BackgroundThere has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters.MethodsFirst, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks.Results and discussionThe average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%.ConclusionsOur findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective.
BackgroundSeverely destructive disasters can often lead to heavy casualties. Large arterial injury in disasters, particularly, often results in high mortality and morbidity. Although minimally invasive intervention has achieved positive effects in diagnosing and treating vascular injuries, it is still unavailable at the disaster area of any country due to lack of on-spot catheterization labs. This study aimed to test the feasibility of adopting interventional techniques to treat haemorrhage of large arterial injuries in remote and austere wild environments after severely destructive disasters, by using a new mobile intervention suite we developed—the mobile minimally invasive interventional shelter (MIS).MethodsLarge animal models of aortic and femoral arterial injuries were established using a newly developed medium vehicle-mounted digital subtraction angiography (DSA) machine in MIS. The endovascular stent-graft exclusion and balloon occlusion combined with surgical hemostasis were performed respectively following the protocols for rapid interventional therapy. The treatment capacity of the shelter was evaluated based on its stability, surgery duration and the clinical results.Results and discussionThe stability of the medical devices in MIS directly relates to the efficiency and success rate of interventional treatment. The newly developed vehicle-mounted DSA machine showed good imaging performance and the operation of all equipments and devices in MIS were stable in interventional procedures. All the interventional treatments for large arterial injuries were performed smoothly. The average time for treating abdominal aortic injury and femoral arterial injury was 23 ± 11 and 55 ± 17 min, respectively. And the operation success rate reached 100 %.ConclusionIt is feasible to perform interventional operations to control haemorrhage of large arterial injuries in MIS outside hospital. The MIS has a great potential to save patients from dying of hemorrhagic shock due to lack of effective treatment devices and approaches in remote and austere wild environments, such as in disaster areas.
Objective To date, transcatheterarterial embolization (TAE) has become a standard treatment to control intracavitary bleeding as an alternative to surgery. Due to excellent biocompatibility and no residual in vivo, biodegradable embolic materials are ideally preferred in TAE. However, only gelfoam is the commercially available biodegradable embolic material used in treating blunt trauma of solid abdominal viscera until now. And its stability and reliability are controversial in the past five decades. Thus, our team put forward an idea producing a new hemostasis embolic material: Thrombin loaded Alginate Calcium Microspheres (TACM), and the physical and pharmacological properties of the TACMs were also examined in this study. Methods Alginate and thrombin were used to synthesise TACMs, which merged the advantages of conventional embolic microspheres and thrombin for treating blunt trauma of substantiality abdomen viscera by TAE. The TACMs were prepared using electrostatic droplet technique under mild conditions. The size distribution, morphology, pharmacological characteristics, changes to thrombus strength, cytotoxicity and systemic toxicity of the TACMs as well as the in vivo feasibility of embolization hemostasia for substantiality abdomen viscera was investigated. Results The thrombin was successfully loaded in microspheres with high encapsulation efficiency and drug loading capacity. The release profile of TACMs was burst effect at early stage and sustained release later on, with the activity of thrombin preserved well. The strength of mixed thrombus, which was used as embolic agent in this research, increased in a dose dependent manner after TACMs were added. In addition, the TACMs were verified to be no cytotoxicity and systemic toxicity, and they were biodegradable in vivo. Finally, the results of preliminary applications revealed that the TACMs could serve as an effective and promising embolic material for blunt trauma and haemorrhage of solid abdominal viscera. Conclusion TACMs can be used as another biocompatible, effective and reliable embolic agent for blunt trauma of substantiality abdomen viscera except gelfoam.
Objective To observe the effects of early internal iliac artery embolization to systemic inflammatory response syndrome in simulated-pelvic-fracture dog combined with massive bleeding canine. Methods 20 adult dogs were randomly divided into the Embolization Group (EG) and Control Group (CG). Such indicators of the 2 groups as heart rate, respiratory rate and body temperature and others were collected then, and IL-6, TNF-α and arterial blood gas were monitored. The indicators of CG targets were collected every 30 min till death after modelling, experimental dogs in EG underwent arterial angiography after 60 min of modelling, and embolized the internal iliac artery of the injured side. Results The average time of SIRS in CG was 3.56 hr, with the occurring rate of 90% (9/10) within 24 h, and mortality rate of 50% (5/10); the average time of SIRS in EG was 5.33 hr, with the occcuring rate of 30% (3/10) within 24 h, and mortality rate of 10% (1/10). When SIRS of EG happened, the mean plasma IL-6 levels was 52.66 ± 7.38 pg/ml and TNF-α level was 11.45 ± 2.72 ng/ml showing significant difference with those of CG (p < 0.05). Conclusion Through on-spot interventional treatment cabin, the early internal iliac artery embolization could control pelvic fracture bleeding, delay the occurring of SIRS, and improve the success rate of the treatment of pelvic fracture combined with bleeding.
Objective There has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial haemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters. Methods First, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed in the unfolded shelter. The sterility assurance level in the sterilised shelter body was determined. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks. Results and Discussion The average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilised shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%. Conclusions Our findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective.
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