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Abu-Zidan FM, Abdel-Kader S, Mousa H, Aiyan AA, Baguneid MS, Jawas A. Camel-related major vascular injuries: A 20-years' experience. Injury 2023; 54:138-144. [PMID: 35934569 DOI: 10.1016/j.injury.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Majority of human animal-related injuries in the United Arab Emirates are caused by camels. These may involve major vessels and can be life-threatening. We aimed to study the biomechanism, injured regions, management, and outcome of major camel-related human vascular injuries. METHODS We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. Studied variables included demography, mechanism of injury, injured structures, clinical presentation, vital signs on arrival, associated injuries, surgical management, ICU stay, length of hospital stay, complications, and outcome. RESULTS Seven patients were studied; all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life-threatening. A camel bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one became vegetative, and one had arm paralysis. CONCLUSIONS Major camel-related vascular injuries have a poor clinical outcome. This is related to the biomechanism of injury which combines penetrating, crushing and blunt trauma. Neck wounds of camel bites can be closed primarily after debridement.
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Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, CMHS, United Arab Emirates University, Al-Ain, United Arab Emirates.
| | - Saleh Abdel-Kader
- Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates
| | - Hussam Mousa
- Department of Surgery, CMHS, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ahmad Al Aiyan
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Ali Jawas
- Department of Surgery, CMHS, United Arab Emirates University, Al-Ain, United Arab Emirates
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Al Wahbi A, Aldakhil S, Al Turki S, El Kayali A, Al Kohlani H, Al Showmer A. Risk factors for amputation in extremity vascular injuries in Saudi Arabia. Vasc Health Risk Manag 2016; 12:229-32. [PMID: 27307745 PMCID: PMC4888860 DOI: 10.2147/vhrm.s91452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies.
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Affiliation(s)
- Abdullah Al Wahbi
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Salman Aldakhil
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saud Al Turki
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman El Kayali
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hussein Al Kohlani
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al Showmer
- Department of Surgery, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Gyedu A, Stewart BT, Nakua E, Quansah R, Donkor P, Mock C, Hardy M, Yangni-Angate KH. Assessment of risk of peripheral vascular disease and vascular care capacity in low- and middle-income countries. Br J Surg 2015; 103:51-9. [PMID: 26560502 DOI: 10.1002/bjs.9956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/01/2015] [Accepted: 08/27/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study aimed to describe national peripheral vascular disease (PVD) risk and health burden, and vascular care capacity in Ghana. The gap between PVD burden and vascular care capacity in low- and middle-income countries was defined, and capacity improvement priorities were identified. METHODS Data to estimate PVD risk factor burden were obtained from the World Health Organization Study on Global Ageing and Adult Health (SAGE), Ghana, and the Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) database. In addition, a novel nationwide assessment of vascular care capacity was performed, with 20 vascular care items assessed at 40 hospitals in Ghana. Factors contributing to specific item deficiency were described. RESULTS From the SAGE database, there were 4305 respondents aged at least 50 years with data to estimate PVD risk. Of these, 57·4 per cent were at moderate to risk high of PVD with at least three risk factors; extrapolating nationally, the estimate was 1 654 557 people. Based on IHME GBD data, the estimated disability-adjusted life-years incurred from PVD increased fivefold from 1990 to 2010 (from 6·3 to 31·7 per 100 000 persons respectively). Vascular care capacity assessment demonstrated marked deficiencies in items for diagnosis, and in perioperative and vascular surgical care. Deficiencies were most often due to absence of equipment, lack of training and technology breakage. CONCLUSION Risk factor reduction and management as well as optimization of current resources are paramount to avoid the large burden of PVD falling on healthcare systems in low- and middle-income countries. These countries are not well equipped to handle vascular surgical care, and rapid development of such capacity would be difficult and expensive.
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Affiliation(s)
- A Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - B T Stewart
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Departments of Surgery, University of Washington, Washington, USA
| | - E Nakua
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - R Quansah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - P Donkor
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - C Mock
- Departments of Surgery, University of Washington, Washington, USA.,Departments of Global Health, University of Washington, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | - M Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, USA
| | - K H Yangni-Angate
- Department of Surgery, Bouake Teaching Hospital, and Department of Thoracic and Cardiovascular Diseases, University of Bouake, Bouake, Ivory Coast
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Al-Ganadi A. Management of Vascular Injury during Current Peaceful Yemeni Revolution. Ann Vasc Surg 2015; 29:1575-80. [DOI: 10.1016/j.avsg.2015.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
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Vascular surgery research in the Gulf Cooperation Council countries. Asian J Surg 2014; 37:100-5. [PMID: 24398446 DOI: 10.1016/j.asjsur.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 08/06/2013] [Accepted: 11/19/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To evaluate the quantity and quality of published vascular surgery research articles from the Gulf Cooperation Council (GCC) countries so as to identify areas for improvement. DESIGN Descriptive study. MATERIALS Published MEDLINE articles on vascular surgery from the GCC countries (1960-2010). METHODS Critical analysis of the articles. RESULTS A total of 146 articles were studied, majority of which were case series/case reports (55.5%); 33% of the articles were prospective. The first author was from a university in 67.1% of the articles. Only one randomized controlled trial was found. The median (range) impact factor of the journals was 1.16 (0.16-12.64). Kuwait had the highest number of publications/country, standardized/100,000 inhabitants. There were 11 experimental studies, which were all from Kuwait. More statistically significant, experimental vascular surgery papers were published prior to 1993 (11/30 compared with 0/111 afterward, p < 0.0001; Fisher exact test). The GCC countries had the lowest vascular surgery research output compared with Turkey, Hong Kong, Singapore, and Japan when standardized by the population. The h index of the GCC countries' vascular research publications was the lowest (19) compared with the other four countries (29-97). Furthermore, the average citation of the GCC countries (5.81) was similar to Turkey (5.66), but less than Hong Kong (17.38), Singapore (12.79), and Japan (11.75). CONCLUSION The quality and quantity of vascular surgery research in the GCC countries should be improved to answer important local questions related to vascular diseases. This needs better strategic planning and more collaboration between various institutions.
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Jawas A, Abbas AK, Nazzal M, Albader M, Abu-Zidan FM. Management of war-related vascular injuries: experience from the second gulf war. World J Emerg Surg 2013; 8:22. [PMID: 23816260 PMCID: PMC3700839 DOI: 10.1186/1749-7922-8-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/27/2013] [Indexed: 01/12/2023] Open
Abstract
AIM To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War. METHODS This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome. RESULTS 36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1-76) days. 5 patients died (14%). CONCLUSIONS Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.
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Affiliation(s)
- Ali Jawas
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates.
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Abu-Zidan FM. What's New in Emergencies, Trauma and Shock? Mapping and managing missile injuries. J Emerg Trauma Shock 2011; 4:159-60. [PMID: 21769197 PMCID: PMC3132350 DOI: 10.4103/0974-2700.82197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 10/11/2010] [Indexed: 11/04/2022] Open
Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, Faculty of Medicine and Health Sciences, P.O. Box 17666, Al-Ain, United Arab Emirates
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