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Mousa A, Zakaria OM, Hanbal I, Sultan TA, El-Gibaly AM, Zakaria MY, Nasr MA, Bosat BE, Sharabi A, Neinaa M, El-Hamid MA, Daoud MY, Amin MM, Odeh AM, Alhaieg OM, Farhan MA, Bubshait M, Al-Mulhim ARS. Operative management of non-iatrogenic pediatric and adolescence peripheral arterial trauma: An experience from a resource challenged setting. Asian J Surg 2018; 42:761-767. [PMID: 30396715 DOI: 10.1016/j.asjsur.2018.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To evaluates the management and outcome of non-iatrogenic pediatric and adolescence extremity arterial injuries in a resource-challenged setting. METHODS A retrospective study of the surgical management for non-iatrogenic extremity arterial trauma in pediatric and adolescence during the period from January 2008 to December 2015. This study was performed in two different countries at tertiary referral university and teaching hospitals having a specialized emergency and trauma centers. A thorough study of each patient record was collected from these centers including, the original demographic data and their clinical presentations. Operative data of each patient was also reported. RESULTS During the 8-year period of the study, 149 pediatric and adolescent extremity arterial trauma patients were treated. They were 93.3% male, and 6.7% female, respectively. The age ranged from 2 to 18 years with a mean of 10.25 ± 4.05 years. Lower extremity arterial trauma was recorded in 51%, while 49% were having upper extremity injuries. Primary repair with end-to-end vascular anastomosis was performed in 51.7%, while an interposition reversed saphenous vein graft was performed in 48.3%. The operative procedures were performed by an experienced vascular surgeon and well-trained pediatric surgeons and general surgeons. Pseudoaneurysms was recorded in 9% of cases. Fasciotomy was performed in 15% of cases. CONCLUSION Treatment of pediatric and adolescent extremity arterial injuries with primary end-to-end vascular anastomoses or with the use of an interposition reversed saphenous vein graft is a reliable, feasible, and more cost-effectiveness technique with good results. Moreover, it should be adopted for all vascular trauma patients, whenever possible.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt; Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
| | - Ossama M Zakaria
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia; Divisions of Pediatric Surgery, Emergency Surgery, Department of General and Emergency Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ibrahim Hanbal
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Tamer A Sultan
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amr M El-Gibaly
- Department of General, Visceral, Thoracic and Vascular Surgery, Hanse Klinikum Stralsund, University Medicine of Greifswald, Germany
| | - Mohamed Y Zakaria
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohammed A Nasr
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Bosat E Bosat
- Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Alaa Sharabi
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohamed Neinaa
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mohamed Abd El-Hamid
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohamed Y Daoud
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mahsoub M Amin
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Ahmed M Odeh
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Omer M Alhaieg
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohamed A Farhan
- Divisions of Pediatric Surgery, Emergency Surgery, Department of General and Emergency Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed Bubshait
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdul Rahman S Al-Mulhim
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Zhong W, Zhao Y, Tian Y, Chen M, Lai X. The protective effects of HGF against apoptosis in vascular endothelial cells caused by peripheral vascular injury. Acta Biochim Biophys Sin (Shanghai) 2018; 50:701-708. [PMID: 29718063 DOI: 10.1093/abbs/gmy048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/09/2018] [Indexed: 01/21/2023] Open
Abstract
Closed vascular injuries have danger of developing critical tissue ischemia with a high risk of amputation and limb loss. However, limited effective strategies exist at present. In this study, we investigate the role of hepatocyte growth factor (HGF) on apoptosis of vascular endothelial cells (VECs). First, apoptosis of VECs was induced by hypoxia treatment with or without HGF. Annexin V-7AAD apoptosis assay revealed that HGF overexpression significantly reduced VEC apoptosis. Then a closed peripheral vascular injury animal model was created by balloon catheter in female New Zealand rabbit. The VECs overexpressing HGF were injected into balloon injury rabbit. TUNEL and caspase 3 staining assays revealed that balloon catheter-treated artery showed severe intimal hyperplasia, with a 70% apoptosis rate (P < 0.05, vs. sham group), while HGF-overexpressing group showed a significant reduction of apoptosis. Furthermore, the expressions of Fas/FasL and their downstream apoptosis-related proteins were significantly decreased in HGF-overexpressing group when compared with those in balloon injury group as detected by western blot analysis. All these data indicated that HGF exhibited anti-apoptotic effects during VEC apoptosis, which might be mediated by the inhibition of Fas/FasL pathway. Our study provides a theoretic basis for the application of HGF in the gene therapy of closed peripheral vascular injury.
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Affiliation(s)
- Wu Zhong
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ye Tian
- Department of Emergency, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Muhu Chen
- Department of Emergency, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xue Lai
- Department of Emergency, the Affiliated Hospital of Southwest Medical University, Luzhou, China
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Abstract
BACKGROUND Drug and alcohol use complicate the presentation and management of traumatic injuries. Impaired hemodynamic recovery and host defense in substance users also predispose these patients to worse outcomes after trauma. We hypothesized that substance abuse, particularly when drugs and alcohol are combined, complicates the presentation, management, and patient outcomes following isolated traumatic peripheral vascular injury. METHODS This is a retrospective analysis of patients admitted with isolated peripheral vascular injury to our Level 1 trauma center between 2006 and 2012. Demographics, presentation, substance use, resuscitation, operative management, intensive care needs, and length of hospital stay were analyzed. RESULTS From 257 patients admitted, 158 patients experienced isolated peripheral vascular injury. Patients were subdivided by blood alcohol level (BAL) and urinary toxicology (utox) screens; negative BAL/negative utox (nonintoxicated, n = 90), negative BAL/positive utox (drug users, n = 27), positive BAL/negative utox (alcohol users, n = 22), and positive BAL/positive utox (polysubstance users, n = 19). Compared with nonintoxicated patients, more polysubstance users experienced lower-extremity injury (79% vs. 47%) and presented more often than alcohol users with proximal injury (83% vs. 45%), lower-extremity injury (79% vs. 36%), and as a result of assault (68.4% vs. 31.8%). Polysubstance users required greater resuscitation, more operations, and more frequently experienced complications than any other cohort. Subsequently, these patients had a greater need for intensive care management and longer hospital stay than nonintoxicated and alcohol users. Moreover, using multivariate logistic regression analysis, we found that polysubstance use, alcohol use, and lower-extremity injury are each independent risk factors for infectious complications. CONCLUSION Our data show that polysubstance users with isolated peripheral vascular injury experience more proximal and lower-extremity injuries, require greater resuscitation, and undergo more operations compared with nonintoxicated patients. Treatment of these patients is more frequently complicated by infection, vascular complications, and increased hospital length of stay.
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