scholarly journals PERIPHERAL VASCULAR INJURIES

2008 ◽  
Vol 15 (01) ◽  
pp. 54-60
Author(s):  
SHABBIR HUSSAIN RANA ◽  
TARIQ MUKHTAR FARANI ◽  
YOUSUF JAMAL ◽  
Muhammad Afzal
Keyword(s):  
Vessel Wall ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Firearm Injuries ◽  
Intravascular Thrombosis ◽  
Appropriate Treatment ◽  
Eventual Loss

Introduction: Peripheral vascular injuries constitute4-6% major trauma. Although uncommon the complication of hemorrhage and Ischemia can be limb threatening andlife threatening. Rapid diagnosis and appropriate treatment is therefore essential. Delay allows irreversible Ischemicinjury to take place and encourages propagation of intravascular thrombosis, which results in eventual loss of functionor even limb itself. Objective: (I) To collect data about different aspect of epidemiology and management of Peripheralvascular injuries. (II) To study the relationship between latent period for revascularization and outcome of surgery.Design: Non interventional observational study. Setting: C M H Kohat. Period: From 01 Jan 2004 to 31 Dec 2006.Material & Methods: Total of 46 cases of all age and sex groups was included in the study. Only those patients wereincluded who had vascular injury to extremities whether direct (penetrating, blunt) or indirect (associated with fractureand dislocations) injuries. Relevant history was obtained from the patients themselves and from their relatives orwitnesses. Relevant physical examination was performed. Necessary investigations were done. Patients were treatedaccording to standard protocol. Results: The peripheral vascular injuries were more common in 21-40 years of agegroup (69%) and among male(82%).Vascular trauma caused by the firearm injuries (60.86%) was the most commoncause, other being road traffic accidents (26.08%) and blunt trauma (13.04%). The most common clinical presentationwas shock and paresthesia (50%). Most off the patient reached hospital within 6-12 hours (47%), and belongs to ruralareas (69%). Frequency of involvement of vessels was femoral artery (41%) and brachial artery (23%). Types ofvascular injuries were , laceration to the vessel wall (56%) and loss of vessel wall segment (17%). End-to-endanastomosis was most common (78%) .others being interposition reverse vein graft (13%) and direct suturing of vesselwall (8.7%)Amputation rate was highest in cases where revascularization occurred after more than 12 hour (71%).Common complications after repair were residual edema (17%) and infection (6%). Overall mortality rate was 4 % andmorbidity rate was 28%. Conclusion: All cases of peripheral vascular injuries should be surgically explored.Revascularization should be achieved within 12 hours. Patients presenting late or with crush injuries may needamputation.

scholarly journals Vascular injuries of the upper extremity

2006 ◽  
Vol 5 (4) ◽  
pp. 271-276 ◽  
Author(s):  
Raafat Shalabi ◽  
Yoysifh Al Amri ◽  
Elham khoujah
Keyword(s):  
Limb Salvage ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Lower Extremity Injury ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Study Results

OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.

scholarly journals A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up

2021 ◽  
Vol 5 (3) ◽  
pp. 27-34
Author(s):  
Dawit Gebregiorgis ◽  
◽  
Berhanu Nega ◽  
Nebyou Seyoum ◽  
◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Primary Repair ◽  
Management Strategies ◽  
Penetrating Trauma ◽  
Vascular Trauma ◽  
Limb Loss ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Road Traffic Accidents

Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting. Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020. Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours). Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.

scholarly journals High Mortality from Major Vascular Trauma in Traffic Accidents: A Population-Based Study

2019 ◽  
Vol 109 (4) ◽  
pp. 328-335
Author(s):  
B. K. Johannesdottir ◽  
U. Johannesdottir ◽  
T. Jonsson ◽  
S. H. Lund ◽  
B. Mogensen ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Population Based ◽  
Vascular Trauma ◽  
Term Survival ◽  
Mortality And Morbidity ◽  
New Injury Severity Score ◽  
Discharged Patients ◽  
Discharge From Hospital

Background and Aims: Injuries involving major arteries are an important cause of mortality and morbidity, most often from road traffic accidents. Our aim was to study the outcome of major vascular trauma from traffic accidents in an entire population, including patients who die at the scene and those who reach hospital alive. Materials and Methods: This was a retrospective analysis of all patients who sustained major vascular trauma in traffic accidents in Iceland from 2000 to 2011. Patient demographics, mechanism, and location of vascular injury and treatment were registered. Injury scores were calculated and overall survival estimated. Results: There were 62 individuals (mean age 44 years, 79% males) with 95 major vascular traumas, giving an incidence of 1.69/100,000 inhabitants (95% confidence interval: 1.27–2.21). A total of 33 died at the scene and 8 during transportation to hospital but 21 (34%) reached hospital alive. Most patients who succumbed had thoracic major vascular traumas (76%) or abdominal major vascular traumas (23%). Mean new injury severity score for the 21 admitted patients was 44. A total of 18 were operated with vascular repair, 3 with endovascular stent graft insertion. The mean hospital stay for discharged patients was 34 days. Altogether, 15 of the 62 patients (24%) survived to discharge from hospital, with a 5-year survival of 86% for discharged patients. Conclusion: Every other patient with major vascular trauma following traffic accidents died at the scene and a further 13% died during transportation to hospital, most of whom sustained major vascular trauma to the thoracic aorta. However, one-third of the patients reached hospital alive and 71% of them survived to discharge, with excellent long-term survival.

scholarly journals Vascular Injury and Its Management: Experience at Universal College of Medical Sciences, Bhairahawa, Nepal

2018 ◽  
Vol 5 (1) ◽  
pp. 8-11
Author(s):  
Santosh Shah ◽  
Rajesh Poudel ◽  
Tika Ram Bhandari ◽  
Damber Bikram Shah ◽  
Ghanshyam Sigdel ◽  
...  
Keyword(s):  
Patient Survival ◽  
Vascular Reconstruction ◽  
Vascular Trauma ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Medical Sciences ◽  
Common Life ◽  
Life Threatening ◽  
Male Patients ◽  
Management Experience

INTRODUCTION: Vascular trauma is a common life-threatening injury leading to serious consequences if not timely and efficiently managed. Although they represent less than 3% of all injuries, they deserve special attention because of their severe complications. The aim of this study was to analyze the causes of injury, presentations, surgical (recent) approaches, outcomes, and complications of vascular trauma.  MATERIALS & METHODS: This was a retrospective analysis performed over 6 months. From December 2015 to May 2016, 12 patients were included in the study and were operated upon for peripheral vascular injuries. Diagnosis was made by physical examination as well as with hand Doppler alone or in combination with Doppler scan. Primary vascular repair was carried out whenever possible; however, if it was not possible, an interposition vein graft was placed.  RESULTS:  Of the total 12 patients who sustained major vascular injuries during this period, 9 sustained injuries to the upper limb vessels, 3 had injuries of the lower limb vessels. Trauma with sharp object was the cause in 4 cases, blunt trauma was the cause in 4 cases and rupture pesudoaneurysm was the cause in 2 cases and ruptured aneurysm was the cause in 2 cases. Of the 12 patients, 12 patients were successfully managed by vascular reconstruction without any residual disability. There were 8 male patients (66.67%) and 4 female patients (33.33%), and their ages ranged from 16–60 years (mean 35 years).  CONCLUSION:  Patients who suffer vascular injuries should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 8-11

scholarly journals Management of Vascular Injury in a Vascular Center of a Developing Country

2021 ◽  
Vol 36 (1) ◽  
pp. 32-37
Author(s):  
Quazi Abul Azad ◽  
Aizizul Islam Khan ◽  
Abdullah Al Mamun ◽  
Nirmal Kanti Dey ◽  
Sajia Sajmin Siddiqua ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Developing Country ◽  
Vascular Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Young Male ◽  
Developed Countries ◽  
Limb Amputation ◽  
Vascular Injuries ◽  
Associated Injuries

In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas. Bangladesh Heart Journal 2021; 36(1) : 32-37

scholarly journals Peripheral vascular injuries due to blunt trauma (road traffic accident): Management and outcome

2012 ◽  
Vol 10 (9) ◽  
pp. 560-562 ◽  
Author(s):  
Mohd Lateef Wani ◽  
Ab Gani Ahangar ◽  
Shadab Nabi Wani ◽  
Ab Majeed Dar ◽  
Farooq Ahmad Ganie ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Accident Management

CT Angiography Effectively Evaluates Extremity Vascular Trauma

2008 ◽  
Vol 74 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Peter D. Peng ◽  
David A. Spain ◽  
Monika Tataria ◽  
Jeffrey C. Hellinger ◽  
Geoffrey D. Rubin ◽  
...  
Keyword(s):  
Trauma Center ◽  
Imaging Modality ◽  
Arterial Injury ◽  
Computed Tomographic Angiography ◽  
Vascular Trauma ◽  
Vascular Imaging ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Diagnostic Modality ◽  
Level I

Traditionally, conventional arteriography is the diagnostic modality of choice to evaluate for arterial injury. Recent technological advances have resulted in multidetector, fine resolution computed tomographic angiography (CTA). This study examines CTA for evaluation of extremity vascular trauma compared with conventional arteriography. Our hypothesis is that CTA provides accurate and timely diagnosis of peripheral vascular injuries and challenges the gold standard of arteriogram. Traumatic extremity injuries over a 5-year period were identified using a Level I trauma center registry and radiology database. Information collected included patient demographics, mechanism, imaging modality, vascular injuries, management, and follow-up. Two thousand two hundred and fifty-one patients were identified with extremity trauma. Twenty-four patients were taken directly to the operating room for evaluation and management of vascular injuries. Fifty-two underwent vascular imaging. Fourteen patients had conventional arteriograms with 13 abnormal studies: 7 were managed operatively, 2 embolized, and 4 observed. Thirty-eight patients underwent CTA with 17 abnormal scans: 9 were managed operatively, 3 embolized, and 5 observed. There were no false negatives or missed injuries. CTA provides accurate peripheral vascular imaging while additionally offering advantages of noninvasiveness and immediate availability. Secondary to these advantages, CTA has supplanted arteriography for initial radio-graphic evaluation of peripheral vascular injuries at our Level I trauma center. This study supports CTA as an effective alternative to conventional arteriography in assessing extremity vascular trauma.

scholarly journals An Experience of Surgical Management of Peripheral Vascular Injuries at Pakistan Institute of Medical Sciences, Islamabad

2020 ◽  
Vol 9 (3) ◽  
pp. 201-206
Author(s):  
Muneeb Ullah ◽  
Seemab Niaz ◽  
Aabid Ali ◽  
Arsalan
Keyword(s):  
Vein Graft ◽  
Tertiary Care ◽  
Penetrating Trauma ◽  
Vascular Trauma ◽  
Initial Assessment ◽  
Prospective Clinical Study ◽  
Care Hospital ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Medical Sciences

Background: Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan. Material and Methods: This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size < 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Collected data included age, gender, duration of injury, nature of injury, operative findings, other associated injuries, type of definitive repair, involvement of artery, complications including amputations, infections, re-exploration, ligation or death. Statistical Package for Social Sciences (SPSS) version 23 was used to analyze data. Results: Out of total 60 patients, 53 (88.3%) were males and 7 (11.7%) were females, with a mean age of 27.8±14.1 years. Most of the patients presented after 6 hours of trauma (n=36; 60%). Blunt trauma accounted for 37 (61.7%) while penetrating trauma was seen in 23 (38.3%) patients. Per operatively, 33 (55%) patients had intimal injury, 7 (11.7%) had partial tear and 20 (33.3%) had complete transection of artery. Primary repair was performed in 9 (15%) patients and reverse vein graft in 51 (85%) patients. Most commonly injured arteries were femoral (n=21; 35%), brachial (n=18; 30%) and popliteal (n=12; 20%) arteries, respectively. Amputations were significantly related to presentation of patients later than 6 hours (P=0.035). Conclusion: Patients who present with vascular trauma need an early diagnosis, referral and timely management in order to save both limb and life of patients with special concern for good quality of life and cost-effective management.

scholarly journals Socio-Demographic Characteristics of Patients Presenting to the Vascular Emergency Department of National Institute of Cardiovascular Diseases (NICVD)

2016 ◽  
Vol 11 (1) ◽  
pp. 3-6
Author(s):  
Sultan Mahmud ◽  
Mohammad Samir Azam Sunny ◽  
Md Enamul Hakim ◽  
Rezwanul Haque ◽  
Md Aftabuddin
Keyword(s):  
Emergency Department ◽  
Cardiovascular Diseases ◽  
Vascular Surgery ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Blunt Injury ◽  
Vascular Injuries ◽  
Care Needs ◽  
Female Ratio ◽  
Epidemiological Characteristics

Emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is rendering service for the patients suffering from vascular trauma since 2001. Data regarding this practice of emergency services is rarely published. This paper aims to provide the epidemiological characteristics of patients presenting the vascular emergency department of NICVD between 01/9/14 to 30/09/14. This study is intended to benefit the policy makers, healthcare providers in Bangladesh to promote and define the specialty of emergency vascular department and to allocate resources more effectively to address country’s acute care needs. In total sixty four (64) patients was attended in this 1 month. The male to female ratio was 60:4 with age range from nine to sixty four years (mean age 30.8years). Among them thirty nine percent patients belong to low socioeconomic class, thirty one percent from middle class and others from affluent family. Forty patients (62.5%) were referred from various institute of Dhaka city and rest from outside Dhaka. Seventy five percent patients came by ambulance, eight percent by private vehicles and rest by other means. Fifty eight patients (90.62%) came with referral papers from other health institutes, where there is no vascular surgery department. Most common cause of referral was vascular trauma (78.12%), other causes of referral were complicate vascular aneurysm (7.8%) and vascular thrombosis (14.06%). The time since injury and seeking treatment for vascular surgery ranged two hours to six days. Mean time was 10.3 hours. Forty cases (62.5%) sustained vascular trauma by accident with sharp cutting objects during occupational and house hold activities, assault (stab injury, blunt injury and gunshot) ten cases (15.62%), road traffic accident seven cases (10.93%), intravenous drug abusers three cases (4.68%), accidentally fall from height three cases (4.68%) and post operative complication one cases (1.56%). This study demonstrates that eighty eight percent study populations presented with arterial injuries and only twelve percent with venous injuries. Associated injuries (tendon, nerve, muscle, fracture of bones and joints dislocation) were present in fifty six patients (87.5%). Most common artery that was injured was radial artery. Vascular Injuries were treated with end to end anastomosis in twenty five patients (36.6%), ligation of vessels in twenty three patients (35.9%), fasciotomy was done in eight patients (12.5%) , embolectomy (fogerty) was done in four patients (6.25%) ,. aneurysmectomy was needed in two patients (3.1%) and interposition venous graft was used in two cases (3%). The emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is taking the entire burden with their small resources to ensure the best quality care for the management of the patients with vascular injuries. The data can inform and guide the allocation of national resources towards emergency care, injury prevention campaigns, emergency service evaluation and clinical guideline development.University Heart Journal Vol. 11, No. 1, January 2015; 3-6

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