Contemporary Management of Axillosubclavian Arterial Injuries Using Data from the AAST PROOVIT Registry

Background: Endovascular repair has emerged as a viable repair option for axillosubclavian arterial injuries in select patients; however, further study of contemporary outcomes is warranted. Methods: The American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry was used to identify patients with axillo-subclavian arterial injuries from 2013 – 2019. Demographics and outcomes were compared between patients undergoing endovascular repair versus open repair. Results: 167 patients were identified, with intervention required in 107 (64.1%). Among these, 24 patients underwent open damage control surgery (primary amputation = 3, ligation = 17, temporary vascular shunt = 4). The remaining 83 patients (91.6% male; mean age 26.0 ± 16) underwent either endovascular repair (36, 43.4%) or open repair (47, 56.6%). Patients managed with definitive endovascular or open repair had similar demographics and presentation, with the only exception that endovascular repair was more commonly employed for traumatic pseudoaneurysms (p=0.004). Endovascular repair was associated with lower 24-hour transfusion requirements (p=0.012), but otherwise the two groups were similar with regards to in-hospital outcomes. Conclusion: Endovascular repair is now employed in > 40% of axillo-subclavian arterial injuries undergoing repair at initial operation and is associated with lower 24 hour transfusion requirements, but otherwise outcomes are comparable to open repair.

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Damage Control for Thoracic Trauma

The American Surgeon ◽

10.1177/000313481408000927 ◽

2014 ◽

Vol 80 (9) ◽

pp. 910-913 ◽

Cited By ~ 8

Author(s):

Michael J. Mackowski ◽

Rebecca E. Barnett ◽

Brian G. Harbrecht ◽

Keith R. Miller ◽

Glen A. Franklin ◽

...

Keyword(s):

Thoracic Trauma ◽

Injury Severity ◽

Damage Control ◽

Damage Control Surgery ◽

Control Techniques ◽

Transfusion Requirements ◽

University Of Louisville ◽

Level I ◽

Temporary Closure ◽

Complications And Mortality

Damage control surgery involves an abbreviated operation followed by resuscitation with planned re-exploration. Damage control techniques can be used in thoracic trauma but has been infrequently reported. Our goal is to describe our experience with the use of damage control techniques in treating thoracic trauma. A retrospective analysis of all patients undergoing damage control thoracic surgery related to trauma from January 1, 2010, to January 1, 2013, at University of Louisville Hospital, a Level I trauma center. Variables studied included injury characteristics, Injury Severity Score, surgery performed, duration of packing, length of stay (LOS), ventilator days, transfusion requirements, complications, and mortality. Twenty-five patients underwent damage control surgery in the chest with packing, temporary closure, and planned re-exploration after stabilization. Seventeen patients underwent anterolateral thoracotomy, and eight patients underwent sternotomy. The mean LOS and duration of temporary packing was 20.6 and 1.4 days in the thoracotomy group, respectively, and 19.5 and 1 day in the sternotomy group, respectively. The overall mortality rate was 40 per cent, 35 per cent in the thoracotomy group and 50 per cent in the sternotomy group. Like in severe abdominal trauma, damage control techniques can be used in the management of severe thoracic injuries with acceptable results.

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Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

Canadian Association of Radiologists Journal ◽

10.1177/0846537120908069 ◽

2020 ◽

Vol 71 (3) ◽

pp. 352-361

Author(s):

Siobhán B. O’Neill ◽

Saira Hamid ◽

Savvas Nicolaou ◽

Sadia R. Qamar

Keyword(s):

American Association ◽

Nonoperative Management ◽

Damage Control ◽

Management Strategies ◽

Damage Control Surgery ◽

Organ Injury ◽

Solid Organ ◽

Imaging Findings ◽

Solid Organ Injury ◽

Imaging Protocols

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

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Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct to damage control surgery for combat trauma

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v1i1.16 ◽

2017 ◽

Vol 1 (1) ◽

pp. 58-62

Author(s):

Jacob J Glaser ◽

William Teeter ◽

Travis Gerlach ◽

Nathanial Fernandez

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

Balloon Occlusion ◽

Combat Trauma ◽

Operating Table ◽

Vascular Control ◽

Resuscitative Thoracotomy ◽

Combat Casualty ◽

Transfusion Requirements ◽

Endovascular Balloon Occlusion

Background: Non compressible torso hemorrhage continues to be the leading cause of preventable death in combat operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative hemorrhage control strategy, with morbidity advantages over resuscitative thoracotomy. We report the first ever use of REBOA in a combat casualty in Afghanistan. Case Report: An 18 year old Afghan male was injured by a single high velocity gunshot wound during partnered operations. He was treated with a damage control operation at the role 2 level, with significant presacral and pelvic bleeding controlled with combat gauze packing. The patient continued to be hemodynamically labile, with ongoing transfusion requirements and required emergent re-exploration. Upon transfer from the gurney to the operating table the patient was noted to be hypotensive with a blood pressure of 62/38. An ER-REBOA catheter was measured for Zone 1 occlusion and placed without difficulty. The patient’s hemodynamics normalized, which allowed for sterile entry into the abdomen and vascular control. After 10 minutes of occlusion the balloon was deflated. Surgical repair was completed and patient survived to discharge. Conclusions: REBOA is an adjunct to hemorrhagic shock that provides temporary proximal control bridge to definitive surgical hemostasis while avoiding the morbidity of a resuscitative thoracotomy. This case represents the first reported use of REBOA in the Afghanistan Theater. This case further supports increased consideration for use of REBOA in the forward setting.

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Damage Control Surgery in Acute Mesenteric Ischemia

Case Medical Research ◽

10.31525/ct1-nct03966430 ◽

2019 ◽

Author(s):

Keyword(s):

Mesenteric Ischemia ◽

Damage Control ◽

Acute Mesenteric Ischemia ◽

Damage Control Surgery

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Trial on Damage Control Surgery for Perforated Diverticulitis With Generalized Peritonitis

Case Medical Research ◽

10.31525/ct1-nct04034407 ◽

2019 ◽

Author(s):

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

Perforated Diverticulitis ◽

Generalized Peritonitis

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Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

BMJ Case Reports ◽

10.1136/bcr-2020-240202 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240202

Author(s):

Benjamin McDonald

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Weight Loss ◽

Differential Diagnosis ◽

Damage Control ◽

Damage Control Surgery ◽

Mesenteric Ischaemia ◽

Abdominal Symptoms ◽

Chronic Mesenteric Ischaemia ◽

Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

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Damage control surgery

Trauma und Berufskrankheit ◽

10.1007/s10039-020-00452-6 ◽

2021 ◽

Vol 21 (S1) ◽

pp. 147-154

Author(s):

C. Güsgen ◽

A. Willms ◽

R. Schwab

Keyword(s):

Damage Control ◽

Damage Control Surgery

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Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00352-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Derek J. Roberts ◽

◽

Niklas Bobrovitz ◽

David A. Zygun ◽

Andrew W. Kirkpatrick ◽

...

Keyword(s):

Systematic Review ◽

Damage Control ◽

Penetrating Trauma ◽

Damage Control Surgery ◽

Trauma Patients ◽

Clinical Scenario ◽

Cross Sectional ◽

Iliac Vessel ◽

Civilian Trauma ◽

Definitive Surgery

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

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