scholarly journals Imaging Anatomy and Surface Localization of External Control Device-Targeted Arteries for Noncompressible Torso Hemorrhage

2021 ◽  
Author(s):  
Hua-yu Zhang ◽  
Yong Guo ◽  
Heng Liu ◽  
Hao Tang ◽  
Yang Li ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Organ Damage ◽  
Control Device ◽  
External Control ◽  
Vertical Distance ◽  
Localization Strategy ◽  
Surface Localization ◽  
The Common

ABSTRACT Background External hemorrhage control devices (EHCDs) are effective in reducing the death risk of noncompressible torso hemorrhage (NCTH), but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on the anatomical features of NCTH-related arteries through CT images to facilitate the optimal design and application of EHCDs. Methods Two hundred patients who underwent abdominal CT were enrolled. Anatomical parameters such as the length of the common iliac artery (CIA), the external iliac artery (EIA), and the common femoral artery were measured; positional relationships among the EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS), and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by the 3D-printed mannequins of 20 real patients. Results Aortic bifurcation (AB) was 7.5 ± 8.6 mm to the left of the umbilicus. The left CIA (left: 46.6 ± 16.0 mm vs. right: 43.3 ± 15.5 mm, P = .038) and the right EIA (left: 102.6 ± 16.3 mm vs. right: 111.5 ± 18.8 mm, P < .001) were longer than their counterparts, respectively. The vertical distance between the CIA terminus and the ipsilateral AB–ASIS line was 19.6 ± 8.2 mm, and the left and right perpendicular intersections were located at the upper one-third and one-fourth of the AB–ASIS line, respectively. The length ratio of EIA–ASIS to ASIS–PT was 0.6:1. The predicted point and its actual subpoint were significantly correlated (P ≤ .002), and the vertical distance between the two points was ≤5.5 mm. Conclusion The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis, and EHCD-related collateral injuries. Trial registration: Ratification no. 2019092. Registered November 4, 2020—retrospectively registered, www.chictr.org.cn.

Imaging Anatomy and Surface Localization of External Control Device - Target ed Arteries for Noncompressible Torso Hemorrhage

2020 ◽  
Author(s):  
huayu zhang ◽  
yong guo ◽  
heng liu ◽  
hao tang ◽  
yang li ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Average Length ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Organ Damage ◽  
External Control ◽  
Vertical Distance ◽  
Contrast Enhanced Ct ◽  
Localization Strategy ◽  
Surface Localization

Abstract Background: Noncompressible torso hemorrhage (NCTH) is the main cause of prehospital death due to war injury. External hemorrhage control devices (EHCDs) are effective in reducing the death risk of NCTH, but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on anatomical features of NCTH-related arteries through human CT images to facilitate the optimal design and application of EHCDs and eventually reduce relevant injuries. Methods: Images of 200 patients aged 18-65 years who underwent abdominal contrast-enhanced CT scans were collected. Anatomical parameters such as the length and diameter of the aortic bifurcation (AB), common iliac artery (CIA), external iliac artery (EIA) and common femoral artery (CFA) were measured, and positional relationships among EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS) and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by 3D-printed mannequins of 20 real patients. Results: The angle and diameter of the AB were 47.1±10.5° and 17.8±2.7 mm, respectively. The AB was 7.5±8.6 mm to the left of umbilicus. The left CIA and right EIA were longer than the contralateral CIA and right EIA (p=0.038 and p=0.000, respectively). The average length of CFA was 39.0±16.6 mm. The CIA was wider than the EIA and the CFA (p=0.000). The distance between the artery and surface decreased from the CIA to the CFA (p=0.000). The vertical distance between the CIA terminus and the ipsilateral AB-ASIS line was 19.6±8.2 mm, and the left and right perpendicular intersections were located at the upper 1/3 and 1/4 of the AB-ASIS line, respectively. The length ratio of EIA-ASIS to ASIS-PT was 0.6:1. The length of the surface location/actual subpoint-ASIS was significantly correlated (p≤0.002), and the vertical distance between the two points of the same artery was ≤ 5.5 mm. Conclusion: The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis and EHCD-related collateral injuries.

Successful and Unsuccessful Blind Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheters Through Damaged Arteries: A Report of Three Cases

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Philip Joseph Wasicek ◽  
William A Teeter ◽  
Peter Hu ◽  
Deborah M Stein ◽  
Thomas M Scalea ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Arterial Injury ◽  
Balloon Occlusion ◽  
Tactile Feedback ◽  
Balloon Inflation ◽  
Iliac Arteries ◽  
Tertiary Center ◽  
The Common

Background: Patients who receive REBOA for temporization of exsanguinating hemorrhage may have occult injuries sustained to the iliac arteries or aorta which may pose increased risks in performing REBOA. There is a paucity of literature describing the successful blind placement of wires and/or catheters for REBOA through damaged vasculature. Methods: Patients admitted between February 2013 and July 2017 at a tertiary center who had a successful or unsuccessful blind placement of a REBOA catheter or wire through a damaged iliac artery or aorta were included. Results: Three patients were identified. Two patients had successful placement of the REBOA catheter; one sustained injury to the external iliac artery, and the other sustained injury to the abdominal aorta. Confirmation of catheter placement was obtained before balloon inflation; and the damaged vessels were identified upon immediate operative intervention. One patient had unsuccessful placement of the REBOA catheter during cardiac arrest despite accurate access of the common femoral artery (CFA).  Conclusions: Emergent, blind placement of wires and catheters past arterial injuries is possible. Physical exam and/or tactile feedback should alert the surgeon to the possibility of arterial injury and imaging confirmation should precede balloon inflation if at all possible to minimize risk of further vascular injury.

scholarly journals Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: An underdiagnosed entity

2009 ◽  
Vol 50 (3) ◽  
pp. 505-509 ◽  
Author(s):  
Anil P. Hingorani ◽  
Enrico Ascher ◽  
Natalie Marks ◽  
Alexander Shiferson ◽  
Nirav Patel ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Iliac Artery ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Iatrogenic Injuries ◽  
The Common

Deep Circumflex Iliac Artery as an Inflow Alternative for Surgical Revascularization: A Case Report

2019 ◽  
Vol 54 (1) ◽  
pp. 85-88
Author(s):  
Makoto Haga ◽  
Shinya Motohashi ◽  
Hidenori Inoue ◽  
Junetsu Akasaka ◽  
Shunya Shindo
Keyword(s):  
Femoral Artery ◽  
Iliac Artery ◽  
Bypass Graft ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Surgical Revascularization ◽  
Deep Circumflex Iliac Artery ◽  
The Common ◽  
Artery Disease ◽  
Pain At Rest

The common femoral artery (CFA) is the most widely used inflow in all types of surgical revascularization in patients with peripheral artery disease. However, the CFA cannot always be used because of calcification, obstruction, or previous dissection. Here, we report a rare case of selecting the deep circumflex iliac artery (DCIA) as a source of inflow to perform a surgical revascularization in a patient with chronic limb-threatening ischemia. A 62-year-old man was admitted to our hospital due to necrotized third and fifth toes with pain at rest. Computed tomography showed severe stenosis of the CFA, superficial femoral artery, and deep femoral artery, and an entirely stented external iliac artery. The DCIA was identified as the only patent artery. Considering the condition of the other arteries, we selected the DCIA as a source of inflow. Deep circumflex iliac–popliteal bypass was performed with a saphenous vein. The bypass graft was patent 9 months after surgery and limb salvage had been achieved.

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