Serious Lower Extremity Venous Injury Management With Ligation: Prospective Overview of 63 Patients

Abstract

Conclusion:Transcranial Doppler (TCD) detection of circulating microemboli can be improved by injection of appropriately targeted microbubbles.Summary: Some ultrasound contrast agents adhere selectively to specific pathologic materials, such as plaque or thrombus. Targeting specific pathologic materials for adherence by microbubbles may allow TCD to distinguish different types of microembolic material. In this study, the authors sought to determine whether TCD detection of circulating thrombus emboli could be enhanced by targeted microbubbles.A technique of binding microbubbles to the surface of thrombus was developed. Binding was confirmed by scanning electron microscopy. Using an in vitro pulsatile flow model, control and targeted microbubbles were introduced to thrombus. Thrombus and tissue mimicking material were then circulated under pulsatile-flow conditions using the model. TCD was used to detect embolic symbols before and after induction of the microbubbles.TCD signal intensities were enhanced by the targeted microbubbles up to 13 dB. Microbubbles were observed to bind moving thrombus even when injected in low concentrations (approximately 36 bubbles per 100 mL). The microbubbles were retained on the thrombus under pulsatile-flow conditions. TCD signal intensity was not enhanced by similar size pieces of tissue mimicking material not enhanced by injection of targeted microbubbles.Comment: Targeted microbubble enhancement of TCD emboli detection may allow determination of what TCD really detects during manipulation of the carotid bifurcation. It may eventually be possible to design targeted therapies to prevent embolization of specific materials.

Vascular Injury in Orthopedic Trauma

“…91 If there is not, an extra-anatomic bypass graft should be fashioned. [92][93][94] Finally, a completion arteriogram should be performed to confirm…”

Effect of temporary shunting on extremity vascular injury: An outcome analysis from the Global War on Terror vascular injury initiative

“…[26][27][28][29] Current reports allude to chronic symptoms associated with venous hypertension, although no others have corroborated increased amputation risk with venous ligation. 30,31 The decreased relative risk of amputation demonstrates the importance of initial venous repair and decompression. Our groups in particular have discussed potential benefits of restoration of venous continuity.…”

Management of Peripheral and Truncal Venous Injuries

“…Techniques used for venous injury repair depend on the vein wall defect and vary from lateral venorrhaphy, end-to-end anastomosis, patch venoplasty, and interposition graft using autologous vein or prosthetic conduit. “The jury is still out” whether ligation or reconstruction should be the method of choice for these injuries and routine ligation proponents ( 19 , 22 ) claim that venous stasis is mitigated by venous collaterals. On the other hand, selective repair supporters report acceptable patency results ( 14 , 23 , 24 ) when certain criteria are met.…”