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 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 Intravascular Shunt in Management of Limb Trauma- A Review

2021 ◽  
pp. 274-281
Author(s):  
Hashem Bark Awadh Abood ◽  
Abdulaziz Munahi Alanazi ◽  
Falah Bader Alhajraf ◽  
Wejdan Nawaf Mesfer Alotaibi ◽  
Bushra Saad Alghamdi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Patient Survival ◽  
Survival Rates ◽  
Tissue Loss ◽  
Vascular Injuries ◽  
Limb Trauma ◽  
Life Threatening ◽  
Arterial Insufficiency ◽  
Soft Tissue Loss

Vascular injuries to the upper or lower limb in the context of significant soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Complex extremity vascular injuries in which acute arterial insufficiency combined with severe or prolonged shocks are unacceptable because warm, warm, skeletal muscle time is often exceeded before adequate revascularization, and are associated with extended ischemia periods or fractures or soft tissue wounds. Revascularizing the limb is essential for the success of the limb rescue. Selective intravascular temporary shunting hence allows better overall care of the patient and can therefore be predicted to increase both limb rescue and patient survival rates. The aim of this article was to review and summarize results of previous literature regarding effectiveness on intravascular shunting as management of limb trauma as well as reviewing its potential complications.

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.

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.

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 Vascular Trauma in the Head and Neck and Endovascular Neurointerventional Management

2020 ◽  
Vol 10 ◽  
pp. 44
Author(s):  
Jeet Patel ◽  
Thien J. Huynh ◽  
Dinesh Rao ◽  
Grzegorz Brzezicki
Keyword(s):  
Head And Neck ◽  
Computed Tomographic Angiography ◽  
Vascular Trauma ◽  
Vascular Injuries ◽  
Computed Tomographic ◽  
Pictorial Essay ◽  
Life Threatening ◽  
Initial Imaging ◽  
Tomographic Angiography ◽  
Work Up

Traumatic vascular injuries of the head and neck can pose life-threatening emergencies, and therefore, the detection and accurate characterization of these injuries by the radiologist is essential. Computed tomographic angiography (CTA) is commonly performed as part of the initial imaging work-up of patients who have sustained blunt or penetrating craniocervical injuries and are suspected to have or are at risk for vascular injuries. This pictorial essay reviews the CTA and conventional angiographic imaging appearance of various vascular injuries that can occur from trauma in the head and neck and also explores the neurointerventional management of these types of injuries.

The Outcome of Patients with Sepsis at Tarakan Hospital Central Jakarta in 2018

2021 ◽  
Vol 2 (2) ◽  
pp. 49
Author(s):  
Ade Dharmawan ◽  
Mieke Joseba Istia ◽  
Henny Tannady Tan ◽  
Suparto Suparto ◽  
Monica Cherlady Anastasia ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Patient Outcomes ◽  
Sepsis Patient ◽  
District Hospital ◽  
Common Source ◽  
Inclusion Criteria ◽  
Common Life ◽  
Source Of Infection ◽  
Life Threatening ◽  
Male Patients

Background: Sepsis is a common, life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, estimated cases for sepsis reached 48.9 million worldwide, with 11 million deaths. Adequate antibiotic therapy is crucial for the treatment of sepsis. Purposes: The objective of this study is to find factors related to sepsis patient outcomes. Methods: We conducted a 1-year retrospective descriptive study with the inclusion criteria of all adult sepsis patients in Tarakan District Hospital in 2018. We compiled 39 samples that fit the inclusion criteria. Results: The distribution gender of this study were 51.2% female and 48.8% male patients; with most patients in the age of <65 years old (53.8%), <7 days in the length of stay (72%), and the most common source of infection was gastrointestinal (33.3%) followed by lungs (28.2%). Conclusion: We found a mortality rate of 59%, with the most common source of infection leading to death was the lungs (81.2%) and treated with single ceftriaxone antibiotic therapy (78.3%). Another factor associated with mortality is inadequate single antibiotic therapy.

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.

Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

2020 ◽  
Author(s):  
Ahmed Mousa ◽  
Ossama M. Zakaria ◽  
Mai A. Elkalla ◽  
Lotfy A. Abdelsattar ◽  
Hamad Al-Game'a
Keyword(s):  
Severity Score ◽  
Vein Graft ◽  
Bypass Surgery ◽  
Age Groups ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Group Iii ◽  
Mangled Extremity ◽  
Group I ◽  
End To End

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.

scholarly journals The OSMR Gene Is Involved in Hirschsprung Associated Enterocolitis Susceptibility through an Altered Downstream Signaling

2021 ◽  
Vol 22 (8) ◽  
pp. 3831
Author(s):  
Tiziana Bachetti ◽  
Francesca Rosamilia ◽  
Martina Bartolucci ◽  
Giuseppe Santamaria ◽  
Manuela Mosconi ◽  
...  
Keyword(s):  
Immune Response ◽  
Oncostatin M ◽  
Common Life ◽  
Downstream Signaling ◽  
Whole Exome ◽  
Gut Homeostasis ◽  
Life Threatening ◽  
Infection And Inflammation ◽  
Susceptibility Variant ◽  
Oncostatin M Receptor

Hirschsprung (HSCR) Associated Enterocolitis (HAEC) is a common life-threatening complication in HSCR. HAEC is suggested to be due to a loss of gut homeostasis caused by impairment of immune system, barrier defense, and microbiome, likely related to genetic causes. No gene has been claimed to contribute to HAEC occurrence, yet. Genetic investigation of HAEC by Whole-Exome Sequencing (WES) on 24 HSCR patients affected (HAEC) or not affected (HSCR-only) by enterocolitis and replication of results on a larger panel of patients allowed the identification of the HAEC susceptibility variant p.H187Q in the Oncostatin-M receptor (OSMR) gene (14.6% in HAEC and 5.1% in HSCR-only, p = 0.0024). Proteomic analysis on the lymphoblastoid cell lines from one HAEC patient homozygote for this variant and one HAEC patient not carrying the variant revealed two well distinct clusters of proteins significantly up or downregulated upon OSM stimulation. A marked enrichment in immune response pathways (q < 0.0001) was shown in the HAEC H187 cell line, while proteins upregulated in the HAEC Q187 lymphoblasts sustained pathways likely involved in pathogen infection and inflammation. In conclusion, OSMR p.H187Q is an HAEC susceptibility variant and perturbates the downstream signaling cascade necessary for the gut immune response and homeostasis maintenance.

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