scholarly journals Current results of arterial injuries seen at femoral and popliteal arteries in civil society

2020 ◽  
Vol 7 (7) ◽  
pp. 2082
Author(s):  
Metin O. Beyaz ◽  
Ibrahim Demir ◽  
Emin C. Ata
Keyword(s):  
Early Intervention ◽  
Saphenous Vein Graft ◽  
Arterial Injury ◽  
University Hospital ◽  
Bleeding Control ◽  
Critical Importance ◽  
Ischemic Time ◽  
Loss Of Life ◽  
Arterial Injuries ◽  
Graft Interposition

Background: Lower extremity arterial injuries caused by penetrating or fired-gun trauma may result in limb or loss of life. Early intervention has critical importance. The aim of this study was to investigate the importance of early intervention and outcomes.Methods: We retrospectively reviewed the data on 144 patients (18 females, 126 males) who were treated in Istanbul Medipol University Hospital between January 2016 to 2018. All patients had an arterial injury at level of femoral and popliteal arteries. Standard statistical methods were used for data analysis.Results: Revascularization was performed to all 144 (18 females, 126 males) patients. Autologous saphenous vein graft interposition was performed in 96 patients. End-to-end repair was performed in 39 patients. 9 patients underwent a polytetrafluoroethylene graft (8 mm ringed) interposition.Conclusions: All viable limbs should be revascularized rapidly. The primary goal is to provide bleeding control rapidly and to prevent the prolongation of ischemic time. It should be kept in mind that in addition to surgical technique, fasciotomy may be required in arterial injuries with ischemic time of more than 6-8 hours.

scholarly journals Penetrating Proximity Wounds and Minimal Arterial Injuries may not be so Benign

2019 ◽  
pp. 1-4
Author(s):  
Jonathan Gates ◽  
Dina Tabello ◽  
Alfred Croteau ◽  
Adam Shen ◽  
Nishant Merchant
Keyword(s):  
Natural History ◽  
Watchful Waiting ◽  
Arterial Injury ◽  
Standard Approach ◽  
Vascular Injuries ◽  
Arterial Injuries ◽  
History Of

There is a well-established body of literature in the management of vascular injuries that underscores the benign natural history of minor so-called occult arterial injuries. The standard approach for the management of the proximity extremity wound has evolved into one of watchful waiting. We present a case of an occult arterial injury that declared itself with an acute arterial bleed after about 30 hours of observation indicating that caution and preparation remain critical in the management of these patients.

Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity

2017 ◽  
Vol 83 (10) ◽  
pp. 1161-1165 ◽  
Author(s):  
Ido Badash ◽  
Karen E. Burtt ◽  
Hyuma A. Leland ◽  
Daniel J. Gould ◽  
Alexis D. Rounds ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Arterial Injury ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Arterial Injuries ◽  
Flap Failure ◽  
Vascular Compromise ◽  
Tissue Reconstruction

Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise. Patients presenting with vascular injury were also more likely to require fasciotomy [odds ratio (OR): 6.5, confidence interval (CI): 2.3–18.2] and to have a nerve deficit (OR: 16.6, CI: 3.9–70.0), fracture of the distal third of the leg (OR: 2.9, CI: 1.15–7.1) and intracranial hemorrhage (OR: 3.84, CI: 1.1–12.9). After soft tissue reconstruction, patients with arterial injuries had a higher rate of amputation (OR: 8.5, CI: 1.3–53.6) and flap failure requiring a return to the operating room (OR: 4.5, CI: 1.5–13.2). Arterial injury did not correlate with infection or overall complication rate. In conclusion, arterial injuries resulted in significant complications for patients with lower extremity fractures requiring flap coverage, although limb salvage was still effective in most cases.

Emergency Central Venous Catheterization during Trauma Resuscitation: A Safety Analysis by Site

2015 ◽  
Vol 81 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Rachel L. Choron ◽  
Andrew Wang ◽  
Kathryn Van Orden ◽  
Lisa Capano-Wehrle ◽  
Mark J. Seamon
Keyword(s):  
Central Venous Catheterization ◽  
Blood Stream Infection ◽  
Arterial Injury ◽  
Blood Stream ◽  
Primary Objective ◽  
Central Venous ◽  
Exact Test ◽  
Arterial Injuries ◽  
Venous Catheterization ◽  
Subclavian Catheter

Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may cause complications including catheter-related blood stream infection (CRBSI), deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. Our primary objective compared subclavian versus femoral CVC complications during initial trauma resuscitations. A retrospective review (2010–2011) at an urban, Level-I Trauma Center reviewed CVCs during initial trauma resuscitations. Demographics, clinical characteristics, and complications including: CRBSIs, DVTs, arterial injuries, pneumothoraces, and PEs were analyzed. Fisher's exact test and Student's t test were used; P ≤ 0.05 was considered statistically significant. Overall, 504 CVCs were placed (subclavian, n = 259; femoral, n = 245). No difference in age (47 ± 22 vs 45 ± 23 years) or body mass index (28 ± 6 vs 29 ± 16 kg/m2) was detected ( P > 0.05) in subclavian vs femoral CVC, but subclavian CVCs had more blunt injuries (81% vs 69%), greater systolic blood pressure (95 ± 55 vs 83 ± 43 mmHg), greater Glasgow Coma Scale (10 ± 5 vs 9 ± 5), and less introducers (49% vs 73%) than femoral CVCs (all P < 0.05). Catheter related arterial injuries, PEs, and CRBSIs were similar in subclavian and femoral groups (3% vs 2%, 0% vs 1%, and 3% vs 3%; all P > 0.05). Catheter-related DVTs occurred in 2 per cent of subclavian and 9 per cent of femoral CVCs ( P < 0.001). There was a 3 per cent occurrence of pneumothorax in the subclavian CVC population. In conclusion, both subclavian and femoral CVCs caused significant complications. Subclavian catheter-related pneumothoraces occurred more commonly and femoral CRBSIs less commonly than expected compared with prior literature in nonemergent scenarios. This suggests that femoral CVC may be safer than subclavian CVC during initial trauma resuscitations.

scholarly journals Pseudoaneurysm formation following a traumatic wrist laceration

CJEM ◽  
2011 ◽  
Vol 13 (01) ◽  
pp. 48-52 ◽  
Author(s):  
Naveen Poonai ◽  
Rodrick Lim ◽  
Tim Lynch
Keyword(s):  
Early Recognition ◽  
Arterial Injury ◽  
Penetrating Injury ◽  
Motor Deficits ◽  
Ulnar Nerve Compression ◽  
Pseudoaneurysm Formation ◽  
Pulsatile Mass ◽  
Definitive Therapy ◽  
High Index Of Suspicion ◽  
Graft Interposition

ABSTRACT Pseudoaneurysms occur secondary to partial disruption of the arterial wall. They are a commonly described complication of arterial injury, with penetrating injury and iatrogenic arterial catheterization being the most common etiologies in children. Many present weeks to months after the injury, and the initial vascular injury is often missed. The complications of pseudoaneurysm, which include thromboembolism, neurapraxia, and compartment syndrome, underscore the importance of early recognition and management. Definitive therapy consists of ultrasound-guided compression or resection and possible graft interposition. We describe a case of pseudoaneurysm formation in the radial artery of an adolescent girl 6weeks following a penetrating injury. The patient’s injury was complicated by sensory and motor deficits consistent with ulnar nerve compression. This case attests to the importance of adequately ruling out arterial injury in penetrating injury and close followup if the history is suggestive. In addition, a high index of suspicion is warranted to facilitate imaging of a pulsatile mass to avoid confusion of a thrombosed artery with an abscess.

scholarly journals Posttraumatic True Aneurysm of the Axillary Artery Following Blunt Trauma

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Tugrul Goncu ◽  
Faruk Toktas ◽  
Osman Tiryakioglu ◽  
Gunduz Yumun ◽  
Sinan Demirtas ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Axillary Artery ◽  
Saphenous Vein Graft ◽  
Artery Aneurysm ◽  
True Aneurysm ◽  
Iatrogenic Trauma ◽  
Long Term Follow Up ◽  
Graft Interposition

The majority of the axillary artery aneurysm cases arise as pseudoaneurysms secondary to blunt or iatrogenic trauma. Isolated traumatic true axillary artery aneurysm is a relatively unusual disorder and generally occurs with repetitive blunt trauma. A 22-year-old female patient with distal axillary artery true aneurysm due to simple blunt axillothoracic trauma is presented. The aneurysm was excised with subpectoral-axillary approach and saphenous vein graft interposition was applied. Long-term follow-up with the patient was uneventful.

scholarly journals Axillary Artery Injuries Surgical experience review in a single vascular trauma center

2020 ◽  
Vol 16 (1) ◽  
pp. 4-9
Author(s):  
Bahaa I. Hamza
Keyword(s):  
Axillary Artery ◽  
Arterial Injury ◽  
Cross Sectional Study ◽  
Vascular Trauma ◽  
Delayed Presentation ◽  
Management Options ◽  
Cross Sectional ◽  
The Third ◽  
Trauma Surgeons ◽  
Graft Interposition

Background: Injuries to blood vessels are among the most dramatic challenges facing trauma surgeons because repair is often urgent, the surgeon has to decide between management options (open or endovascular), and gaining control and reconstructing a major arterial injury can be technically demanding .Objective:,To analyze the cause of injury, surgical approach, outcome and complications of axillary artery injuries.Methods A descriptive cross-sectional study on fifty patients at Ibn-Alnafees hospital in Baghdad from January 2005 to December 2010Results Males were more commonly affected than female with ratio of 6.1:1. Most injuries were caused by bullet and shell (84%), followed by stab wounds (10%) and blunt trauma (6%). Patients were divided into three groups according to the involved part of the axillary artery: the first part, the second part and the third part. The second part represents most of the cases (48%), the third part account for (30%), while the least is the first part (22%). Resection and end to end anastomosis was done in 80% of the cases, lateral repair in 8%, graft interposition in 8 % and ligation in 4%.Conclusion: The outcome of the injury in this study was in general good. The morbidity of the patients due to nerve injury and wound infection still problem. Mortality due to associated injury and delayed presentation was 4% which is acceptable as compared with other studies.

A critical appraisal of impact of compounding factors in limb salvage decision making in combat extremity vascular trauma

2020 ◽  
pp. bmjmilitary-2020-001508 ◽  
Author(s):  
Amila S Ratnayake ◽  
M Bala ◽  
C J Fox ◽  
A U Jayatilleke ◽  
S P B Thalgaspitiya ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Vascular Reconstruction ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Large Animal ◽  
Vascular Injuries ◽  
Skeletal Trauma ◽  
Anatomy And Physiology ◽  
Arterial Injuries ◽  
The Impact

ObjectiveFor more than half a century, surgeons who managed vascular injuries were guided by a 6-hour maximum ischaemic time dogma in their decision to proceed with vascular reconstruction or not. Contemporary large animal survival model experiments aimed at redefining the critical ischaemic time threshold concluded this to be less than 5 hours. Our clinical experience from recent combat vascular trauma contradicts this dogma with limb salvage following vascular reconstruction with an average ischaemic time of 6 hours.MethodsDuring an 8-month period of the Sri Lankan Civil War, all patients with penetrating extremity vascular injuries were prospectively recorded by a single surgeon and retrospectively analysed. A total of 76 arterial injuries was analysed for demography, injury anatomy and physiology, treatment and outcomes. Subsequent statistical analysis was performed to evaluate the impact of independent variables to include; injury anatomy, concomitant venous, skeletal trauma, shock at presentation and time delay from injury to reconstruction.ResultsIn this study, the 76 extremity arterial injuries had a median ischaemic time of 290 (IQR 225–375) min. Segmental arterial injury (p=0.02), skeletal trauma (p=0.05) and fasciotomy (p=0.03) were found to have a stronger correlation to subsequent amputation than ischaemic time.ConclusionsMultiple factors affect limb viability following compromised distal circulation and our data show a trend towards various subsets of limbs that are more vulnerable due to inherent or acquired paucity of collateral circulation. Early identification and prioritisation of these limbs could achieve functional limb salvage if recognised. Further prospective research should look into the clinical, biochemical and morphological markers to facilitate selection and prioritisation of limb revascularisation.

Arterial Injuries Associated with Blunt Fractures in the Lower Extremity

2016 ◽  
Vol 82 (9) ◽  
pp. 820-824 ◽  
Author(s):  
Jamie J. Coleman ◽  
Saharnaz Tavoosi ◽  
Ben L. Zarzaur ◽  
Brian L. Brewer ◽  
Grace S. Rozycki ◽  
...  
Keyword(s):  
Lower Extremity ◽  
High Velocity ◽  
Injury Severity ◽  
Delayed Diagnosis ◽  
Arterial Injury ◽  
Low Velocity ◽  
Arterial Injuries ◽  
Younger Age ◽  
Level I ◽  
Associated Risk Factors

Problems related to the combination of an arterial injury and a blunt fracture in the lower extremity are well known—delayed diagnosis, damaged soft tissue, and high amputation rate. The actual incidence of this injury pattern is, however, unknown. The purposes of this study were to determine the current incidence of named arterial injuries in patients with blunt fractures in the lower extremities and assess potential associated risk factors. This was a 7-year (2007–2013) retrospective review of patients ≥18 years with blunt lower extremity fractures at a Level I trauma center. Fracture location and concomitant arterial injury were determined and patients stratified by age, gender, and injury velocity. Low injury velocity was defined as falls or assaults, whereas an injury secondary to a motorized vehicle was defined as high velocity. A total of 4413 patients (mean age 52.2 years, 54.3% male, mean Injury Severity Score 13.1) were identified. Forty-six patients (1.04%) had arterial injuries (20.4% common femoral, 8.2% superficial femoral, 44.9% popliteal, and 26.5% shank). After stratifying by age and injury velocity, younger age was associated with a significantly higher rate of vascular injury. For high-velocity injuries, there was no difference based on age. In conclusion, the prevalence of arterial injury after blunt lower extremity fractures is 1.04 per cent in our study. A significant paradoxical relationship exists between age and associated arterial injuries in patients with low-velocity injuries. If these data are confirmed in future studies, a low index of suspicion in patients >55 years after falls is appropriate.

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