Iatrogenic Vascular Injuries

AbstractThis study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 40.5 and 49%, respectively. On the other hand, 10.5% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma (p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury (p = 0.001). The MESS has a significant correlation to both age groups I and II (p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

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Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v1i1.6 ◽

2017 ◽

Vol 1 (1) ◽

pp. 22-27

Author(s):

Edwin R Faulconer ◽

Rachel M Russo ◽

Anders J Davidson ◽

Meryl A Simon ◽

Erik S DeSoucy ◽

...

Keyword(s):

Lower Extremity ◽

Open Surgery ◽

Management Strategies ◽

Balloon Occlusion ◽

Vascular Injuries ◽

Endovascular Management ◽

Review Of The Literature ◽

Junctional Zone ◽

Endovascular Interventions ◽

Direct Pressure

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

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CHANGES IN BLOOD PROTEOME OF COSMONAUTS WITH MICRO- AND MACROVASCULAR INJURIES DUE TO G-LOADS AT THE FINAL STAGE OF LONG-DURATION SPACE MISSIONS

Aerospace and Environmental Medicine ◽

10.21687/0233-528x-2020-54-5-5-14 ◽

2020 ◽

Vol 54 (5) ◽

pp. 5-14

Author(s):

L.Kh. Pastushkova ◽

◽

K.S. Kireev ◽

I.M. Larina ◽

◽

...

Keyword(s):

Endothelial Cells ◽

Soft Tissues ◽

Blood Rheology ◽

Landing Site ◽

Space Missions ◽

Vascular Injuries ◽

New Approach ◽

Long Duration ◽

Integrated Response

The integrated response of the human proteome to re-entry g-loads following long-term space missions was studied in 13 male cosmonauts at the age of 44 ± 6 years. Examination at the landing site discovered local petechial hemorrhages into soft tissues of the back and lower legs. The paper presents a new approach to evaluation of petechia and soft tissue hemorrhages in cosmonauts on return to Earth. Proteomic analysis was performed with the use of LC-MS. Bioinformation analysis was made using Perseus, PubMed, Uniprot and ANDSystem software. Nine out of 19 significantly different (p < 0.05) proteins were related to vascular injuries directly. We described proteins with a primarily protecting effect against endothelial cells apoptosis and augmentation of vascular permeability, proteins that are responsible for blood rheology and proteins antagonistic to the main triggers of ischeamia-reperfusion injuries of the lungs, liver and other parenchymal organs.

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Transarterial Embolization of the Renal Arteries for the Management of Iatrogenic Renal Vascular Injuries: Two Centers Experience in 150+ Patients

10.1055/s-0041-1729096 ◽

2020 ◽

Author(s):

Kassimi Mariam ◽

Guerroum Hind ◽

Habi Jihane ◽

Rami Amal ◽

Berrada Sophia ◽

...

Keyword(s):

Transarterial Embolization ◽

Renal Arteries ◽

Vascular Injuries ◽

Renal Vascular

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Iatrogenic Renal Vascular Injuries, Angiographic Findings, and Embolization

10.1055/s-0041-1730662 ◽

2018 ◽

Author(s):

Ahmed Sayed Awad ◽

Amr Nassef

Keyword(s):

Vascular Injuries ◽

Renal Vascular ◽

Angiographic Findings

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Intra-abdominal Inferior Vena Cava Injuries: Operative Strategies and Outcomes

The American Surgeon ◽

10.1177/0003134820973395 ◽

2020 ◽

pp. 000313482097339

Author(s):

Christine A. Castater ◽

Margo Carlin ◽

Virginia D. Parker ◽

Chris Sciarretta ◽

Deepika Koganti ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Mortality Rates ◽

Volume Resuscitation ◽

Vascular Injuries ◽

Trauma Centers ◽

Review Of The Literature ◽

Hemorrhage Control ◽

Operative Strategies

Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.

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Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review

European Spine Journal ◽

10.1007/s00586-021-06956-4 ◽

2021 ◽

Author(s):

Alice Giotta Lucifero ◽

Cristian Gragnaniello ◽

Matias Baldoncini ◽

Alvaro Campero ◽

Gabriele Savioli ◽

...

Keyword(s):

At Risk ◽

Lumbar Spine ◽

Spine Surgery ◽

Iliac Vein ◽

Lumbar Spine Surgery ◽

Common Iliac Vein ◽

Suture Repair ◽

Vascular Injuries ◽

Mesh Terms ◽

Thoracic And Lumbar Spine

Abstract Purpose To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. Methods PubMed, Medline, and Embase databases were utilized for a comprehensive literature search based on keywords and mesh terms to find articles reporting iatrogenic vascular injury during thoracic and lumbar spine surgery. English articles published in the last ten years were selected. The search was refined based on best match and relevance. Results Fifty-six articles were eligible, for a cumulative volume of 261 lesions. Vascular injuries occurred in 82% of instrumented procedures and in 59% during anterior approaches. The common iliac vein (CIV) was the most involved vessel, injured in 49% of anterior lumbar approaches. Common iliac artery, CIV, and aorta were affected in 40%, 28%, and 28% of posterior approaches, respectively. Segmental arteries were injured in 68% of lateral approaches. Direct vessel laceration occurred in 81% of cases and recognized intraoperatively in 39% of cases. Conclusions Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.

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