George's Vascular Institute, St George's University of London, London, UK
| |
Collapse
|
19
|
Foster BR, Anderson SW, Uyeda JW, Brooks JG, Soto JA. Integration of 64-Detector Lower Extremity CT Angiography into Whole-Body Trauma Imaging: Feasibility and Early Experience. Radiology 2011; 261:787-95. [DOI: 10.1148/radiol.11100604] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
20
|
Prospective Evaluation of Multidetector Computed Tomography for Extremity Vascular Trauma. ACTA ACUST UNITED AC 2011; 70:808-15. [DOI: 10.1097/ta.0b013e3182118384] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
21
|
Vascular insufficiency of the upper extremity. J Hand Surg Am 2010; 35:1545-53; quiz 1553. [PMID: 20807633 DOI: 10.1016/j.jhsa.2010.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/06/2010] [Indexed: 02/02/2023]
Abstract
Vascular insufficiency of the upper extremity can be due to acute vascular injury, chronic vasospastic disease, and occlusive disease. Its treatment requires a thorough understanding of the vascular anatomy of the upper extremity, diagnostic modalities, and medical and surgical management options. Promising advances continue to be made in surgical treatment and medical therapy.
Collapse
|
22
|
|
23
|
Shah N, Anderson SW, Vu M, Pieroni S, Rhea JT, Soto JA. Extremity CT angiography: application to trauma using 64-MDCT. Emerg Radiol 2009; 16:425-32. [DOI: 10.1007/s10140-009-0805-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/27/2009] [Indexed: 10/21/2022]
|