In-hospital outcomes of patients with non-iatrogenic civilian 					vascular trauma

Summary: Background: Morbidity, lesion pattern, management and short-term outcomes of civilian vascular trauma are rarely evaluated. Therefore, analysis of in hospital results in patients with non-iatrogenic vascular trauma in a tertiary referral hospital was performed. Patients and methods: Retrospective evaluation of patients with vascular trauma from 2007–2017 was done. 48 patients (34 male, 14 females, mean age 56 years) were included. Excluded were patients with iatrogenic vascular complications. Major cause of vascular trauma were traffic accidents in 43.8 %, fall from great heights in 27.1 %, sport and home related injuries in 16.8 %, suicidal injuries in 4.2 % and gunshot wounds in 2.1 % (other 6.3 %). 60.4 % of patients presented with blunt, 39.6 % of patients with penetrating vascular trauma. More than half of the cases included polytraumatized patients (54.4 %). Results: Most commonly affected were the popliteal (25.0 %) and the axillar artery (18.8 %). Aortic injuries were present in 14.6 % of cases, whereas the femoral and subclavian artery were involved in 12.6 % and 10.4 %. Vascular reconstruction was performed by interposition graft in 45.9 %, direct suture in 18.8 %, patchplasty in 10.4 %, ligation in 12.4 %, and implantation of stentgraft in 12.5 %. Postoperative complication rate was 54.2 %. Rate of in-hospital major amputation was 14.6 % and in-hospital mortality was 14.6 % as well. Comparison between blunt and penetrating trauma as to postoperative complication (p = 0.322), blood transfusion (p = 0.452) and amputation (p = 0.304) showed no significant differences, whereas lethality in blunt trauma was 20.6 % vs. 5.2 % in penetrating trauma. Injury severity score (ISS) was significantly elevated for blunt trauma patients (mean ISS Score blunt 32 vs 21 penetrating, p = 0.043). Conclusions: The majority of vascular lesions is caused by blunt trauma. Blunt lesions do also show a severe injury pattern, compared to penetrating trauma, and the complication rate remains high. However, by means of vascular reconstruction, limb salvage is feasible in a high percentage of cases.

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A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17006859 ◽

2017 ◽

Vol 32 (6) ◽

pp. 631-635 ◽

Cited By ~ 2

Author(s):

Joshua Nackenson ◽

Amado A. Baez ◽

Jonathan P. Meizoso

Keyword(s):

Emergency Medical Services ◽

Blunt Trauma ◽

Injury Severity ◽

Femur Fracture ◽

Descriptive Analysis ◽

Penetrating Trauma ◽

Physical Exam ◽

Medical Services ◽

Prehospital Treatment ◽

Emergency Medical

AbstractStudy ObjectivesTraction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).MethodsThis is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.ResultsThere were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).ConclusionAlthough signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.NackensonJ, BaezAA, MeizosoJP. A descriptive analysis of traction splint utilization and IV analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

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Iatrogenic Vascular Complications Associated With External Ventricular Drain Placement: A Report of 8 Cases and Review of the Literature

Operative Neurosurgery ◽

10.1227/neu.0b013e318279e783 ◽

2012 ◽

Vol 72 (2) ◽

pp. ons208-ons213 ◽

Cited By ~ 2

Author(s):

Jennifer Kosty ◽

Bryan Pukenas ◽

Michelle Smith ◽

Phillip B. Storm ◽

Eric Zager ◽

...

Keyword(s):

Transarterial Embolization ◽

External Ventricular Drain ◽

Superficial Temporal Artery ◽

Vascular Complications ◽

Temporal Artery ◽

Vascular Trauma ◽

Vascular Lesions ◽

Ventricular Catheter ◽

Traumatic Aneurysm ◽

Arteriovenous Fistulas

Abstract BACKGROUND: Placement of an external ventricular drain (EVD) is a commonly performed and often lifesaving procedure. Although hemorrhage is one of the commonest complications associated with the procedure, ventricular catheter–induced vascular injury is rarely reported. OBJECTIVE: To describe 9 cases of EVD-related vascular trauma: 7 arteriovenous fistulas and 2 traumatic aneurysms. METHODS: During a 3-year period, 299 patients had EVDs placed. Eight patients (2.75%), 3 male and 5 female (mean age, 48 ± 20 years), developed vascular lesions associated with EVDs. Six patients developed arteriovenous fistulas and 2 patients developed a traumatic aneurysm. The arterial feeders of 5 superficial draining fistulas arose from the middle meningeal artery, and the arterial feeder of a deep-draining fistula originated from a lenticulostriate artery. One traumatic aneurysm arose from a distal branch of the anterior cerebral artery, and the second from a branch of the superficial temporal artery. Four of the superficial fistulas were treated with transarterial embolization. RESULTS: Two superficial fistulas and the deep-draining fistula resolved spontaneously after EVD removal. The intracranial aneurysm was embolized with Onyx18, and the superficial temporal artery aneurysm was managed conservatively. There were no hemorrhages associated with any of these vascular lesions and no complications after treatment. CONCLUSION: Our data suggest that iatrogenic vascular trauma associated with EVD insertions (2.75%) may be more common than is currently appreciated. Endovascular treatment is effective and may be necessary when these lesions do not resolve spontaneously.

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Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

Colombia Medica ◽

10.25100/cm.v51i1.4224 ◽

2020 ◽

Author(s):

Carlos Ordoñez ◽

Carlos García ◽

Michael W. Parra ◽

Edison Angamarca ◽

Mónica Guzmán-Rodríguez ◽

...

Keyword(s):

Blunt Trauma ◽

Injury Severity ◽

Penetrating Trauma ◽

Severe Trauma ◽

Whole Body ◽

Surgical Interventions ◽

Single Pass ◽

Group 3 ◽

Group 2 ◽

Group 1

Purpose: The objective of this study was to evaluate the implementation of a new Single-Pass WBCT Protocol in the management of patients with severe trauma. Methods: This was an observational, prospective study of polytrauma patients who underwent WBCT. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, WBCT parameters and outcome variables were evaluated. Results: 263 patients were included. Median Injury Severity Score (ISS) was 22 (IQR: 16-22). Time between arrival to the ED and completing the WBCT was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50); p=0.96]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. RSR 85% (p=0.69); Group 2: TRISS 69% vs. RSR 74% (p=0.25); Group 3: TRISS 93% vs. RSR 87% (p=0.07)]. Conclusion: This new Single-Pass WBCT Protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

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Diaphragmatic Injuries: What Has Changed over a 20-Year Period?

The American Surgeon ◽

10.1177/000313481007600520 ◽

2010 ◽

Vol 76 (5) ◽

pp. 512-516 ◽

Cited By ~ 8

Author(s):

Peter P. Lopez ◽

Jorge Arango ◽

Theresa M. Gallup ◽

Stephen M. Cohn ◽

John Myers ◽

...

Keyword(s):

Blunt Trauma ◽

Chart Review ◽

Injury Severity ◽

Penetrating Trauma ◽

Retrospective Chart Review ◽

Diaphragmatic Injury ◽

Associated Injuries ◽

Severity Scores ◽

Diaphragm Injuries ◽

Overall Mortality

Traumatic diaphragmatic injuries are uncommon events but are associated with a high mortality. We hypothesize that injury pattern has changed over time with increasing prevalence of blunt injuries. A retrospective chart review was performed of 124 patients who sustained traumatic diaphragmatic injuries over the 20-year period between January 1,1986 and December 31, 2005. Penetrating trauma accounted for 65 per cent (80/124) of all diaphragm injuries, and blunt trauma for 35 per cent (44/124). Mean Injury Severity Scores of 19 ± 9 and 34 ± 13 were observed for the penetrating and blunt trauma groups, respectively ( P = 0.001). Blunt traumatic diaphragm injuries increased from 13 per cent in the first 10-year period to 66 per cent in the second 10-year period ( P = 0.001). The overall mortality was 9 per cent (11/124) with 10 deaths resulting from blunt trauma and one resulting from penetrating trauma ( P < 0.001). The mortality rate increased from 3 to 17 per cent over the two decades ( P = 0.007). Our data suggests that over the last 20 years, the increase in mortality associated with traumatic diaphragmatic injury is primarily related to an increase in the proportion of patients with blunt trauma as a cause of their diaphragmatic injury and associated injuries.

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The Epidemiology of and Outcome from Pancreatoduodenal Trauma in the UK, 1989–2013

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925060712 ◽

2015 ◽

Vol 97 (2) ◽

pp. 125-130 ◽

Cited By ~ 20

Author(s):

DA O’Reilly ◽

O Bouamra ◽

A Kausar ◽

EJ Dickson ◽

F Lecky

Keyword(s):

Blunt Trauma ◽

Injury Severity ◽

Road Traffic ◽

Penetrating Trauma ◽

Research Network ◽

Common Mechanism ◽

Female Ratio ◽

Road Traffic Collision ◽

The Uk ◽

Type Of Injury

IntroductionPancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989–2013.MethodsThe Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both.ResultsOf 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14–35) for blunt trauma and 14 (IQR: 9–18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation.ConclusionsIsolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.

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Analysis of Mortality in Traumatically Injured Patients Based on Body Mass Index and Mechanism Reveals Highest Mortality among the Underweight in Comparison with the Ideal Weight Patients

The American Surgeon ◽

10.1177/000313481708300419 ◽

2017 ◽

Vol 83 (4) ◽

pp. 341-347

Author(s):

Kevin Treto ◽

Karen Safcsak ◽

David Chesire ◽

Indermeet S. Bhullar

Keyword(s):

Body Mass Index ◽

Blunt Trauma ◽

Body Mass ◽

Injury Severity ◽

Traumatic Injury ◽

Penetrating Trauma ◽

Gunshot Wounds ◽

Protective Role ◽

Ideal Weight ◽

Significant Difference

The purpose of this study was to evaluate the effect of body mass index (BMI) on mortality after traumatic injury. The records of patients from 2012 to 2015 were retrospectively reviewed. The patients were stratified into the following groups based on admission BMI (kg/m2): underweight (UW) (BMI <19), ideal weight (IW) (BMI = 19–24.9), overweight (OW) (BMI = 25–29.9), obese (OB) (BMI = 30–39.9), and morbid obese (MO) (BMI >40). The groups were well matched with no significant differences in demographics and Injury Severity Score. Morality for the IW group was compared with the remaining BMI groups. A total of 6049 patients were identified. In comparison with IW group, the UW mortality was significantly higher (IW vs UW, 4.1% vs 8.8%, P = 0.001); however, the there was no significant difference with remaining groups. There was also no significant difference in mortality between IW and the remaining groups for patients that went directly to the operating room or for patients that had penetrating trauma (stab wounds and gunshot wounds). However, for blunt trauma, the mortality was significantly higher for UW (IW vs UW, 4.3% vs 9.4%, P = 0.001), no different for IW vs OW (4.3% vs 3.7%, P = 0.3), and significantly lower for IW vs OB (4.3% vs 2.8%, P = 0.04) and for IW vs MO (4.3% vs 1.0%, P = 0.03). After traumatic injuries, it is the underweight patients (BMI <19) and not the obese, that are at a significantly higher risk for overall mortality; this difference is especially evident after blunt trauma where obesity may actually confer a protective role.

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An isolated iliac vein injury due to blunt trauma by a bicycle handlebar without a pelvic fracture: A case report

Turkish Journal of Vascular Surgery ◽

10.9739/tjvs.2021.781 ◽

2020 ◽

Vol 30 (2) ◽

pp. 148-150

Author(s):

İbrahim Duvan ◽

İlker İnce ◽

Melike Şenkal ◽

Kasım Karapınar ◽

Uğursay Kızıltepe

Keyword(s):

Blunt Trauma ◽

Hypovolemic Shock ◽

Penetrating Trauma ◽

Rare Condition ◽

External Iliac Artery ◽

Iliac Vein ◽

Massive Bleeding ◽

Vascular Trauma ◽

Skeletal Injury ◽

Vein Injury

Abdominal and pelvic blunt vascular trauma without skeletal injury is considered a rare condition. Iliac vein injuries are usually seen with penetrating trauma, whereas they result from blunt trauma very rarely. A 15-year-old boy was admitted who fell from a bicycle and got his left hypogastric region hit by the handlebar. He had an isolated left external iliac vein injury and massive bleeding related to this blunt trauma, which eventually resulted in hypovolemic shock and a huge regional hematoma. The hematoma compressed the left external iliac artery and triggered ischemia. In conclusion, prompt diagnosis and treatment are of utmost importance to save the extremities and lives of patients.

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Endovascular treatment of penetrating arterial trauma with stent grafts

VASA ◽

10.1024/0301-1526/a000672 ◽

2018 ◽

Vol 47 (2) ◽

pp. 125-130 ◽

Cited By ~ 10

Author(s):

Rodrigo Bruno Biagioni ◽

Marcelo Calil Burihan ◽

Felipe Nasser ◽

Luisa Ciucci Biagioni ◽

José Carlos Ingrund

Keyword(s):

Endovascular Treatment ◽

Injury Severity ◽

Operating Time ◽

Penetrating Trauma ◽

Vascular Trauma ◽

Covered Stents ◽

Arterial Injuries ◽

Keywords Trauma ◽

The Mean

Abstract. Background: The endovascular management of arterial injuries has resulted in reduced operating time, blood loss, hospital mortality, lower incidence of sepsis, and decrease in mortality rates. For penetrating trauma, however, the benefits of endovascular therapy are questionable. Patients and methods: Data were obtained by retrospective analysis of electronic medical records. All patients with vascular trauma seeking care at our institution from January 2010 to December 2015 were reviewed. A total of 223 vascular trauma patients were enrolled. Of these, 18 patients (8 %) were treated with endovascular techniques. The data related to clinical presentation, patient characteristics, technical aspects of the treatment, and follow-up were analysed. Results: The mean patient age was 35.4 ± 17.8 years, 94 % were male. The mean injury severity score was 10.4 ± 2.5. The most commonly observed trauma mechanism was a gunshot in 10 cases (55 %), followed by lesions provoked by arterial catheter misplacement in five cases (27 %), and stab wounds in three cases (16.6 %). The main injury site was the subclavian artery, accounting for eight cases (44 %), followed by the superficial femoral artery and the tibiofibular trunk in two cases, respectively (18 %). The anterior tibial, fibular artery, axillary, common carotid, superior mesenteric, and profunda femoris were each affected once. Arteriovenous fistula was detected in nine cases (50 %), pseudoaneurysms in nine cases (50 %), and short occlusion in two cases (11 %). The mean follow-up duration was 753 days. The primary patency rate was 92.3 and 61.5 % after one and two years, respectively. The survival rate was 94.4 % after one and two years. Infection of the stents or limb amputations were not identified at follow-up. Conclusions: The endovascular treatment of penetrating arterial injuries with covered stents is feasible. However, the criteria used to choose the best method must be individualized. Keywords: Trauma, endovascular, stent graft, gunshot, stab wound

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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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Managing vascular access and closure for percutaneous mechanical circulatory support

European Heart Journal Supplements ◽

10.1093/eurheartj/suab002 ◽

2021 ◽

Vol 23 (Supplement_A) ◽

pp. A10-A14

Author(s):

Konstantinos Karatolios ◽

Patrick Hunziker ◽

David Schibilsky

Keyword(s):

Mechanical Circulatory Support ◽

Axillary Artery ◽

Vascular Complications ◽

Vascular Trauma ◽

Circulatory Support ◽

Femoral Access ◽

Arterial Access ◽

Femoral Arterial Access ◽

Artery Disease ◽

Critical Aspects

Abstract Even with current generation mechanical circulatory support (MCS) devices, vascular complications are still considerable risks in MCS that influence patients’ recovery and survival. Hence, efforts are made to reduce vascular trauma and obtaining safe and adequate arterial access using state-of-the-art techniques is one of the most critical aspects for optimizing the outcomes and efficiency of percutaneous MCS. Femoral arterial access remains necessary for numerous large-bore access procedures and is most commonly used for MCS, whereas percutaneous axillary artery access is typically considered an alternative for the delivery of MCS, especially in patients with severe peripheral artery disease. This article will address the access, maintenance, closure and complication management of large-bore femoral access and concisely describe alternative access routes.

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