Evaluation and Management of Peripheral Vascular Injury. Part 1. Western Trauma Association/Critical Decisions in Trauma

Feliciano, David V.; Moore, Frederick A.; Moore, Ernest E.; West, Michael A.; Davis, James W.; Cocanour, Christine S.; Kozar, Rosemary A.; McIntyre, Robert C.

doi:10.1097/ta.0b013e31821b5bdd

Cited by 116 publications

(145 citation statements)

References 41 publications

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“…Though rare, they can be associated with significant morbidity and devastating complications such as threat to the limb or the life. Peripheral arterial injuries account for approximately 40-75 % of all vascular injuries [2]. Risk factors, diagnosis, and the management considerations vary depending on the vessel.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Arterial Injuries: an Indian Experience

Joshi

2015

Indian J Surg

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Arterial injuries present the most challenging conditions in surgical practice. Many fail to reach the specialist in time and end up losing limbs or lives. Though well addressed elsewhere, it has received less attention in developing countries like India. There is a need to study these injuries from the perspective of countries like India. The aims of the study are to (1) analyze the epidemiology, presentation, and outcomes of arterial injuries operated by the author in Indian settings; (2) identify factors associated with adverse outcomes; and (3) discuss the critical issues with relevance to our country. Retrospective analysis of arterial injuries operated by the author between July 2010 and February 2014 at our institution was performed. Patients with feasibility of revascularization were included and nonviable limbs requiring primary amputations were excluded. Sixty-one patients fulfilled the criteria of which 55 (90.1 %) were males and 6 (9.8 %) females aged between 5 and 70 years. The mean duration of presentation was 21 h. Majority were resultant of road traffic accidents (62.7 %). Among 49 (80.3 %) noniatrogenic injuries, the mechanism was blunt in 46 (93.8 %, n=49) and penetrating in 3 (6.1 %) cases. Iatrogenic injuries were seen in 12 (19.6 %) cases. Lower limbs accounted for 37 (60.6 %) cases, popliteal segment being common, 22 (36 %) cases. Bony injuries were associated in 39 (63.9 %) cases. The most common procedure was interposition graft (49.1 %). Six (9.8 %) patients required an amputation resulting in 55 (90.1 %) salvaged limbs.Reaching a specialist center in appropriate time can result in good limb salvage rates and functional outcomes. Creating awareness and training the personnel are the critical issues in the management of arterial injuries in India.

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Section: Introductionmentioning

confidence: 99%

Peripheral Arterial Injuries: an Indian Experience

Joshi

2015

Indian J Surg

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“…Although, more proximal vascular injuries may present with palpable distal pulses up to 70%, secondary to a good collateralization at the shoulder or axilla [8]. It is therefore recommended to discharge patient with only "soft signs" of vascular [4]. In the present case, the patient exhibited with symmetrical radial pulses and had only "soft signs" of vascular injury, like wound proximity to the major vessels.…”

Section: Discussionmentioning

confidence: 70%

“…It is commoner in arteries (80%) than veins (20%) [6]. Drapanas T. et al [4] study showed that the majority of the patients with arterial injury have other associated injuries. Among the 226 patients, 41.1% were found to have injuries to adjacent veins, 10% had neurological deficits with decreased motor function and 8.3% of the patients with extremity injuries had long bone fractures.…”

Section: Discussionmentioning

confidence: 98%

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Pellet Embolization after Subclavian Artery Injury: A Case Report

Černevičiūtė¹,

Sahebally²,

Mourad³

et al. 2017

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Acute upper limb ischemia caused by a gunshot penetrating vascular injury and subsequent arterial embolization by foreign body is uncommon in everyday practice and is associated with high morbidity/mortality rates, especially with emergency surgery. We present the case of a 72-year old male who attempted suicide using a gun. A gunshot entry wound was evident in the right upper chest region with no pellet exit wound. Radial pulses were palpable bilaterally. Angiography revealed right subclavian artery direct injury and pellet embolization to the brachial artery. The patient underwent open surgery, with reversed saphenous vein interposition graft to replace subclavian artery defect. A pellet was removed by a separate arteriotomy in the brachial artery. Associated injuries were clavicle-comminuted fracture and subclavian vein injury. The patient remained well 5 months later with no reported complications. In conclusions, the presence of radial pulses alone on clinical exam cannot rule out the presence of a significant vascular injury.

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“…A good coordination between trauma and vascular specialist during resuscitation and the planning of treatment is essential. The traditional approach to vascular trauma is open surgical repair however endovascular techniques are gaining terrain [2,3]. In surgically demanding areas like the thoracic aorta and its branches the endovascular repair has proven its effectiveness [4,5].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

Smeets¹

2017

Clin Med Rev Case Rep

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Blunt traumatic injury to the subclavian, axillary or brachial artery is uncommon and could have devastating consequences. Historically open repair is performed however reports of successful endovascular treatments are increasing. A case is described of a seventy one-year-old patient with a blunt injury to his right arm after being crushed in a closing hydraulic door of a truck. He sustained a traumatic dissection of his right brachial artery with associated nerve injury to the brachial plexus. After trauma resuscitation he was successfully treated in the hybrid operation room. Through the common femoral artery a helical stent (Supera) was placed in the injured brachial artery. Postoperative recovery was without complications. Additional treatment for the nerve injury was performed several months after trauma by the neurosurgeon. Functional recovery of his right arm was good except for fine motoric functioning which is still recovering.A review of the literature was performed to identify endovascular repair of blunt traumatic injury to the upper extremity. A total of 28 papers described 55 patients who underwent 56 procedures for subclavian, axillary and brachial injuries. The subclavian artery was affected and treated in 36 patients, in 16 patients axillary injury was treated and only 4 brachial arteries received endovascular repair. Technical success rate of endovascular treatment is good and stent graft patency rates are sufficient. Type of injury which was treated, the follow up technique, anticoagulant therapy and follow up duration varied extensively in the literature. Endovascular treatment of blunt arterial trauma to the upper extremity appears to be feasible. No definite conclusion can be drawn concerning best type of stent graft, best follow up regime or post-operative medical treatment. Treating a patient in a hybrid operation room seems advisable to facilitate conversion to open treatment or treat associated traumatic injuries if necessary.

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Evaluation and Management of Peripheral Vascular Injury. Part 1. Western Trauma Association/Critical Decisions in Trauma

Cited by 116 publications

References 41 publications

Peripheral Arterial Injuries: an Indian Experience

Peripheral Arterial Injuries: an Indian Experience

Pellet Embolization after Subclavian Artery Injury: A Case Report

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature

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