Vascular trauma in the Amazon - the challenge of great distances

Góes, Adenauer Marinho de Oliveira; Rodrigues, Allan Dias Vasconcelos; Braga, Fábio Brito; Andrade, Mariseth Carvalho de; Abib, Simone de Campos Vieira

doi:10.1590/0100-69912015004009

Cited by 9 publications

(24 citation statements)

References 15 publications

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“…Our result confirms arterial trauma as primarily a disease in young males similar to other regions of the world[101314151617] with gunshot injuries being the most common cause as has been shown in other parts of Nigeria and the developing world. [10141618] Khan, however, reported road traffic accidents as the most common cause of arterial injuries in his study[13] while in the study by Perkins in a major British trauma center, stab wounds were the most common. [17] The relatively high crime rates in the period under study in Southwest Nigeria probably accounted for the gunshot injuries and assault by knives recorded by us in this series.…”

Section: Discussionsupporting

confidence: 87%

Pattern of extremity arterial injury and outcome of repair in Southwest, Nigeria

et al. 2019

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Background: Extremity arterial injuries are an important cause of loss of life/limb after trauma. Early intervention is important for the good outcome. Objectives: The objective of this study is to review the pattern of presentation and study the factors that influences the outcome of extremity arterial injuries in our hospital. Patients and Methods: This is a retrospective study of all patients with injuries to the extremity arteries requiring surgical intervention from July 2007 to June 2015. Data obtained included biodata, ischemic time, arteries involved, surgical intervention, and outcomes and analyzed using SPSS version 22. Setting: Our hospital is the main referral hospital for vascular trauma serving four adjoining states in Nigeria and is linked to major cities by at least 3 Trunk-A federal roads. Subjects: The subjects are patients who were managed in our cardiovascular surgical unit for the study duration (July 2007–June 2015) who had extremity arterial injuries. Results: A total of 36 patients presenting with 40 arterial injuries in 37 limbs were studied. The mean age was 28.4 ± 10.3 years with male preponderance (88.9%). Gunshot injuries were the most common cause of arterial injuries (37.8%), followed by assault (27%). The mean time from injury to presentation for acute injuries was 20.4 h but 23 of the patients (63.8%) presented to the accident and emergency department within 12 h of injury. A limb salvage rate of 64.9% was achieved though ischemic times of ≥12 h were associated with poor outcomes. Conclusion: Prolonged ischemic time is associated with poor outcomes. Efforts should be put in place to reduce the limb ischemic times.

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Section: Discussionsupporting

confidence: 87%

Pattern of extremity arterial injury and outcome of repair in Southwest, Nigeria

et al. 2019

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“…We reported an approximately 10% mortality rate, which was higher in the elderly, blunt trauma, patients with bone fractures, a major intracavitary artery injury and in those with large blood loss. In 10 studies on peripheral artery injury, mortality rates ranged between 1.5 and 8.5% (mean 4.5%) [1, 6, 7, 9, 10, 16–20]. Mortality has been reported to be higher after iatrogenic vascular injury (4.9%) compared to non‐iatrogenic vascular trauma (2.5%) [13], a finding not confirmed in our study.…”

Section: Discussioncontrasting

confidence: 77%

Outcome Predictors in Civilian and Iatrogenic Arterial Trauma

et al. 2020

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Background Our aim was to identify predictors of mortality and limb loss in iatrogenic and civilian arterial trauma. Methods Cases were identified by searching prospectively maintained registries. Multivariable logistic regression was used to identify independent outcome predictors.Results During the study period, 285 patients with arterial trauma were managed with endovascular (n = 20) or open (n = 265) repair. Iatrogenic injuries increased in frequency during the course of the study, from 23.9% during the first decade to 35.9 and 55.7% during the second and third decade, respectively (p \ 0.001). Endovascular management increased in frequency during the course of the study, from 0% during the first decade to 5.1 and 11.1% during the second and third decade, respectively (p = 0.005). Mortality was 9.8%, and limb loss (in cases with injury of the aorta or limb arteries, n = 259) was 6.2%. Independent predictors of mortality included increased age (odds ratio, 95% confidence interval [OR, 95% CI] 1.05 (1.02-1.07), p \ 0.001), blunt trauma (OR [95% CI] 4.8 (1.9-12.2), p = 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.25 (1.1-1.4), p = 0.001). Independent predictors of limb loss included the first half of the study period (OR [95% CI] 3.9 (1.1-14.1), p = 0.04), lower extremity arterial trauma (vs upper extremity, aortic, common or external iliac artery trauma, OR [95% CI] 8.3 (1.9-35.7), p = 0.004), bone fracture (OR [95% CI] 16.9 (4.7-62.5), p \ 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.16 (1.02-1.33), p = 0.024). Conclusion Increasingly iatrogenic in cause and managed by endovascular methods, arterial trauma remains a problem associated with significant mortality and limb loss. Identification of unfavourable outcome predictors may help clinicians involved with arterial trauma to escalate the level of care.

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“…Sobre este último parâmetro, estudo de revisão com recorte temporal de 10 anos constatou uma sobrevida de até 88% nos pacientes que foram submetidos aos SVT (SUBRAMANIAN A, et al, 2008). Com relação ao impacto sobre as amputações descrito Brazilian Journal of Development, Curitiba, v.7, n.11, p. 109125-109132 nov. 2021 anteriormente, apesar de a maior parte das produções científicas disponíveis apontarem para resultados concordantes a este descrito, a pesquisa de Góes Junior et al ( 2018), que englobou 288 pacientes, não verificou um aumento de amputações quando performada a ligadura vascular, procedimento este classicamente realizado, ainda nos dias atuais (GOÉS JUNIOR AMO, et al, 2018).…”

Section: Discussionunclassified

Shunt temporário em trauma vascular: relato de caso / Temporary shunt in vascular trauma: case report

Magaldi¹,

Silva²,

Costa³

et al. 2021

BJDV

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Traumas vasculares ocorrem, geralmente, em cerca de 0,7 a 2,0% dos casos de traumas gerais. Dentre as estratégias para reparo vascular, o uso dos shunts vasculares temporários (SVT) deve ser ressaltado, repercutindo positivamente sobre as menores taxas de amputação e na maior sobrevida do paciente. Ademais, esses dispositivos podem ser usados não apenas nas clássicas cirurgias de controle de danos, mas, também, representam recursos valiosos à manutenção da perfusão de órgãos vitais e extremidades enquanto se realizam intervenções em lesões de maior gravidade, sendo, no mesmo tempo cirúrgico, substituídos pela correção definitiva. Avaliar as situações em que a utilização dos SVT possa ser benéfica corrobora para o adequado gerenciamento do quadro clínico da vítima e, na ausência da equipe de cirurgia vascular, proceder a sua realização pode se tornar função do cirurgião geral.

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Vascular trauma in the Amazon - the challenge of great distances

Cited by 9 publications

References 15 publications

Pattern of extremity arterial injury and outcome of repair in Southwest, Nigeria

Pattern of extremity arterial injury and outcome of repair in Southwest, Nigeria

Outcome Predictors in Civilian and Iatrogenic Arterial Trauma

Shunt temporário em trauma vascular: relato de caso / Temporary shunt in vascular trauma: case report

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