The effect of early endovascular intervention on the outcome of traumatic vascular injuries

Abstract

Bu çalışmada erken dönemde anjiyografik olarak tanı konulan travmatik vasküler yaralanmaların endovasküler yöntemlerle tedavisine ilişkin orta dönem sonuçlarımız bildirildi. Ça lış ma pla nı: Ocak 2007-Aralık 2010 tarihleri arasında ateşli silah yaralanması ya da şüpheli penetran/künt travma nedeni ile kliniğimize başvuran ve vasküler yaralanma şüphesi bulunan hastalar erken dönemde incelendi. Anjiyografik değerlendirme sonrası 10 hastada vasküler yaralanma nedeni ile endovasküler tedavi uygulandı. Vasküler yaralanmaların nedeni üç hastada penetran yaralanma, altı hastada ateşli silah yaralanması, bir bir hastada ise künt travma idi. Hastaların altısında yalancı anevrizma (ikisinde arteriyovenöz fistül eşlik ediyordu), üçünde rüptür ve birinde aksiller arter-bronşiyal fistül mevcuttu. Bul gu lar: Arteriyel rüptür bulunan olgularda koil embolizasyonu uygulandı. Yalancı anevrizma ve arteriyovenöz ya da arteriyobronşiyal fistül bulunan olgularda stent greft implantasyonu uygulandı. Bütün işlemler lokal anestezi altında gerçekleştirildi. Vasküler yaralanmaya bağlı semptomlar ameliyat sonrası üçüncü günde kayboldu ve hastalar 5. günde taburcu edildi. Bütün hastalar ameliyat sonrası 3. ve 12. ayda renkli Doppler ultrasonografi ile incelendi. Takiplerinde ekstravazasyon, stenoz ve iskemi bulgusuna rastlanmadı. So nuç: Travma ya da ateşli silah yaralanması sonrası gözden kaçan vasküler yaralanmalar, uzun dönemde ekstremite disfonksiyonuna yol açabilir. Vasküler yaralanma şüphesi bulunan hastaların anjiyografik olarak değerlendirilmesi erken dönemde tedavi şansı sağlar. Anjiyografik değerlendirmede vasküler yaralanma tespit edilen hastaların aynı işlem esnasında endovasküler yöntemlerle tedavisi; daha az kan transfüzyonu, daha kısa yoğun bakım kalış süresi ve düşük mortalite ile ilişkilidir. Anah tar söz cük ler: Endovasküler işlem; travma; vasküler hasar. Background: In this study, we reported mid-term results of early endovascular treatment modalities for traumatic vascular injuries confirmed by angiography. Methods: Between January 2007 and December 2010, patients who were admitted to our clinic with gunshot injury or suspected penetrating/blunt injuries and suspected vascular injury were examined. After angiographic examination, 10 patients underwent endovascular treatment due to vascular injury. Vascular injuries were due to penetrating injury in three patients, gunshot injury in six patients and blunt trauma in one patient. Six patients presented with a pseudoaneurysm (two of which associated with arteriovenous fistula), three with rupture and one with axillary artery-to-bronchial fistula. Results: Coil embolization was performed in patients with arterial rupture. Stent graft implantation was performed in patients with pseudoaneurysm formation, arteriovenous or artery-to-bronchial fistula. All procedures were performed under local anesthesia. Symptoms related to vascular injury disappeared within postoperative three days and they were discharged on the postoperative fifth day. All patients were reexamined by color D...

Pseudoaneurysm of head and neck vessels has been frequently observed in road side bomb blast victims

“…This, being minimally invasive technique, has a number of benefits including less chances of bleeding during per-operative and post-operative period, decreased duration of hospital stay and lower mortality rate. 4,18 But, in third world countries surgery remains the treatment of choice, as highlighted by Malik A et al 2 and Amirjamshidi A et al 7 too. The biggest reason behind choosing this option is non-affordability of the patients, who are subjected to huge professional fee of precious trained personals and expensive charges of endovascular inventory.…”

“…2 Though this is a late complication after primary traumatic vascular injury, false aneurysms in the victims of penetrating injury presents early as compared to those from blunt injury. 4 Post-traumatic false aneurysms do occur in increased frequency in upper and lower limb extremities, 2 but due to an increase in the number of cases from bomb blast and fire arm injuries in this region, as a result of recent war in the neighboring country and infrequent violent situations in this part of the world, we have experienced magnified number of patients who presented with pseudoaneurysms involving vessels of head and neck after suffering from roadside bomb blasts injuries.…”

Emergency vascular injuries: patient profile, management strategies and risk factors for mortality

“…Uncontrolled bleeding and hemodynamic instability were also important factors precluding endovascular interventions; however, hybrid operating rooms with endovascular capabilities may permit more liberal use of endovascular techniques. Temizkan et al [18] suggested that early angiography in hybrid rooms during other procedures facilitated early diagnosis and treatment of vascular injuries yielding improved outcomes.…”

Histopathological evaluation of the arterial wall damage in upper limb injuries

“…All these factors contribute to the difficulty in determining the arterial damage and injury severity in the upper extremity crush injuries. [21][22][23][24] The severity of the arterial injury can be assessed more accurately with the combination of imaging data, histopathological assessment, and the direct intraoperative visualization. [19,20] Optimal treatment can be also suggested accordingly, which should be the priority of the developing treatment guidelines for the artery injuries.…”