scholarly journals Delayed Presentation Of Missed Vascular Injuries And Pitfalls In Primary Treatment– Experience Of A Vascular Surgery Unit In Pakistan

2018 ◽  
Vol 08 (04) ◽  
pp. 258-262
Author(s):  
Ahsin Manzoor Bhatti ◽  
Junaid Mansoor ◽  
Haroon Sabir Khan
Keyword(s):  
Vascular Surgery ◽  
Vascular Injury ◽  
Tertiary Care ◽  
Primary Treatment ◽  
Vascular Trauma ◽  
Adverse Outcomes ◽  
Delayed Presentation ◽  
Vascular Injuries ◽  
Vascular Repair ◽  
Missed Injuries

Objective: To analyze errors in primary treatment of vascular injuries and delayed presentations of missed vascular injuries as a surrogate indicator of need for improved vascular surgical training of upcoming general surgeons. Materials and methods: This retrospective observational study was carried out at vascular surgery department of two tertiary care hospitals of Armed Forces from Jan 2012 to June 2017. Hospital records of all patients with vascular trauma were analyzed for presence of pitfalls in primary treatment and delayed presentation of missed vascular injuries which resulted in redo surgeries or adverse outcomes. Results: Out of 256 patients with vascular injury sequel 41 had either a problem in primary treatment or presented with delayed complications of missed injuries. The omissions can be divided into: missed injuries (24/41), technical errors in initial repair (12/24), reperfusion of mangled Extremity (3/41) and non availability of a surgeon capable of undertaking vascular repair. The commonest operative fault was failure to debride the vessel adequately and vascular repair under tension. The commonest primary assessment problem was failure to timely appreciate hard signs of vascular injury. Conclusion: With better training and emphasizing the need of thorough clinical examination outcome of vascular trauma can be improved.

scholarly journals Clinical Profile of Extremity Vascular Surgeries at Trivandrum Medical College

2021 ◽  
Vol 10 (37) ◽  
pp. 3207-3212
Author(s):  
Sony Paul Suraja ◽  
Vinu C. V ◽  
Kishore Lal J ◽  
Ravi Kumar T.D ◽  
Suresh Kumar J
Keyword(s):  
Lower Extremity ◽  
Vascular Surgery ◽  
Upper Extremity ◽  
Vascular Injury ◽  
Vascular Trauma ◽  
Clinical Profile ◽  
Vascular Injuries ◽  
Total Study Population ◽  
Female Ratio ◽  
Medical College

BACKGROUND One of the most common emergency diseases is traumatic vascular injury. The damage mechanism is linked to the environment and the time frame. The treatment of vascular injury is evolving in tandem with the passage of time. In short, vascular injury treatment ranges from simple to complex, and from simple to diverse. Patients suffering from vascular injury can now benefit from advanced medical equipment. Traditional treatments, on the other hand, continue to play an important role. It remains to be seen which treatment method will be adopted as the standard. Traumatic vascular injury is an emergency in surgery, mainly characterized by damage to veins and arteries. Haemorrhage (commonly from truncal vascular injuries) and ischemia (typical of peripheral arterial injuries) are the main clinical manifestations of vascular injuries. If vascular trauma has not been treated in time, it may cause disability or even death, especially for limb vascular surgery. There are many difficulties in diagnosis and treatment of vascular injuries, which have brought many challenges to the surgeons since the 20th century. Vascular trauma accounts for 3 % of all traumatic injuries. Vascular injury may lead to severe complications, so early diagnosis and timely treatment are critical. The purpose of this study was to assess the clinical profile of emergency extremity vascular cases at Trivandrum medical college. METHODS The demographic details, aetiology, mode of injury, limb and structures involved, concomitant injuries, clinical finding, delay in reaching trauma centre and surgical intervention done were recorded in a planned proforma and analysis was done. In this retrospective cross-sectional study, a total of 67 patients with extremity vascular emergencies referred to and called for intraoperative assistance in cardiovascular and thoracic surgery, Trivandrum Medical College over a period of 2 years from January 2018 to December 2019were included. RESULTS The mean age was 44 (SD 16.2) years with male to female ratio being 10.1 : 1.0. Trauma was the most common aetiology of vascular emergency (76.1 %). Out of the total study population, lower extremity emergencies (82 %) were high compared to upper extremity emergencies (18 %). Popliteal and superficial femoral arteries were the most common sites of injury in lower extremity, whereas radial and brachial arteries were the most common arteries involved in the upper extremity. Vessels were seen contused in majority of patients (46.3 %) followed by thrombosis, transection and rupture. No patients presented with venous injuries. But tendon and nerve injuries were present in 36 patients (53.7 %). Average time delay in reaching trauma center was 3 hours. Simple injuries to arteries were repaired with simple stitches as direct repair in 2 patients (2.99 %) and end to end anastomosis was done in 19 patients after resecting the injured segment. CONCLUSIONS Majority of the affected patients belonged to younger age group with trauma being the predominant aetiology. This may be due to the increase in incidence of road traffic accidents and other industrial accidents. Road safety measures are needed and awareness among public should be increased to reduce these types of injuries. All patients presented to our centre could be managed by performing emergency vascular surgeries, owing to timely reporting to hospital and by better use of imaging modalities. KEY WORDS Extremity Vascular Surgery, Anastomosis, Embolectomy

scholarly journals Vascular injuries during gynecological laparoscopy: the vascular surgeon's advice

2005 ◽  
Vol 123 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Marcello Barbosa Barros ◽  
Francisco S. Lozano ◽  
Luis Queral
Keyword(s):  
Small Bowel ◽  
Vascular Surgery ◽  
Vascular Injury ◽  
Postoperative Period ◽  
Vascular Injuries ◽  
Venous Graft ◽  
Vascular Surgeon ◽  
Gynecological Laparoscopy

CONTEXT: Iatrogenic vascular problems due to laparoscopy are a well recognized problem and lead to significant repercussions. In this context, a ten-year review of cases topic is presented, based on experience gained while heading two important vascular surgery services. CASES: Five patients with vascular injuries during elective laparoscopy are described. These patients presented with seven lesions of iliac vessels. All cases were evaluated immediately and required laparotomy, provisional hemostasis and urgent attendance by a vascular surgeon. Direct suturing was performed in three cases. One aortoiliac bypass and one ilioiliac reversed venous graft were made. Venous lesions were sutured. One case of a point-like perforation of the small bowel was found. There were no deaths and no complications during the postoperative period. DISCUSSION: Important points on this subject are made, and advice is given. There needs to be immediate recognition of the vascular injury, and expert repair by a vascular surgeon is recommended, in order to significantly reduce the degree of complications.

scholarly journals Maintaining vascular trauma proficiency for military non-vascular surgeons

2020 ◽  
Vol 5 (1) ◽  
pp. e000475
Author(s):  
Andrew Hall ◽  
Iram Qureshi ◽  
Kegan Brumagen ◽  
Jacob Glaser
Keyword(s):  
Vascular Surgery ◽  
High Volume ◽  
Vascular Trauma ◽  
University Hospital ◽  
General Surgeon ◽  
Vascular Injuries ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Combat Casualty ◽  
Civilian Trauma

BackgroundVascular injuries in combat casualty patients are common and remain an ongoing concern. In civilian trauma centers, vascular surgeons are frequently available to treat vascular injuries. Within the military, vascular surgeons are not available at all locations where specialty expertise may be optimal. This study aims to determine if a visiting surgeon model, where a general surgeon can visit a civilian trauma center, would be practical in maintaining proficiency in vascular surgery.MethodsAll vascular trauma relevant cases done by any surgical service were identified during a 2-year period at Saint Louis University Hospital between October 1, 2016 and September 30, 2018. These included cases performed by trauma/general, thoracic, vascular, and orthopedic surgery. Predictions on the number of call days to experience an operative case were then calculated.ResultsA total of 316 vascular cases were performed during the time period. A surgeon on call for five 24-hour shifts would experience 2.1 urgent vascular cases with 95% certainty. To achieve five cases with 95% certainty, a surgeon would have to be on call for 34 24-hour shifts.DiscussionA visiting surgeon model would be very difficult to maintain to acquire or maintain proficiency in vascular surgery. High-volume trauma centers, or centers with significant open vascular cases in addition to trauma, may have more reasonable time requirements, but would have to be evaluated using these methods.Level of evidenceEconomic and value-based evaluations, level II.

scholarly journals Operative management and outcomes of brachial artery revascularization following delayed presentation of traumatic brachial artery injury: surgical persistence rewarded

2021 ◽  
Vol 8 (6) ◽  
pp. 1793
Author(s):  
Madhur Kumar ◽  
Subrata Pramanik ◽  
Anubhav Gupta
Keyword(s):  
Functional Outcome ◽  
Vascular Injury ◽  
Brachial Artery ◽  
Primary Repair ◽  
Tertiary Care ◽  
Lower Limbs ◽  
Neurological Injury ◽  
Delayed Presentation ◽  
Artery Injury ◽  
End To End

Background: Dearth of expertise to manage vascular trauma spiraled with delay in diagnosis and referral to tertiary care centers continue to plague a developing nation like India. The brachial artery is the commonest artery to be injured in extremity following trauma. Although the patients present late, revascularization to salvage the limb and to maintain its function is advocated. This retrospective study was done to evaluate the management and outcomes of brachial artery revascularization in patients with delayed presentation of traumatic brachial artery injury.Methods: Twenty-six patients of traumatic brachial artery injury who met the inclusion criteria during 1-year study period (August 2019 to July 2020) were included. Patients with iatrogenic vascular injury, severe vascular injury associated with massive orthopaedic neuromuscular injury (i.e., crush injury), mottled upper limb and injury to neck, chest, abdomen, lower limbs or any pseudoaneurysm were excluded. Data were analysed.Results: Amongst 26 patients studied, 24 (92.30%) patients had complete transection of the artery. Of these, 19 (79.16%) had primary repair in the form of end-to-end anastomosis and 7 (29.16%) underwent reverse interposition saphenous vein grafting. Two patients with partial laceration of brachial artery underwent primary (lateral) repair. Associated fracture of humerus was managed with internal fixation following revascularization. Four cases underwent end to end repair of median nerve. Majority, 22 (84.61%) had good functional outcome and 4 (15.38%) had satisfactory functional results. Limb salvage rates was 100%.Conclusions: Revascularization beyond warm ischemia time is still desirable to prevent limb loss. Traumatic neurological injury affects the functional outcome. 

scholarly journals Management of Vascular Injury in a Vascular Center of a Developing Country

2021 ◽  
Vol 36 (1) ◽  
pp. 32-37
Author(s):  
Quazi Abul Azad ◽  
Aizizul Islam Khan ◽  
Abdullah Al Mamun ◽  
Nirmal Kanti Dey ◽  
Sajia Sajmin Siddiqua ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Developing Country ◽  
Vascular Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Young Male ◽  
Developed Countries ◽  
Limb Amputation ◽  
Vascular Injuries ◽  
Associated Injuries

In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas. Bangladesh Heart Journal 2021; 36(1) : 32-37

Postintubation Hypotension in General Anesthesia

2016 ◽  
Vol 31 (10) ◽  
pp. 667-675 ◽  
Author(s):  
Robert S. Green ◽  
Michael B. Butler
Keyword(s):  
Mechanical Ventilation ◽  
Vascular Surgery ◽  
General Anesthesia ◽  
Unit Length ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Chart Audit ◽  
Study Objective ◽  
Poor Outcomes

Background: Postintubation hypotension (PIH) is an adverse event associated with poor outcomes in emergency department endotracheal intubations. Study objective was to determine the incidence of PIH and its impact on outcomes following tracheal intubation in a general anesthesia population. Methods: Structured chart audit of adult patients intubated for a vascular surgery procedure at a tertiary care center over a 3-year period. Outcomes included in-hospital mortality, extended intensive care unit length of stay (ICU LOS), and requirement for postoperative (postop) hemodialysis or mechanical ventilation. Results: Incidence of PIH was 60% (837 of 1395). Patients who developed PIH had increased mortality (8.8% PIH vs 5.2% no-PIH; P = .014), extended ICU LOS (7.9% PIH vs 2.0% no-PIH; P < .001), and postop mechanical ventilation requirement (20.7% PIH vs 3.8% no-PIH; P < .001). When controlling for confounding factors, PIH was associated with extended ICU LOS (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.01-6.62, P = .049), postop ventilation (OR 2.43, 95% CI 1.27-4.74, P = .008), and a composite end point (OR 1.72, 95% CI 1.02-2.92, P = .043). Conclusions: Development of PIH occurs in 60% of patients undergoing intubation for vascular surgery and was associated with adverse outcomes including extended ICU LOS and postop ventilation requirement.

scholarly journals An Experience of Surgical Management of Peripheral Vascular Injuries at Pakistan Institute of Medical Sciences, Islamabad

2020 ◽  
Vol 9 (3) ◽  
pp. 201-206
Author(s):  
Muneeb Ullah ◽  
Seemab Niaz ◽  
Aabid Ali ◽  
Arsalan
Keyword(s):  
Vein Graft ◽  
Tertiary Care ◽  
Penetrating Trauma ◽  
Vascular Trauma ◽  
Initial Assessment ◽  
Prospective Clinical Study ◽  
Care Hospital ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Medical Sciences

Background: Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan. Material and Methods: This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size < 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Collected data included age, gender, duration of injury, nature of injury, operative findings, other associated injuries, type of definitive repair, involvement of artery, complications including amputations, infections, re-exploration, ligation or death. Statistical Package for Social Sciences (SPSS) version 23 was used to analyze data. Results: Out of total 60 patients, 53 (88.3%) were males and 7 (11.7%) were females, with a mean age of 27.8±14.1 years. Most of the patients presented after 6 hours of trauma (n=36; 60%). Blunt trauma accounted for 37 (61.7%) while penetrating trauma was seen in 23 (38.3%) patients. Per operatively, 33 (55%) patients had intimal injury, 7 (11.7%) had partial tear and 20 (33.3%) had complete transection of artery. Primary repair was performed in 9 (15%) patients and reverse vein graft in 51 (85%) patients. Most commonly injured arteries were femoral (n=21; 35%), brachial (n=18; 30%) and popliteal (n=12; 20%) arteries, respectively. Amputations were significantly related to presentation of patients later than 6 hours (P=0.035). Conclusion: Patients who present with vascular trauma need an early diagnosis, referral and timely management in order to save both limb and life of patients with special concern for good quality of life and cost-effective management.

scholarly journals Socio-Demographic Characteristics of Patients Presenting to the Vascular Emergency Department of National Institute of Cardiovascular Diseases (NICVD)

2016 ◽  
Vol 11 (1) ◽  
pp. 3-6
Author(s):  
Sultan Mahmud ◽  
Mohammad Samir Azam Sunny ◽  
Md Enamul Hakim ◽  
Rezwanul Haque ◽  
Md Aftabuddin
Keyword(s):  
Emergency Department ◽  
Cardiovascular Diseases ◽  
Vascular Surgery ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Blunt Injury ◽  
Vascular Injuries ◽  
Care Needs ◽  
Female Ratio ◽  
Epidemiological Characteristics

Emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is rendering service for the patients suffering from vascular trauma since 2001. Data regarding this practice of emergency services is rarely published. This paper aims to provide the epidemiological characteristics of patients presenting the vascular emergency department of NICVD between 01/9/14 to 30/09/14. This study is intended to benefit the policy makers, healthcare providers in Bangladesh to promote and define the specialty of emergency vascular department and to allocate resources more effectively to address country’s acute care needs. In total sixty four (64) patients was attended in this 1 month. The male to female ratio was 60:4 with age range from nine to sixty four years (mean age 30.8years). Among them thirty nine percent patients belong to low socioeconomic class, thirty one percent from middle class and others from affluent family. Forty patients (62.5%) were referred from various institute of Dhaka city and rest from outside Dhaka. Seventy five percent patients came by ambulance, eight percent by private vehicles and rest by other means. Fifty eight patients (90.62%) came with referral papers from other health institutes, where there is no vascular surgery department. Most common cause of referral was vascular trauma (78.12%), other causes of referral were complicate vascular aneurysm (7.8%) and vascular thrombosis (14.06%). The time since injury and seeking treatment for vascular surgery ranged two hours to six days. Mean time was 10.3 hours. Forty cases (62.5%) sustained vascular trauma by accident with sharp cutting objects during occupational and house hold activities, assault (stab injury, blunt injury and gunshot) ten cases (15.62%), road traffic accident seven cases (10.93%), intravenous drug abusers three cases (4.68%), accidentally fall from height three cases (4.68%) and post operative complication one cases (1.56%). This study demonstrates that eighty eight percent study populations presented with arterial injuries and only twelve percent with venous injuries. Associated injuries (tendon, nerve, muscle, fracture of bones and joints dislocation) were present in fifty six patients (87.5%). Most common artery that was injured was radial artery. Vascular Injuries were treated with end to end anastomosis in twenty five patients (36.6%), ligation of vessels in twenty three patients (35.9%), fasciotomy was done in eight patients (12.5%) , embolectomy (fogerty) was done in four patients (6.25%) ,. aneurysmectomy was needed in two patients (3.1%) and interposition venous graft was used in two cases (3%). The emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is taking the entire burden with their small resources to ensure the best quality care for the management of the patients with vascular injuries. The data can inform and guide the allocation of national resources towards emergency care, injury prevention campaigns, emergency service evaluation and clinical guideline development.University Heart Journal Vol. 11, No. 1, January 2015; 3-6

Redefining the Role of Arterial Imaging in the Management of Penetrating Zone 3 Neck Injuries

Vascular ◽  
2005 ◽  
Vol 13 (3) ◽  
pp. 158-163 ◽  
Author(s):  
Eric Ferguson ◽  
James W. Dennis ◽  
Jonathan H. Vu ◽  
Eric R. Frykberg
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vascular Injury ◽  
Internal Carotid ◽  
Vascular Trauma ◽  
Vascular Injuries ◽  
Neck Injuries ◽  
Neck Trauma ◽  
External Compression

The purpose of this study was to assess the role of arteriography (AG) in the diagnosis and treatment of vascular trauma in patients with zone 3 penetrating neck injuries. The records of all cases of penetrating neck trauma for the past 14 years at a level 1 trauma center were reviewed retrospectively. Eight hundred forty-four penetrating neck injuries were documented, of which 72 (8.5%) traversed zone 3 of the neck (gunshot, 35; stab, 32; shotgun, 5). Twenty patients (27%) had hard signs of vascular injury (hemorrhage, expanding hematoma, bruit, thrill, neurologic deficit). Twelve of these (60%) underwent immediate exploration, 1 had no significant injury, and 11 had successful surgical repair or ligation of the vascular injury. AG in the other eight patients with hard signs revealed injuries requiring embolization (three patients), urokinase infusion (one patient), and observation (three patients) and one normal examination. Fifty-two patients had no hard signs of vascular injury. Twenty-four of these underwent AG, of which 18 were negative. Positive findings included internal carotid artery narrowings (two patients), external compression of the internal carotid artery (one patient), vertebral artery intimal flap (one patient), and nonbleeding injuries to small, noncritical arteries (two patients), none of which required treatment. Twenty-four of the remaining 28 patients were observed clinically, and 4 patients had negative explorations. Nine patients had ultrasonography performed, but these examinations did not yield any useful information. The absence of hard signs reliably excludes surgically significant vascular injuries in penetrating zone 3 neck trauma, suggesting that AG is not necessary. Hard signs in stable patients should mandate AG because these vascular injuries may be amenable to endovascular therapy.

Diagnostic workup and endovascular treatment of popliteal artery trauma

VASA ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Cheong J. Lee ◽  
Rory Loo ◽  
Max V. Wohlauer ◽  
Parag J. Patel
Keyword(s):  
Vascular Injury ◽  
Gold Standard ◽  
Imaging Techniques ◽  
Computed Tomographic Angiography ◽  
Vascular Trauma ◽  
Endovascular Techniques ◽  
Computed Tomographic ◽  
Arterial Injuries ◽  
Arterial Trauma ◽  
Peripheral Arterial

Abstract. Although management paradigms for certain arterial trauma, such as aortic injuries, have moved towards an endovascular approach, the application of endovascular techniques for the treatment of peripheral arterial injuries continues to be debated. In the realm of peripheral vascular trauma, popliteal arterial injuries remain a devastating condition with significant rates of limb loss. Expedient management is essential and surgical revascularization has been the gold standard. Initial clinical assessment of vascular injury is aided by readily available imaging techniques such as duplex ultrasonography and high resolution computed tomographic angiography. Conventional catheter based angiography, however, remain the gold standard in the determination of vascular injury. There are limited data examining the outcomes of endovascular techniques to address popliteal arterial injuries. In this review, we examine the imaging modalities and current approaches and data regarding endovascular techniques for the management popliteal arterial trauma.

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