Peripheral vascular injuries and their management in accra

SUMMARY BACKGROUND

The true incidence of vascular injuries in Ghana is not known on account of low reporting.

OBJECTIVE

We performed a study aimed at reviewing the pattern of injuries to peripheral vessels, and also the pattern of referral, presentation and management of these injuries at the Korle-Bu Teaching Hospital, Accra.

METHOD

The study covered the period of January 1989 to March 2005 and involved a review of all peripheral vessel injuries referred for vascular surgical opinion.

RESULTS

Fifty two (52) patients with aged between 13-50 years were reviewed. Penetrating trauma (82.7%) and blunt trauma (11.5%) were the commonest modes of injury. Arterial injuries (63.5%) and combined arterial and venous injuries (23.1%) were the commonest forms of injury. Brachial artery injuries were the commonest injuries seen. Associated nerve injuries occurred in 25% of patients most of whom also had brachial artery injuries. Late presentations of false aneurysms and arteriovenous fistulae were seen in 40.4% patients. There were delays in referring patients (range 1 hour to 4 years). Vascular investigations like angiograms and duplex scanning were obtained in only 25.0% of patients. Vascular reconstruction was successful in 84.6% patients and 7.7% of patients required major limb amputation and an equal number of patients died from other injuries.

CONCLUSION

There is undue delay in referring patients with vascular injuries for intervention due to the inability of the initial attending medical personnel to recognize these injuries. Most of these injuries can be adequately treated without the use of sophisticated investigations, which are usually expensive.

Imaging in penetrating neck injuries

The neck is a close compartment wherein many vital structures like carotid and vertebral vessels, larynx, trachea, pharynx, oesophagus and spinal cord are packed closely. As a result penetrating neck injury with either sharp objects like knife or projectile injury can result in significant morbidity and mortality. There have been considerable changes in management strategies of penetrating neck injuries time to time with most of injuries managed conservatively in hemodynamically stable patients. CT angiography plays an important role in detecting injuries to structure which require immediate surgery/ endovascular intervention and helps to avoid unnecessary surgical exploration in stable patients. This article intends to familiarize radiologists with imaging features of injuries to various structures of neck which shouldn't be missed and highlight stepwise approach for evaluation of neck structures in penetrating injury.

The role of computed tomography in arterial injury evaluation in solid organ trauma

BACKGROUND

Abdominal solid organ trauma accounts for 86.9% of all blunt abdominal trauma cases, among which 5%-25% of cases are associated with arterial injuries. Aim: In this study, we aimed to determine the characteristics and diagnostic functions of computed tomography (CT) scans during the diagnosis of arterial injuries, including active extravasation, pseudoaneurysm, and arteriovenous fistula associated with solid organ trauma compared with digital subtraction angiography (DSA).

METHODS

From July 2019 to March 2020, a retrospective study was performed on 44 patients who presented with clinical manifestations of blunt abdominal injury and CT diagnosis of arterial injuries due to solid organ trauma, including active extravasation, pseudoaneurysm, and arteriovenous fistula, and later underwent DSA at Vietduc Hospital, in Hanoi, Vietnam. The features of arterial lesions on CT scan was described. Value of CT scan for the diagnosis of arterial injuries was analyzed compared to the DSA findings.

RESULTS

There were 53 arterial lesions observed on CT scan including 15 active extravasations, 34 pseudoaneurysms, and 4 arteriovenous fistulas while 51 arterial lesions were observed on DSA including 15 active extravasations, 30 pseudoaneurysms, and 6 arteriovenous fistulas. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of active extravasation, pseudoaneurysm, and arteriovenous fistula on CT scan were 93.3%, 97.7%, 93.3%, 97.7% and 96.6% ; 90%, 75%, 79.4%, 87.5% and 82.8%; and 66.7%, 100%, 100%, 96.3% and 96.6%, respectively.

CONCLUSIONS

Our study showed that CT scans had high sensitivity and specificity for the diagnosis of active extravasation; however, CT scans demonstrated low specificity for detecting pseudoaneurysm and low sensitivity for the diagnosis of arteriovenous fistula.

Predictors of long-term outcomes after polytetrafluoroethylene-covered stent-graft repair of peripheral arterial aneurysms, pseudo-aneurysms, and arterio-venous fistulas

OBJECTIVES

To evaluate the primary patency rate at three years for the infra-aortic peripheral arterial pathologies treated with polytetrafluoroethylene-covered stent-grafts.

METHODS

Patients treated with self-expandable polytetrafluoroethylene-covered stent-grafts for infra-aortic peripheral arterial aneurysms, pseudo-aneurysms, and arterio-venous fistulas were evaluated retrospectively. A total of 48 patients (35 male, 13 female; mean age: 53.8 ± 13.5) were included with 29.0 ± 16.5 months (median 27, range 4-70) mean follow-up period. The primary objective was to determine the primary patency rate at three years. The secondary objectives were to compare type and localization of pathology, and length and diameter of the stent-grafts with primary patency rate. Kaplan-Meier test was used as the main statistical method.

RESULTS

Overall mean primary patency rate at three years was 77.10%. Polytetrafluoroethylene-covered stent-graft implantation in aneurysms had worse primary patency rate than pseudo-aneurysms and arterio-venous fistulas (66.6%, P = 0.03; 76.9%, P = 0.03; 88.2%, P = 0.01, respectively). Stent-graft location, length, and diameter are not associated with primary patency rate (P > 0.05) but stent diameter is associated with better primary assisted and secondary patency rates (P < 0.05).

CONCLUSIONS

Pathology of the lesion is associated with the long-term primary patency rate of polytetrafluoroethylene-covered stent-grafts but not the stent-graft location, length, or diameter. Stent diameter is associated with primary assisted and secondary patency rates.