scholarly journals Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

2021 ◽  
Author(s):  
Mohammad Esmaeil Barbati ◽  
Frank Hildebrand ◽  
Hagen Andruszkow ◽  
Rolf Lefering ◽  
Michael Jacobs ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Hemodynamic Instability ◽  
Arterial Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Venous Injury ◽  
Major Vessel ◽  
Time Of Admission ◽  
Abdominal Vascular Injuries

Abstract BackgroundAbdominal vascular injuries and the resulting hemorrhagic shock are still one of the main causes of death in trauma patients. This study details the etiology, frequency and effect of major vessel lesions of the abdomen in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® who met the following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups based on the type of vessel injuries: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients met the inclusion criteria. A blunt mechanism of abdominal vascular injuries was more frequent in all three groups. All types of vessel injuries were more prevalent in patients with relevant abdominal trauma followed by relevant thoracic trauma. On admission to hospital the rate of patients with shock were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Patients with venous injury alone or together with arterial injuries had higher early (within first 24h) mortality rates (isolated arterial injury OR: 1.31; 95%, CI 1.14-1.50, p<0.001; isolated venous injury OR: 1.48; 95%, CI 1.10-1.98, p=0.010) and also in-hospital mortality.ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

scholarly journals Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

2021 ◽  
Author(s):  
Mohammad Esmaeil Barbati ◽  
Frank Hildebrand ◽  
Hagen Andruszkow ◽  
Rolf Lefering ◽  
Michael Jacobs ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Hemodynamic Instability ◽  
Arterial Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Venous Injury ◽  
Arterial And Venous Injuries ◽  
Time Of Admission ◽  
Abdominal Vascular Injuries

Abstract BackgroundThis study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® with following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients were included. All types of vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10-1.98, p=0.010).ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

scholarly journals Prevalence and outcome of abdominal vascular injury in severe trauma patients based on a TraumaRegister DGU international registry analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammad Esmaeil Barbati ◽  
Frank Hildebrand ◽  
Hagen Andruszkow ◽  
Rolf Lefering ◽  
Michael J. Jacobs ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Vascular Injury ◽  
Arterial Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Comparable Rate ◽  
Venous Injury ◽  
The Impact ◽  
Abdominal Vascular Injuries

AbstractThis study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. The impact of arterial, venous and mixed vascular injuries on patients’ outcome was of interest, as in particular the relevance of venous vessel injury may be underestimated and not adequately assessed in literature so far. All patients of TraumaRegister DGU with the following criteria were included: online documentation of european trauma centers, age 16–85 years, presence of abdominal vascular injury and Abbreviated Injury Scale (AIS) ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries. Reporting in this study adheres to the STROBE criteria. A total of 2949 patients were included. All types of abdominal vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n = 606, 33%) and venous injury alone (n = 95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10–1.98, p = 0.010). Abdominal arterial and venous injury in patients suffering from severe trauma were associated with a comparable rate of hemodynamic instability at the time of admission. 24 h as well as in-hospital mortality rate were similar in in patients with venous injury and arterial injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible subtle venous injury.

scholarly journals Association between vascular injury identified via echo-Doppler examination and talus fracture-dislocation

2018 ◽  
Vol 12 (2) ◽  
pp. 84-89
Author(s):  
Andresa Ramires Hoshino Ferreira ◽  
Rui Dos Santos Barroco ◽  
Álvaro Diego Pupa De Freitas ◽  
Bruno Rodrigues De Miranda ◽  
Letícia Zaccaria Prates de Oliveira ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Arterial Injury ◽  
Lower Limbs ◽  
Fracture Dislocation ◽  
Vascular Injuries ◽  
Colour Doppler ◽  
Talus Fracture ◽  
Level Of Evidence ◽  
Doppler Examination ◽  
Venous Injury

Objective: To investigate the association between talus fracture-dislocation and the occurrence of pre-operative vascular injuries identified via echo-colour Doppler examination of the lower limbs and to assess whether these injuries directly affect talar necrosis. Methods: Retrospective study with data collection on 26 patients with a diagnosis of talus fracture-dislocation who were evaluated by pre-operative arterial and venous echo-colour Doppler from 2004 to 2015. Results: The sample included 26 patients (26 feet), ranging in age from 16 to 62 years, with a mean follow-up time of 2 years and 9 months. A total of six (23.07%) changes were diagnosed via echo-colour Doppler, of which five (83.33%) were due to arterial injury of the ‘segmental occlusion of the posterior tibial artery’ type and one (16.67%) was due to venous injury of the ‘recent deep venous thrombosis of the popliteal-distal segment’ type, with no arterial injury. No significant association was found between the vascular injuries diagnosed by Doppler and progression to necrosis. Conclusion: A significant portion of the patients with talus fracture-dislocation presented with vascular injury diagnosed by echo-colour Doppler, although no association was found between vascular injury and outcomes of osteonecrosis. Level of Evidence IV; Diagnostic studies.

scholarly journals Computed Tomography Angiography is the Definitive Vascular Imaging Modality for Penetrating Neck Injury: A South African Experience

2017 ◽  
Vol 107 (1) ◽  
pp. 23-30 ◽  
Author(s):  
A. S. Madsen ◽  
V. Y. Kong ◽  
G. V. Oosthuizen ◽  
J. L. Bruce ◽  
G. L. Laing ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vascular Injury ◽  
Computed Tomography Angiography ◽  
Imaging Modality ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Neck Injury ◽  
Predictive Values ◽  
Venous Injury ◽  
Penetrating Neck Injury

Background and Aims: Computed tomography angiography has become central to the diagnostic algorithm for penetrating neck injury, but despite its widespread use the literature to support this adoption is limited. We reviewed our experience with computed tomography angiography for the identification of vascular trauma in hemodynamically stable patients with penetrating neck injury at a major trauma center in South Africa. Materials and Methods: A prospectively kept trauma registry capturing data in real time was retrospectively reviewed. All patients with penetrating neck injury investigated with computed tomography angiography as the initial vascular investigation during a 47-month period were included. Results: A total of 380 patients were included. Indications for computed tomography angiography were as follows: hard signs (13), soft signs (201), no signs but proximity/zone I or III wounds (141), and undefined signs of vascular injury (25). Of the 380 scans, 7 (1.8%) were indeterminate, 299 (78.7%) negative, and 74 (19.5%) positive for a vascular injury (54 arterial and 20 isolated venous injury). Eight were false positive and 4 false negative. The sensitivity, specificity, positive, and negative predictive values for detecting arterial injury were 93.9%, 97.5%, 85.2%, and 99.1%, respectively. Overall, the yield for demonstrating “true arterial injury” was 12.1% (46/380); hard signs: 76.9% (10/13), soft signs: 16.4% (33/201), and no signs: 2.1% (3/141) which all were secondary to gunshot wounds). Only 8.4% (32/380) required intervention for arterial injury and none for isolated venous injury (hard signs: 62.0%, soft signs: 11.4%, and no signs: 0.7%). No serious complications resulted from computed tomography angiography. Conclusion: Computed tomography angiography is a safe and effective imaging modality for the investigation of vascular trauma post penetrating neck injury. Asymptomatic patients with stab wounds do not need to be imaged regardless of proximity concerns. Symptomatic stable patients including a subgroup with hard signs should be imaged rather than explored. Computed tomography angiography provides an interventional road map and can identify injuries amenable to endovascular or conservative management.

Factors Contributing to Morbidity after Combined Arterial and Venous Lower Extremity Trauma

2018 ◽  
Vol 84 (7) ◽  
pp. 1217-1222 ◽  
Author(s):  
Nathan R. Manley ◽  
Louis J. Magnotti ◽  
Timothy C. Fabian ◽  
Michael B. Cutshall ◽  
Martin A. Croce ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Trauma Patients ◽  
Secondary Intervention ◽  
Ischemic Time ◽  
Packed Red Blood Cells ◽  
Venous Injury ◽  
Arterial And Venous Injuries ◽  
The Impact

The purpose of this study was to evaluate the impact of management of venous injury on clinical outcomes in patients with combined lower extremity arterial and venous trauma. Patients with common and external iliac, common and superficial femoral, and popliteal artery injuries were identified. Patients who underwent vein repair and those who received vein ligation were compared. The analysis was repeated for those patients who required secondary intervention for their arterial injury and those who did not require secondary intervention. Seventy patients were identified with both arterial and venous injuries: 40 underwent vein ligation and 30 received vein repair. There was no difference in ischemic time between patients undergoing vein repair compared with ligation. Vein ligation did not produce a higher incidence of muscle debridement (10% vs 15%, P = 0.72), necessity for secondary intervention (10% vs 7.5%, P = 0.99), or amputation (3.3% vs 7.5%, P = 0.63). Patients who required secondary intervention had a greater degree of shock on presentation (packed red blood cells (PRBC), 13 units vs 6 units, P = 0.02) and were more likely to require muscle debridement (50% vs 9%, P = 0.02) and amputation (33% vs 3%, P = 0.03). Vein ligation did not impact muscle ischemia or success of arterial repair in patients with combined venous and arterial trauma in the lower extremities. Patient morbidity after extremity vascular trauma is most related to degree of shock.

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

National temporal variation in major trauma in England, Wales and Northern Ireland

Trauma ◽  
2021 ◽  
pp. 146040862098226
Author(s):  
Will Kieffer ◽  
Daniel Michalik ◽  
Jason Bernard ◽  
Omar Bouamra ◽  
Benedict Rogers
Keyword(s):  
Northern Ireland ◽  
Temporal Variation ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Causes Of Mortality ◽  
Injured Patients ◽  
Time Of Admission

Introduction Trauma is one of the leading causes of mortality worldwide, but little is known of the temporal variation in major trauma across England, Wales and Northern Ireland. Proper workforce and infrastructure planning requires identification of the caseload burden and its temporal variation. Materials and Methods The Trauma Audit Research Network (TARN) database for admissions attending Major Trauma Centres (MTCs) between 1st April 2011 and 31st March 2018 was analysed. TARN records data on all trauma patients admitted to hospital who are alive at the time of admission to hospital. Major trauma was classified as an Injury Severity Score (ISS) >15. Results A total of 158,440 cases were analysed. Case ascertainment was over 95% for 2013 onwards. There was a statistically significant variation in caseload by year (p < 0.0001), times of admissions (p < 0.0001), caseload admitted during weekends vs weekdays, 53% vs 47% (p < 0.0001), caseload by season with most patients admitted during summer (p < 0.0001). The ISS varied by time of admission with most patients admitted between 1800 and 0559 (p < 0.0001), weekend vs weekday with more severely injured patients admitted during the weekend (p < 0.0001) and by season p < 0.0001). Discussion and Conclusion: There is a significant national temporal variation in major trauma workload. The reasons are complex and there are multiple theories and confounding factors to explain it. This is the largest dataset for hospitals submitting to TARN which can help guide workforce and resource allocation to further improve trauma outcomes.

Splanchnic Hypoperfusion-Directed Therapies in Trauma: A Prospective, Randomized Trial

2005 ◽  
Vol 71 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Stephen M. Cohn ◽  
Stephen M. Cohn ◽  
Orlando Kirton ◽  
Margaret Brown ◽  
S. Morad Hameed ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Injury Severity ◽  
Ischemia Reperfusion ◽  
Unit Group ◽  
Severe Trauma ◽  
Prospective Randomized Trial ◽  
Gastric Tonometry ◽  
Trauma Patients ◽  
Splanchnic Perfusion ◽  
Splanchnic Hypoperfusion

Splanchnic hypoperfusion as reflected by gastric intramucosal acidosis has been recognized as an important determinant of outcome in shock. A comprehensive splanchnic hypoperfusion-ischemia reperfusion (IRP) protocol was evaluated against conventional shock management protocols in critical trauma patients. The study was a prospective randomized trial comparing three therapeutic approaches to hypoperfusion after severe trauma in 151 trauma patients admitted to the intensive care unit. Group 1 patients received hemodynamic support based on conventional indicators of hypoperfusion. In group 2, resuscitation was further guided by gastric tonometry-derived estimates of splanchnic hypoperfusion and included more invasive hemodynamic monitoring and additional administration of colloid or crystalloid solutions, or inotropic support. Group 3 patients additionally received therapies specifically aimed at optimizing splanchnic perfusion and minimizing oxidant-mediated damage from reperfusion. The three groups were similar based on age, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II Scores. There were no statistically significant differences in mortality rates, organ dysfunction, ventilator days, or length of stay between any of the interventions. Techniques of optimization of splanchnic perfusion and minimization of oxidant-mediated reperfusion injury evaluated in this study were not advantageous relative to standard resuscitation measures guided by conventional or tonometric measures of hypoperfusion in the therapy of occult and clinical shock in trauma patients.

scholarly journals Inadvertent arterial & venous injury by bone marrow biopsy needle: case report on rescue embolization techniques

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Chris Siu-Chun Tsai ◽  
Simon Chun-Ho Yu
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Vascular Injury ◽  
Iliac Artery ◽  
Morbidity And Mortality ◽  
Biopsy Needle ◽  
Venous Injury ◽  
Patient Morbidity ◽  
Internal Iliac ◽  
Life Threatening

Abstract Background Bone marrow biopsy is a common medical procedure for diagnosis and characterization of haematological diseases. It is generally regarded as a safe procedure with low rate of major complications. Inadvertent vascular injury is however an uncommon but important complication of bone marrow biopsy procedure. The knowledge of a safe and effective embolization method is crucial for interventional radiologists to reduce significant patient morbidity and mortality, shall such inadvertent vascular injury occurs. Case presentation Bedside bone marrow biopsy was performed for an elderly gentleman to evaluate for his underlying acute leukaemia. Biopsy needle inadvertently injured the internal iliac artery and vein during the procedure. Coil embolization was carefully performed across injured arterial segment via the culprit biopsy needle until contrast cessation. Concomitant venous injury was subsequently confirmed on angiography when the needle was withdrawn for a short distance from the iliac artery. This venous injury was tackled by further withdrawing the biopsy needle to distal end of the bone marrow tract for tract embolization with coils and gelatin sponges. High caution was made to avoid coil dislodgement into the iliac vein, to prevent pulmonary embolism. Patient was clinically stable throughout the procedure. Post-procedure contrast CT shows no pelvic haematoma or contrast extravasation. Conclusions This case illustrates rescue embolization techniques for rare life-threatening concomitant internal iliac arterial and venous injuries by a bone marrow biopsy needle. Interventional radiologists can play an important role in carrying out precise embolization to avoid significant patient morbidity and mortality in the case of life-threatening haemorrhage.

scholarly journals Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

2021 ◽  
Author(s):  
David T. McGreevy ◽  
Mitra Sadeghi ◽  
Kristofer F. Nilsson ◽  
Tal M. Hörer
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
University Hospital ◽  
Trauma Patients ◽  
Single Center ◽  
Hemorrhage Control ◽  
Single Center Experience ◽  
Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

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