Litrature Review Trauma Vascular

Vascular traumatic is trauma to the blood vessels caused by blunt injuries such as a hard impact or penetrating injuries such as sharp object injuries, penetrating bullet shots. Massive haemorrhage is the main cause of vascular trauma, resulting in death. Therefore, prompt treatment is needed to avoid other complications or even death due to uncontrolled bleeding. Vascular surgeons are the key to trauma injury patients, by controlling bleeding and vascular reconstruction, using aspects of open and endovascular surgical techniques. Diagnostic protocols are needed to identify injuries and consider the best tactics for surgical treatment of vascular injuries. Accurate, non-invasive diagnostic imaging techniques are key to this strategy. The aim of this review is to determine the optimal diagnostic imaging in patients with suspected vascular injury in the anatomic region and the method of treatment with retrospective or prospective data collection which is preferable to CT angiography compared to other methods. CT angiography can be declared the gold standard for diagnosing vascular injury in patients.

Ex-situ hepatectomy: Indications, Techniques and Results

Ex situ hepatectomy is a novel approach, used in treating complicated liver tumors, which are otherwise unresectable via conventional methods including organ perfusion, liver transplant, hemodynamic management, vascular reconstruction or even extended hepatic resection. The Ex situ hepatectomy technique denotes the entire removal of the infected liver, which is then perfused in a cold preservation solution, which allows the surgeon to remove tumors, which were otherwise unreachable when the liver is situated in the body. In so doing, the tumor is restricted ex situ on the surgeon stable, while the remaining liver is implanted orthotopically. Notably, the works on Ex situ hepatectomy techniques are credited to Pichlmary 1990, who proposed the surgical approach in the treatment of bilateral liver leiomyosarcoma. More to that, there are only a handful of successful Ex situ hepatectomy cases which have been recorded on a global scale, given the complexity of the operation. Secondary as well as primary liver tumors are some of the most commonly occurring liver tumors in humans.

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

Background: In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Case summary: Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient’s condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. Conclusions: If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.

In vivo performance of electrospun tubular hyaluronic acid/collagen nanofibrous scaffolds for vascular reconstruction in the rabbit model

One of the main challenges of tissue-engineered vascular prostheses is restenosis due to intimal hyperplasia. The aim of this study is to develop a material for scaffolds able to support cell growth while tolerating physiological conditions and maintaining the patency of carotid artery model. Tubular hyaluronic acid (HA)-functionalized collagen nanofibrous composite scaffolds were prepared by sequential electrospinning method. The tubular composite scaffold has well-controlled biophysical and biochemical signals, providing a good matrix for the adhesion and proliferation of vascular endothelial cells (ECs), but resisting to platelets adhesion when exposed to blood. Carotid artery replacement experiment from 6-week rabbits showed that the HA/collagen nanofibrous composite scaffold grafts with endothelialization on the luminal surface could maintain vascular patency. At retrieval, the composite scaffold maintained good structural integrity and had comparable mechanical strength as the native artery. This study indicating that electrospun scaffolds combined with cells may become an alternative to prosthetic grafts for vascular reconstruction. Graphical Abstract

Congenital Anatomical Variant with Cranial Origin of Internal Iliac Arteries

We report the case of a 73-year-old male who underwent abdominal multidetector computed tomography with vascular reconstruction that highlighted a congenital variant of iliac arteries. Iliac artery anatomical variants are exceedingly rare and only a few cases have been reported in the literature.

Bioengineered Acellular Vessel Implantation in a Patient with Chronic Limb-Threatening Ischemia: A Case Report and Discussion of Implications for Trauma

The ideal conduit for vascular reconstruction is one that can be obtained “off the shelf” and demonstrates long-term patency, tissue incorporation and resistance to infection. Currently available conduits, such as autologous vein and synthetic grafts, are limited in one or more of these areas. The Human Acellular Vessel (HAV), a bioengineered, acellular blood vessel, can be obtained “off the shelf” and has shown promise in each of these properties. We describe a case in which the HAV was utilized for open bypass reconstruction in a patient with chronic limb-threatening ischemia who lacked alternative reconstructive options. The case is followed by a discussion of potential broader applications of this novel implant, specifically in the management of vascular trauma.