Endovascular to Extracorporeal Organ Support for Vascular Trauma and Shock

Abstract. Although management paradigms for certain arterial trauma, such as aortic injuries, have moved towards an endovascular approach, the application of endovascular techniques for the treatment of peripheral arterial injuries continues to be debated. In the realm of peripheral vascular trauma, popliteal arterial injuries remain a devastating condition with significant rates of limb loss. Expedient management is essential and surgical revascularization has been the gold standard. Initial clinical assessment of vascular injury is aided by readily available imaging techniques such as duplex ultrasonography and high resolution computed tomographic angiography. Conventional catheter based angiography, however, remain the gold standard in the determination of vascular injury. There are limited data examining the outcomes of endovascular techniques to address popliteal arterial injuries. In this review, we examine the imaging modalities and current approaches and data regarding endovascular techniques for the management popliteal arterial trauma.

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Vascular trauma of the hand – a systematic review

VASA ◽

10.1024/0301-1526/a000743 ◽

2019 ◽

Vol 48 (3) ◽

pp. 205-215 ◽

Cited By ~ 1

Author(s):

Uwe Wahl ◽

Ingmar Kaden ◽

Andreas Köhler ◽

Tobias Hirsch

Keyword(s):

Duplex Sonography ◽

Vascular Trauma ◽

Vascular Lesions ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Limited Information ◽

Endovascular Interventions ◽

Provocation Tests ◽

Objective Basis ◽

Allen Test

Abstract. Hypothenar or thenar hammer syndrome (HHS) and hand-arm vibration syndrome (HAVS) are diseases caused by acute or chronic trauma to the upper extremities. Since both diseases are generally related to occupation and are recognised as occupational diseases in most countries, vascular physicians need to be able to distinguish between the two entities and differentiate them from other diagnoses. A total of 867 articles were identified as part of an Internet search on PubMed and in non-listed occupational journals. For the analysis we included 119 entries on HHS as well as 101 papers on HAVS. A professional history and a job analysis were key components when surveying the patient’s medical history. The Doppler-Allen test, duplex sonography and optical acral pulse oscillometry were suitable for finding an objective basis for the clinical tests. In the case of HHS, digital subtraction angiography was used to confirm the diagnosis and plan treatment. Radiological tomographic techniques provided very limited information distal to the wrist. The vascular component of HAVS proved to be strongly dependent on temperature and had to be differentiated from the various other causes of secondary Raynaud’s phenomenon. The disease was medicated with anticoagulants and vasoactive substances. If these were not effective, a bypass was performed in addition to various endovascular interventions, especially in the case of HHS. Despite the relatively large number of people exposed, trauma-induced circulatory disorders of the hands can be observed in a comparatively small number of cases. For the diagnosis of HHS, the morphological detection of vascular lesions through imaging is essential since the disorder can be accompanied by critical limb ischaemia, which may require bypass surgery. In the case of HAVS, vascular and sensoneurological pathologies must be objectified through provocation tests. The main therapeutic approach to HAVS is preventing exposure.

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The Inhibition of Platelet Aggregation by an Aorta Intima Extract

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647710 ◽

1974 ◽

Vol 32 (02/03) ◽

pp. 417-431 ◽

Cited By ~ 14

Author(s):

A. du P Heyns ◽

D. J van den Berg ◽

G. M Potgieter ◽

F. P Retief

Keyword(s):

Platelet Aggregation ◽

Degradation Products ◽

Adenosine Diphosphate ◽

Inhibitory Effect ◽

Protective Role ◽

Vascular Trauma ◽

Wear And Tear ◽

Sequential Addition ◽

Aggregation Activity

SummaryThe platelet aggregating activity of extracts of different layers of the arterial wall was compared to that of Achilles tendon. Arterial media and tendon extracts, adjusted to equivalent protein content as an index of concentration, aggregated platelets to the same extent but an arterial intima extract did not aggregate platelets. Platelet aggregation induced by collagen could be inhibited by mixing with intima extract, but only to a maximum of about 80%. Pre-mixing adenosine diphosphate (ADP) with intima extracts diminished the platelet aggregation activity of the ADP. Depending on the relationship between ADP and intima extract concentrations aggregating activity could either be completely inhibited or inhibition abolished. Incubation of ADP with intima extract and subsequent separation of degradation products by paper chromatography, demonstrated a time-dependent breakdown of ADP with AMP, adenosine, inosine and hypoxanthine as metabolic products; ADP removal was complete. Collagen, thrombin and adrenaline aggregate platelets mainly by endogenous ADP of the release reaction. Results of experiments comparing inhibition of aggregation caused by premixing aggregating agent with intima extract, before exposure to platelets, and the sequential addition of first the intima extract and then aggregating agent to platelets, suggest that the inhibitory effect of intima extract results from ADP breakdown. It is suggested that this ADP degradation by intima extract may play a protective role in vivo by limiting the size of platelet aggregates forming at the site of minimal “wear and tear” vascular trauma.

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A P-Selectin/CD62P Monoclonal Antibody (LYP-20), in Tandem with Flow Cytometry, Detects in vivo Activated Circulating Rat Platelets in Severe Vascular Trauma

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648952 ◽

1994 ◽

Vol 72 (05) ◽

pp. 745-749 ◽

Cited By ~ 7

Author(s):

Elza Chignier ◽

Maud Parise ◽

Lilian McGregor ◽

Caroline Delabre ◽

Sylvie Faucompret ◽

...

Keyword(s):

Monoclonal Antibody ◽

Flow Cytometry ◽

Platelet Activation ◽

Peripheral Blood ◽

Vascular Trauma ◽

Activated Platelets ◽

Group I ◽

Group Ii ◽

Rat Platelets

SummaryP-selectin, also known as CD62P, GMP140 or PADGEM, is present in platelet a-granules and endothelial cell Weibel-Palade bodies and is very rapidly expressed on the surface of these cells on activation. In this study, an anti P-selectin monoclonal antibody (LYP20) was used, in tandem with flow cytometry, to identify activated platelets at the site of induced vascular trauma or in peripheral blood. Moreover, electron microscopy was performed to characterize sites of vascular trauma and quantify the number of adhering platelets. The same induced vascular trauma was observed to result into animals responding in 2 different ways (Group I, Group II) following the degree of platelet activation. Five rats, out of 14 with induced vascular trauma, had more than half of their circulating platelets expressing P-selectin when drawn at the site of the trauma (67.4% ± 3.44) or in peripheral blood (78.5% ± 2.5) (Group I). In the remaining 9 animals a much smaller proportion of circulating platelets expressed P-selectin when assayed from trauma sites (18% ± 3.34) or in peripheral blood (18.0% ± 4.30) (Group II). Enhanced P-selectin expression by circulating platelets in Group I, compared to Group II, appears to be linked to the degree of activated platelets adhering at sites of trauma (171 ± 15 × 103 platelets versus 48 ± 31 × 103 platelets per mm2). In the 5 control animals, that were not operated on, platelets expressing P-selectin when drawn at the site of a mock trauma (7.0% ± 1.84) or in the peripheral blood (11.2% ± 3.30) showed little activation. In addition, no platelet adhesion was seen on the vascular bed of these animals. Results from this study show that analysis of P-selectin (CD62P) expression, in circulating platelets, is a valuable and rapid marker of platelet activation following severe vascular trauma induced in rats. However, activated platelets were not detected to the same extent in the peripheral blood of all animals having undergone vascular trauma. It is conceivable that platelets, depending on the degree of activation, may be actively sequestered in organs and prevented from circulating. Alternatively, P-selectin may be rapidly endocytosed, or not expressed, by activated circulating platelets depending on the type of agonists implicated in vivo activation.

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The Role of Stent Design and Polymers in Safety Outcomes – A Review

European Cardiology Review ◽

10.15420/ecr.2012.8.1.63 ◽

2012 ◽

Vol 8 (1) ◽

pp. 63

Author(s):

Carlo Zivelonghi ◽

Giulia Geremia ◽

Michele Pighi ◽

Flavio Ribichini ◽

◽

...

Keyword(s):

Clinical Performance ◽

Drug Carrier ◽

Chemical Properties ◽

Vascular Wall ◽

Radial Force ◽

Vascular Trauma ◽

Polymer Composition ◽

Drug Eluting Stent ◽

Stent Design ◽

Drug Elution

Each component of a drug-eluting stent (DES) contributes to the safety of the device. Continuous efforts are being dedicated to the search of the optimal compromise between facility of use, safety and long-term efficacy. Shorter balloons reduce the vascular trauma beyond the stent struts; the metallic composition of the stent platform and the platform itself interact with the vascular wall in a long-lasting equilibrium between radial force, vessel patency and reparative cellular regrowth. The modality of drug elution is largely regulated by the chosen drug carrier, rather than by the chemical properties of the drug itself. Drug elution can be accomplished by permanent polymers that remain in the vessel wall forever, by biodegradable polymers that leave the naked metallic structure behind after their complete absorption, or even by direct release of the drug from stent reservoirs. The clinical performance of DESs has been exhaustively assessed in a large number of studies that have showed rapid and continuous improvements, from the first-generation DESs to the latest devices, based on substantial changes in stent design and polymer composition.

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Erste Erfahrungen mit dem ADVOS®-Verfahren (Advanced Organ Support) bei Patienten mit alkoholischer Steatohepatitis

10.26226/morressier.57ffb53ed462b8028d890c46 ◽

2016 ◽

Author(s):

Wolfgang Huber

Keyword(s):

Organ Support

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Medical Therapeutics Derived from Leeches (Phy. Annelida; Cl. Hirudinea)

MacEwan University Student eJournal ◽

10.31542/j.muse.297 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Christopher Everett Warren Clarke

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Heart Attack ◽

Blood Feeding ◽

Vascular Trauma ◽

Biological Molecules ◽

Future Treatment ◽

Medical Therapeutics

Of all blood feeding invertebrates, few are more notorious than leeches. Throughout their existence as ectoparasites, leeches have evolved to release biological molecules in their saliva that act to counter the responses of the prey’s body to vascular trauma. Inadvertently, these very molecules have been used by humans for centuries for medicinal purposes; however, it is only recently that their cellular action has been elucidated. As a result, these compounds have been isolated and mass produced to treat a wide variety of conditions ranging from heart attack to Alzheimer’s disease and continued work suggests that these isolates will be an important future treatment for metastasis.

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Post-Tonsillectomy Hemorrhage Diagnosis and Management

Otolaryngology ◽

10.1016/j.otohns.2008.05.113 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P34-P35 ◽

Cited By ~ 2

Author(s):

Michael S Morris

Keyword(s):

Ct Angiography ◽

Early Stage ◽

Cardiopulmonary Arrest ◽

Vascular Trauma ◽

Post Mortem ◽

Direct Examination ◽

Operative Field ◽

Different Types ◽

Vascular Physiology ◽

Vascular Spasm

Objective 1) Better recognize pathophysiology of postoperative tonsillectomy hemorrhage. 2) Be able to better differentiate the different types of post-tonsillectomy hemorrhage based upon understanding the vascular physiology and adjust management accordingly. Methods Post-tonsillectomy complications in children and adults were reviewed. 7 cases of hemorrhage, including 5 deaths, were carefully reviewed. Patients ranged between 2–40 years of age. This represents the largest series of post-tonsillectomy deaths reported to date. All postoperative deaths were due to bleeding and cardiopulmonary arrest. Post-mortem analysis was undertaken on those patients. CT angiography was reviewed in one surviving patient and the utility of this type of scanning is discussed. Results Post-tonsillectomy bleeding is one of the most worrisome otolaryngology concerns. Patients with bleeding on postoperative days 2–3 reported episodic bleeding stopping spontaneously. In these patients, the episode of unobserved bleeding signaled a vascular spasm with a likehood of recurrence. When the bleeding recurred it was massive and occured in a uncontrolled setting, leading to a poor outcome. Vascular trauma and spasm is likely. Conclusions Postoperative tonsillectomy bleeding is better managed by differentiating those patients with early stage bleeding on postoperative days 2–3. Direct examination of the operative field is imperative. Ancillary testing including CT angiograpy is helpful in the evaluation.

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Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

Blood Purification ◽

10.1159/000517280 ◽

2021 ◽

pp. 1-10

Author(s):

Guglielmo Consales ◽

Lucia Zamidei ◽

Franco Turani ◽

Diego Atzeni ◽

Paolo Isoni ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Multiorgan Failure ◽

Invasive Mechanical Ventilation ◽

Respiratory Acidosis ◽

Kidney Injury ◽

Protective Ventilation ◽

Retrospective Observational Study ◽

Organ Support ◽

Chronic Obstructive

Background: Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO2R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO2 with very low extracorporeal blood flows (<400 mL/min). Objectives: To evaluate efficacy and safety of combined ECCO2R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. Methods: We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO2R-CRRT were recorded. Results: Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO2 clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. Conclusion: ECCO2R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

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Intrahepatic vascular trauma

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000675 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000675

Author(s):

Melike Harfouche ◽

David V Feliciano

Keyword(s):

Vascular Trauma

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