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Cuneo MR, Flinn Patterson AN, Causey MW. Endovascular management of posterior tibial arteriovenous fistula and pseudoaneurysms secondary to penetrating trauma. J Vasc Surg 2025; 81:983-984. [PMID: 38513782 DOI: 10.1016/j.jvs.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Micaela R Cuneo
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX
| | | | - Marlin W Causey
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX
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2
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Gilat EK, Khaitovitch B, Barash Y, Tau N, Konen E, Halak M, Silverberg D, Raguan B, Sorin V, Raskin D. Diagnostic angiography for identification and management of late vascular injuries in war-related traumatic peripheral vascular injuries: A retrospective cohort study. PLoS One 2025; 20:e0319761. [PMID: 40100856 PMCID: PMC11918411 DOI: 10.1371/journal.pone.0319761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 02/07/2025] [Indexed: 03/20/2025] Open
Abstract
PURPOSE One of the feared complications of war-related peripheral vascular injury is the development of delayed hemorrhage. This study describes our experience with an innovative protocol of surveillance diagnostic angiography to detect occult late vascular complications in an effort to prevent delayed hemorrhage. MATERIALS AND METHODS This retrospective cohort study was conducted at a single level one trauma center, reviewing patients with war-related peripheral vascular injuries caused by penetrating trauma from October 7th, 2023, to January 21st, 2024. Data collected included patient demographics, primary injury characteristics, associated complications, incidence of late vascular injuries (either symptomatic or occult), means of diagnosis, treatment strategies and outcomes. RESULTS The cohort included 41 patients with war-related peripheral vascular injuries affecting 51 limbs. All patients were male (100%) with a median age of 25 years, the majority being soldiers (85%). 24 occurrences of late vascular injuries were observed in 22 (43%) out of 51 limbs (100%). Half were symptomatic, with delayed hemorrhage occurring in 5 limbs in total (10%), and half were asymptomatic. A total of 17 surveillance diagnostic angiographies were performed with the sole indication of identifying occult late vascular injuries in asymptomatic patients, of which 4 (24%) were positive for findings. Five additional diagnostic angiographies were performed to assess late injuries discovered incidentally on imaging studies that were performed for other indications, and all were positive for late vascular injuries. Of all late vascular injuries, a total of 83% required subsequent treatment. CONCLUSIONS Late vascular injuries are a potentially lethal complication of war-related peripheral vascular injury. Aggressive surveillance with diagnostic angiography prior to discharge from a high intensity care unit can detect asymptomatic late vascular injuries, the treatment of which may prevent life-threatening hemorrhage.
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Affiliation(s)
- Efrat Keren Gilat
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Khaitovitch
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Tau
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Halak
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Vascular Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Daniel Silverberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Vascular Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Barak Raguan
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Trauma Unit, Division of General Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Vera Sorin
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Raskin
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gnaedinger AG, Tian-Yang Yu A, Hadi J, Saliba S, Tian WM, Fernandez J, Vatsaas CJ, Agarwal S, Haines K. Lower Extremity Penetrating Trauma Care Associated With Race and Income in the United States of America. J Surg Res 2025; 306:364-370. [PMID: 39847852 DOI: 10.1016/j.jss.2024.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 11/14/2024] [Accepted: 11/30/2024] [Indexed: 01/25/2025]
Abstract
INTRODUCTION For lower extremity penetrating traumas (LEPT), the impact of race and insurance status, as a surrogate of socioeconomic status, is still not fully elucidated. This study aims to explore the relationship between these variables and the likelihood of receiving an amputation for LEPT to further identify disparities in trauma care. METHODS We analyzed the 2017-2019 Trauma Quality Improvement Program databases to identify patients with LEPT. Univariate analysis of various patient factors was performed for mortality. Linear and logistic multivariate regressions were then conducted for the primary and secondary outcomes using significant variables from the univariate analysis. Finally, multivariate logistic regression identified associations between race, ethnicity, primary payor, and amputation rates. RESULTS The independent factors significantly linked to amputation included Black race (odds ratio (OR) 0.745, P < 0.001), Medicare (OR 0.557, P < 0.001), Medicaid (OR 0.697, P < 0.001), and uninsured status (OR 0.661, P < 0.001). We additionally evaluated the incidence of death among the penetrating trauma victims and determined that male (OR 2.008, P < 0.001), Black (OR 1.801, P = 0.001), and uninsured patients (OR 1.910, P = 0.003) were more likely to die during admission than the privately insured. CONCLUSIONS Compared to privately insured victims, uninsured patients and those on Medicaid and Medicare experience lower amputation rates post-LEPT. Black patients were found to have not only a decreased likelihood of receiving an amputation following LEPT but also an increased rate of mortality during admission compared to Caucasian victims. These findings underscore the urgency to address institutional barriers hindering vulnerable populations from accessing appropriate care after trauma.
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Affiliation(s)
| | | | - Jaafar Hadi
- Department of Surgery, Duke University, Durham, North Carolina
| | - Sarah Saliba
- Department of Surgery, Duke University, Durham, North Carolina
| | - William M Tian
- School of Medicine, Duke University, Durham, North Carolina
| | | | - Cory J Vatsaas
- Department of Surgery, Duke University, Durham, North Carolina
| | - Suresh Agarwal
- Department of Surgery, Duke University, Durham, North Carolina
| | - Krista Haines
- Department of Surgery, Duke University, Durham, North Carolina.
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Vincent Y, Rossillon A, Baltazard C, Poichotte A, Boddaert G, Leclere JB, Beranger F, Avaro JP, de Lesquen H. Endovascular surgery in the French role 3 medical treatment facility: Is there a need? A 10-year retrospective analysis. Injury 2025; 56:112049. [PMID: 39612869 DOI: 10.1016/j.injury.2024.112049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 11/17/2024] [Indexed: 12/01/2024]
Abstract
OBJECTIVE Vascular surgery for war-related traumatic injuries represents 3 to 17.6 % of all emergency surgical procedures, and around 5 % in French Medical Treatment Facilities (MTFs). Most of these lesions are treated by open surgery, but the role of endovascular surgery in French MTFs has not been assessed yet. The aims of this study are to assess the possible role of endovascular surgery by describing vascular surgical management in recent conflicts, and identify potential gaps in vascular surgery training. METHODS Data were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2011 to 2021. All patients treated in French Role 2 Enhanced or 3 MTFs requiring emergency surgery for peripheral vascular injury were included. The mechanism of injury, type of vascular injury and surgical management were reported. Patients eligible to receive endovascular surgery were described as a subgroup, and surgical management was described according to surgeon's specialty. RESULTS Out of the 2137 patients admitted for emergency or delayed emergency surgery, we reported 21 patients (0.98 %) with peripheral vascular injuries requiring emergency surgery, of which 19 (90.5 %) with at least one arterial lesion. Most injuries were combat-related (n = 18 [86 %]). Arterial injuries involved mainly femoral (n = 8 [38.1 %]) or humeral (n = 5 [23.8 %]) arteries, primarily handled by vascular shunting or bypass. Arteriography before or after surgery was not a was not common practice (n = 4 [19 %]). Six patients (28.6 %) were deemed eligible for endovascular surgery. CONCLUSION Peripheral vascular lesion requiring emergency surgery are relatively uncommon in French MTFs. However, they require specific surgical training to deal with their complexity. Endovascular surgery does not appear to offer sufficient benefit for systematic deployment in French MTFs, and pre- and post-operative arteriography may be of interest for diagnostic use. The establishment of a French vascular mobile unit for complex cases may be of interest.
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Affiliation(s)
- Yohann Vincent
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Alexandre Rossillon
- Vascular Surgery Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | | | - Antoine Poichotte
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | | | - Jean-Baptise Leclere
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Fabien Beranger
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
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5
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Chalidis B, Davitis V, Papadopoulos P, Pitsilos C. Subclavian vessels injury: An underestimated complication of clavicular fractures. World J Crit Care Med 2024; 13:98579. [PMID: 39655299 PMCID: PMC11577540 DOI: 10.5492/wjccm.v13.i4.98579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 10/31/2024] Open
Abstract
Clavicle fractures are frequent orthopedic injuries, often resulting from direct trauma or a fall. Most clavicle fractures are treated conservatively without any complications or adverse effects. Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures. They are potentially life-threatening conditions leading to hemorrhage, hematoma, pseudoaneurysm or upper limb ischemia. However, the clinical presentation might be obscure and easily missed, particularly in closed and minimally displaced clavicular fractures, and timely diagnosis relies on early clinical suspicion. Currently, computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency, as it demonstrates high accuracy and temporal resolution, acute turnaround time, and capability of multiplanar reconstruction. Depending on the hemodynamic stability of the patient and the severity of the injury, subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively. Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia, followed by stabilization of the displaced clavicle fracture. This review aims to provide a comprehensive overview of the incidence, clinical presentation, diagnostic approaches, and current management strategies of clavicle fractures associated with subclavian vessel injuries.
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Affiliation(s)
- Byron Chalidis
- First Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasileios Davitis
- Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
| | - Pericles Papadopoulos
- Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
| | - Charalampos Pitsilos
- Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
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Tamburrini S, Lassandro G, Tiralongo F, Iacobellis F, Ronza FM, Liguori C, Comune R, Pezzullo F, Galluzzo M, Masala S, Granata V, Basile A, Scaglione M. CTA Imaging of Peripheral Arterial Injuries. Diagnostics (Basel) 2024; 14:1356. [PMID: 39001246 PMCID: PMC11240895 DOI: 10.3390/diagnostics14131356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Traumatic vascular injuries consist of direct or indirect damage to arteries and/or veins and account for 3% of all traumatic injuries. Typical consequences are hemorrhage and ischemia. Vascular injuries of the extremities can occur isolated or in association with major trauma and other organ injuries. They account for 1-2% of patients admitted to emergency departments and for approximately 50% of all arterial injuries. Lower extremities are more frequently injured than upper ones in the adult population. The outcome of vascular injuries is strictly correlated to the environment and the time background. Treatment can be challenging, notably in polytrauma because of the dilemma of which injury should be prioritized, and treatment delay can cause disability or even death, especially for limb vascular injury. Our purposes are to discuss the role of computed tomography angiography (CTA) in the diagnosis of vascular trauma and its optimized protocol to achieve a definitive diagnosis and to assess the radiological signs of vascular injuries and the possible pitfalls.
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Affiliation(s)
- Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy
| | | | - Carlo Liguori
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Filomena Pezzullo
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Grande-Garcia R, Anaya-Ayala JE, Barragán-Galindo L, Vera R, Laparra-Escareno H, Varela-Arzate A, Chapa-Ibargüengoitia M, Hinojosa CA. Ischemic Complication of a Rare Traumatic True Brachial Artery Aneurysm: A Case Report. Vasc Specialist Int 2024; 40:4. [PMID: 38311376 PMCID: PMC10839554 DOI: 10.5758/vsi.230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
True brachial artery aneurysms are rare. We present the case of a 47-year-old male who was referred to our clinic for the evaluation of progressive right arm claudication. He had suffered a gunshot wound in the right elbow 16 years before his symptoms. Computed tomography angiography revealed a thrombosed true brachial artery aneurysm. The patient was placed in the operating room, and aneurysm resection and reconstruction were performed using an interposition saphenous vein graft. His postoperative period was uneventful, and 1 year after the procedure, he remained asymptomatic. True brachial artery aneurysms associated with remote traumas are rare. This case illustrates the clinical presentation and successful management of arterial reconstruction using an autologous vein graft.
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Affiliation(s)
- Ricardo Grande-Garcia
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier E. Anaya-Ayala
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis Barragán-Galindo
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Renata Vera
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Astrid Varela-Arzate
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa-Ibargüengoitia
- Departments of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A. Hinojosa
- Departments of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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8
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Kim JH. [Role of Interventional Radiologists in Trauma Centers]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:784-791. [PMID: 37559809 PMCID: PMC10407069 DOI: 10.3348/jksr.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023]
Abstract
Based on statistics available in Korea, trauma centers play a critical role in treatment of patients with trauma. Interventional radiologists in trauma centers perform various procedures, including embolization, which constitutes the basic treatment for control of hemorrhage, although interventions such as stent graft insertion may also be used. Although emergency interventional procedures have been used conventionally, rapid and effective hemorrhage control is important in patients with trauma. Therefore, it is important to accurately understand and implement the concept of damage control interventional radiology, which has gained attention in recent times, to reduce preventable trauma-induced mortality rates.
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Badalamenti G, Ferrer C, Calvagna C, Franchin M, Piffaretti G, Taglialavoro J, Bassini S, Griselli F, Grando B, Lepidi S, D'Oria M. Major vascular traumas to the neck, upper limbs, and chest: Clinical presentation, diagnostic approach, and management strategies. Semin Vasc Surg 2023; 36:258-267. [PMID: 37330239 DOI: 10.1053/j.semvascsurg.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Major vascular traumas to the neck, upper limbs, and chest may arise from penetrating and/or blunt mechanisms, resulting in a range of clinical scenarios. Lesions to the carotid arteries may also lead to neurologic complications, such as stroke. The increasing use of invasive arterial access for diagnostic and/or interventional purposes has increased the rate of iatrogenic injuries, which usually occur in older and hospitalized patients. Bleeding control and restoration of perfusion represent the two main goals of treatment for vascular traumatic lesions. Open surgery still represents the gold standard for most lesions, although endovascular approaches have increasingly emerged as feasible and effective options, particularly for management of subclavian and aortic injuries. In addition to advanced imaging (including ultrasound, contrast-enhanced cross-sectional imaging, and arteriography) and life support measures, multidisciplinary care is required, particularly in the setting of concomitant injuries to the bones, soft tissues, or other vital organs. Modern vascular surgeons should be familiar with the whole armamentarium of open and endovascular techniques needed to manage major vascular traumas safely and promptly.
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Affiliation(s)
- Giovanni Badalamenti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Ciro Ferrer
- Vascular and Endovascular Surgery Unit, 90352 San Giovanni - Addolorata Hospital, Roma, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Marco Franchin
- Vascular Surgery Unit, Circolo University Teaching Hospital, University of Insubria - ASST Settelaghi, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, Circolo University Teaching Hospital, University of Insubria - ASST Settelaghi, Varese, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Beatrice Grando
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy.
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Ntola VC, Hardcastle TC. Diagnostic Approaches to Vascular Injury in Polytrauma-A Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13061019. [PMID: 36980328 PMCID: PMC10046960 DOI: 10.3390/diagnostics13061019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Polytrauma is understood as significant injuries, occurring at the same time, to two or more anatomical regions (the ISS regions) or organ systems, with at least one of the injuries considered as posing a threat to life. Trauma is the main cause of unexpected demise in individuals below the age of 44 years and represents a huge burden on society. Vascular injury is highly morbid; it can lead to rapid exsanguination and death, posing a threat to both life and the limb. Independent predictors of outcome include mechanism of injury, associated injuries, and time from injury to definitive care. The mechanisms of vascular injury in the setting of polytrauma are either blunt, penetrating or a combination of the two. METHODS Comprehensive literature review of current diagnostic approaches to traumatic vascular injury in the context of polytrauma. The factors influencing the diagnostic approach are highlighted. The focus is the epidemiology of vascular injury and diagnostic approaches to it in the context of polytrauma. RESULTS Traumatic vascular injuries are associated with limb loss or even death. They are characterised by multiple injuries, the dilemma of the diagnostic approach, timing of intervention and higher risk of limb loss or death. The systematic approach in terms of clinical diagnosis and imaging is crucial in order save life and preserve the limb. The various diagnostic tools to individualise the investigation are discussed. CONCLUSION This paper highlights the significance of timely and appropriate use of diagnostic tools for traumatic vascular trauma to save life and to preserve the limb. The associated injury also plays a crucial role in deciding the imaging modalities. At times, more than one investigation may be required.
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Affiliation(s)
- Vuyolwethu C Ntola
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban 4058, South Africa
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban 4058, South Africa
- Trauma and Burns Service, Inkosi Albert Luthuli Central Hospital, Durban 4058, South Africa
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11
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Lip HTC, Huei TJ, Peng LE, Huan KZ, Sen CJ, Muhamad I, Mohamad Y, Alwi RI. Outcomes of traumatic extremity vascular injuries from a Malaysian level 1 trauma center. Injury 2022; 53:3005-3010. [PMID: 35410740 DOI: 10.1016/j.injury.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/03/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In Malaysia, management of traumatic vascular injuries is at the discretion of the treating surgeon (trauma or vascular surgery). This study was conducted to report on the epidemiology, mechanism of injury and outcomes of vascular injuries managed in a regional level 1 trauma center. METHODS This is a retrospective cohort study of all patients treated for traumatic extremity vascular injuries from January 2018 to December 2020. Demography, mechanism of injury, pre-operative physiologic vital signs, vessel injured, injury severity (NISS, RTS and TRISS score), type of revascularization surgery, fasciotomy, post-operative blood investigations, operative outcomes (amputation, length of stay and ICU admission) and long-term rehabilitation follow-up were recorded and analyzed. RESULTS Amongst the 35 recorded vascular injuries only 28 patients had adequate data that were included in the analysis. Majority of patients were males (23/28patients; 82%). Blunt injury to vessels was more likely in motorcycle crashes (16/28patients; 76%) than in automobile crashes (5/28patients; 24%). There were three lower limb amputees (3/3patients; 100%) that had early fasciotomy and were associated with three-fold higher post-operative median (interquartile range) CK levels of 16740 (8157 to 23116) u/l. Only two thirds (16/28 patients) had active rehabilitation follow-up and were back to work after a median duration of four months. CONCLUSION Male gender, blunt injury, road traffic crashes and motorcycles were the majority of vascular injuries. Lower limb vascular injuries had poorer outcome with three amputations performed after attempts at revascularization. Fasciotomy and high CK level may be related to higher risk of limb loss. Our study highlights the importance of rehabilitation and long-term follow-up in this cohort of patients.
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Affiliation(s)
- Henry Tan Chor Lip
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia.
| | - Tan Jih Huei
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Lee Ee Peng
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Khoo Zi Huan
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Chuah Jun Sen
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Izwan Muhamad
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Yuzaidi Mohamad
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
| | - Rizal Imran Alwi
- Trauma Surgery Unit, Department of General Surgery, Hospital Sultanah Aminah, Jalan Abu Bakar, masjid abu bakar, Johor Bahru 81100, Malaysia
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12
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Chen Zhou ZH, Martínez Chamorro E, Ibánez Sanz L, Sanz De Lucas R, Chico Fernández M, Borruel Nacenta S. Traumatic arterial injuries in upper and lower limbs: what every radiologist should know. Emerg Radiol 2022; 29:781-790. [PMID: 35513546 DOI: 10.1007/s10140-022-02053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Traumatic arterial injuries of the extremities are a rare but potentially fatal event. Computed tomography (CT) angiography of the extremities has become the technique of choice and can provide rapid accurate detection and characterization of vascular lesions. Vascular injuries can be classified in active hemorrhage, vasospasm, occlusion, post-traumatic arteriovenous fistula, pseudoaneurysm, and patterns of intimal injuries. The learning objectives of this pictorial essay are to review the normal arterial anatomy of the upper and lower limbs, describe the technique of CT angiography in vascular trauma of the extremities, describe and illustrate the CT-angiography findings of traumatic arterial injuries, and know the potential pitfalls when interpreting a CT-angiography of the extremities.
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Affiliation(s)
- Zhao Hui Chen Zhou
- Department of Radiology, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Elena Martínez Chamorro
- Department of Radiology, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Laín Ibánez Sanz
- Department of Radiology, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Raquel Sanz De Lucas
- Department of Radiology, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Mario Chico Fernández
- Intensive Care Unit, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Susana Borruel Nacenta
- Department of Radiology, Hospital Universitario Doce de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
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13
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Kim Y, Choi K, Choi S, Keum MA, Kim S, Kyoung KH, Kim JT, Noh M. Case reports of iatrogenic vascular injury in the trauma field: what is the same and what is different? JOURNAL OF TRAUMA AND INJURY 2022; 35:123-127. [PMID: 39381180 PMCID: PMC11309190 DOI: 10.20408/jti.2021.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/05/2022] Open
Abstract
Iatrogenic vascular injury (IVI) can occur with any technique or type of surgery performed around a blood vessel. Patients with severe trauma are at risk of IVI. In this study, we describe our experiences of IVI in the trauma field. We reviewed five patients who were diagnosed with an IVI and received either surgical or endovascular treatment. Of the five patients, one had an arterial injury, three had venous injuries, and one had an arteriovenous fistula, a form of combined arterial and venous injuries. Of the five patients, four had undergone orthopedic surgery. The IVIs of three patients were immediately identified in the operating room and simultaneous vascular repair was performed. The remaining one patient underwent additional surgery for occlusion related to entrapment of the superficial femoral artery by a surgical wire used during orthopedic surgery. Complications presumably related to the IVI were identified in two patients. IVI in trauma patients can be successfully managed, but significant morbidity can occur. If an IVI is suspected, immediate evaluation and management are required.
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Affiliation(s)
- Youngwoong Kim
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyunghak Choi
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seongho Choi
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Ae Keum
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sungjeep Kim
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyu-Hyouck Kyoung
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jihoon T Kim
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Minsu Noh
- Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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14
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Morris P, McCloskey R, Bulman D. Iatrogenesis in the Context of Residential Dementia Care: A Concept Analysis. Innov Aging 2022; 6:igac028. [PMID: 35832201 PMCID: PMC9273406 DOI: 10.1093/geroni/igac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm. Research Design and Methods Walker and Avant's method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across 4 electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept. Results Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this article is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that result in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident's safety and dignity. Discussion and Implications The definition of iatrogenesis proposed in this article is an initial step toward developing evidence-based practice for the provision of nonconsensual assistance in residential dementia care. A theoretical definition like the one proposed in this article may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents' experiences of health care-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of nonconsensual care.
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Affiliation(s)
- Patricia Morris
- School of Graduate Studies, University of New Brunswick, Saint John, New Brunswick, Canada
- Geriatric Medicine Clinic, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Rose McCloskey
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Donna Bulman
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
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15
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Circumferential intimal tear with thrombosis of right superficial femoral artery due to penetrating injury by bull horn: A case report. Ann Med Surg (Lond) 2022; 74:103228. [PMID: 35127064 PMCID: PMC8792411 DOI: 10.1016/j.amsu.2021.103228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
In agrarian countries where bulls are used for farming and stock breeding, bull horn injuries are common. Bull horn injuries range from blunt trauma to penetrating injuries, which can cause massive hemorrhage. Vascular injuries to the limbs by goring bull horn injury usually involve transection of vessels but rarely cause intimal tear with thrombus formation. Here, we report an unusual case of a 33-year-old male with circumferential intimal tear with thrombosis in the subintimal region of the right superficial femoral artery without transection of the vessel following penetrating injury to the right thigh caused by a bull's horn. There was a pulse deficit above the popliteal artery, and Doppler ultrasonography revealed decreased flow indicative of underlying femoral vessel injury for which the wound was surgically explored. It was followed by right superficial femoral arteriotomy at the site of the thrombus with the evacuation of a 6 cm long clot, revealing a 6 cm long endothelial injury in the same vessel. Next, an interposition reversed saphenous graft was placed in the same location. Following this, Doppler ultrasonography was done that revealed restoration of blood flow to the site of thrombosis. Thus, in a case of bull horn injury, thrombosis should be ruled out with prompt surgical wound exploration despite the presence of an intact vessel.
Bull horn injury to extremities can cause intimal tears with subintimal thrombosis, partially impeding blood flow. Diagnostic dilemma can occur due to contrasting radiological and clinical findings in injuries with vascular occlusion. Surgical wound exploration without CECT scan can be considered a diagnostic and therapeutic approach for revascularization.
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16
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Wang Z, Wang X, Wan JB, Xu F, Zhao N, Chen M. Optical Imaging in the Second Near Infrared Window for Vascular Bioimaging. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2103780. [PMID: 34643028 DOI: 10.1002/smll.202103780] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Indexed: 06/13/2023]
Abstract
Optical imaging in the second near infrared region (NIR-II, 1000-1700 nm) provides higher resolution and deeper penetration depth for accurate and real-time vascular anatomy, blood dynamics, and function information, effectively contributing to the early diagnosis and curative effect assessment of vascular anomalies. Currently, NIR-II optical imaging demonstrates encouraging results including long-term monitoring of vascular injury and regeneration, real-time feedback of blood perfusion, tracking of lymphatic metastases, and imaging-guided surgery. This review summarizes the latest progresses of NIR-II optical imaging for angiography including fluorescence imaging, photoacoustic (PA) imaging, and optical coherence tomography (OCT). The development of current NIR-II fluorescence, PA, and OCT probes (i.e., single-walled carbon nanotubes, quantum dots, rare earth doped nanoparticles, noble metal-based nanostructures, organic dye-based probes, and semiconductor polymer nanoparticles), highlighting probe optimization regarding high brightness, longwave emission, and biocompatibility through chemical modification or nanotechnology, is first introduced. The application of NIR-II probes in angiography based on the classification of peripheral vascular, cerebrovascular, tumor vessel, and cardiovascular, is then reviewed. Major challenges and opportunities in the NIR-II optical imaging for vascular imaging are finally discussed.
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Affiliation(s)
- Zi'an Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Xuan Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Jian-Bo Wan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Fujian Xu
- Key Laboratory of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100000, China
| | - Nana Zhao
- Key Laboratory of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100000, China
| | - Meiwan Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
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17
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Choufani C, de Saint Roman C, Bianchin D, Tricoteaux G, Lefort H. [Bleeding management in the operating theatre]. REVUE DE L'INFIRMIÈRE 2021; 70:31-33. [PMID: 34446232 DOI: 10.1016/j.revinf.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite all the measures taken preoperatively, bleeding may persist and require surgical control. Before considering treatment, it is necessary to establish the diagnosis with the origin of the bleeding. The surgical procedure depends on the aetiology. There are many surgical options and adjuvant measures to consider. They should be known by the operating theatre nurse, who is a major player in surgical management. Successful control of bleeding requires quality multidisciplinary collaboration.
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Affiliation(s)
- Camille Choufani
- Service de chirurgie orthopédique, hôpital d'instruction des armées Sainte-Anne, 2 boulevard Sainte-Anne, 83800 Toulon, France.
| | - Charlotte de Saint Roman
- Service de chirurgie viscérale, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57070 Metz, France
| | - David Bianchin
- Service du bloc opératoire, centre hospitalier Édouard-Herriot, 5 place d'Arsonval, 69003 Lyon, France
| | - Gérald Tricoteaux
- Service du bloc opératoire, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57070 Metz, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France; Structure des urgences, hôpital d'instruction des armées Lavéran, 34 boulevard Lavéran, 13384 Marseille, France
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18
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Herrera MA, Millán M, Del Valle AM, Betancourt-Cajiao M, Caicedo Y, Caicedo I, Gallego LM, Rivera D, Parra MW, Ordoñez CA. Damage control of peripheral vascular trauma - Don't be afraid of axillary or popliteal fosses. Colomb Med (Cali) 2021; 52:e4074735. [PMID: 34188323 PMCID: PMC8216047 DOI: 10.25100/cm.v52i2.4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.
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Affiliation(s)
- Mario Alain Herrera
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | | | | | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Isabella Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | | | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
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19
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Asmar S, Bible L, Obaid O, Tang A, Khurrum M, Castanon L, Ditillo M, Joseph B. Open vs Endovascular Treatment of Traumatic Peripheral Arterial Injury: Propensity Matched Analysis. J Am Coll Surg 2021; 233:131-138.e4. [PMID: 33771677 DOI: 10.1016/j.jamcollsurg.2021.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arterial injuries occur in the setting of blunt and penetrating trauma. Despite increasing use, there remains a paucity of data comparing long-term outcomes of endovascular vs open repair management of these injuries. The aim of our study was to compare outcomes and readmission rates of open vs endovascular repair of traumatic arterial injuries. STUDY DESIGN The National Readmission Database (2011-2014) was queried for all adult (age ≥ 18 y) patients presenting with peripheral arterial (axillary, brachial, femoral, and popliteal) injuries. Patients were stratified into 2 groups based on intervention: open vs endovascular approach. Propensity score matching (1:2 ratio) was performed. Outcomes measures were complications, length of stay (LOS), 30-day readmission, and cost of readmission. RESULTS A matched cohort of 786 patients was obtained (endovascular: 262, open: 524). Mean age was 45 ± 17 years, and 79% were males. Median LOS was 4 (range 2-6) days for the endovascular group vs 3 (range 2-5) days for the open group (p < 0.01). The endovascular group had higher rates of seroma (4% vs 2%; p = 0.04) and arterial thrombosis (13% vs 7%; p < 0.01) during index hospitalization. Patients who underwent endovascular repair had higher 30-day readmission (11% vs 7%; p = 0.03) and a higher 30-day open-reoperation rate (6% vs 2%; p < 0.01). On subanalysis of the patients who were readmitted, the median cost of each readmission was higher in the endovascular group $47,000 ($27,202-$56,763) compared with $21,000 ($11,889-$43,503) in the open group. CONCLUSIONS Endovascular repair for peripheral arterial injuries was associated with higher rates of in-hospital complications, readmissions, and costs. As this new technology continues to undergo refinement, a thorough re-evaluation of its indications, risks, and benefits is warranted.
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Affiliation(s)
- Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Omar Obaid
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
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