Trauma is a leading cause of death and disability in young adults in developed countries with the high impact on future patient quality of life and productivity. The traumatic injury of the vessels is one of the most dangerous types of injury, requiring a fast and reliable diagnosis and, in vast majority of cases, immediate surgical treatment. In this chapter, the authors describe various types of vascular injuries according to injury types and locations. The prehospital care algorithms in patients with vascular trauma are proposed with the emphasis on bleeding control techniques and transportation technique to the nearest hospital. In the next subsection, the various peripheral vascular injuries of specific body areas are described. The truncal vessel trauma is discussed in the next subsection, focusing on fast diagnosis and decision on surgery. In the last subsection, a problem of iatrogenic vascular injury is described due to a rapid increase of minimally invasive techniques in which a vascular injury, as a complication of therapy, may occur.
IntroductionVarious modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy.AimThe authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures.Material and methodsThe early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference.ResultsNo intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing.ConclusionsThe proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with long-term follow-up are needed.
Among patients presenting with acute abdominal symptoms, patients with acute mesenteric ischemia (AMI) constitute 0.09% - 0.2% of cases. Unfortunately, due to the short period between the first symptoms and irreversible ischemic changes in the intestine, the mortality rate in this group is high – up to 60% - 100%. We present a case of a 75-yearold female with severe comorbidities (ischemic heart disease, atrial fibrillation, poorly controlled arterial hypertension, and a history of colorectal carcinoma previously treated with radio- and chemotherapy). The patient was admitted due to severe abdominal pain. Computed tomography (CT) confirmed superior mesenteric artery (SMA) and celiac trunk embolism. Due to the relatively short time of symptoms onset as well as the soft abdomen, the patient was qualified for percutaneous treatment. Successful percutaneous transluminal angioplasty was performed with stent implantation to SMA and celiac trunk (Neptun C, Balton, Poland). As a result, the patency of both arteries was fully restored. The patient’s condition improved within 24 hours, and she was discharged home.
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