scholarly journals An isolated iliac vein injury due to blunt trauma by a bicycle handlebar without a pelvic fracture: A case report

2020 ◽  
Vol 30 (2) ◽  
pp. 148-150
Author(s):  
İbrahim Duvan ◽  
İlker İnce ◽  
Melike Şenkal ◽  
Kasım Karapınar ◽  
Uğursay Kızıltepe
Keyword(s):  
Blunt Trauma ◽  
Hypovolemic Shock ◽  
Penetrating Trauma ◽  
Rare Condition ◽  
External Iliac Artery ◽  
Iliac Vein ◽  
Massive Bleeding ◽  
Vascular Trauma ◽  
Skeletal Injury ◽  
Vein Injury

Abdominal and pelvic blunt vascular trauma without skeletal injury is considered a rare condition. Iliac vein injuries are usually seen with penetrating trauma, whereas they result from blunt trauma very rarely. A 15-year-old boy was admitted who fell from a bicycle and got his left hypogastric region hit by the handlebar. He had an isolated left external iliac vein injury and massive bleeding related to this blunt trauma, which eventually resulted in hypovolemic shock and a huge regional hematoma. The hematoma compressed the left external iliac artery and triggered ischemia. In conclusion, prompt diagnosis and treatment are of utmost importance to save the extremities and lives of patients.

scholarly journals Embolization for massive bleeding due to spontaneous left external iliac vein rupture: report of a successful case

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Eijun Sueyoshi ◽  
Ichiro Sakamoto ◽  
Masataka Uetani
Keyword(s):  
Spontaneous Rupture ◽  
Hypovolemic Shock ◽  
Balloon Catheter ◽  
Vena Cava ◽  
Iliac Vein ◽  
Massive Bleeding ◽  
Invasive Approach ◽  
External Iliac Vein ◽  
Successful Case ◽  
Life Threatening

Abstract Background Spontaneous rupture of the iliac vein has rarely been reported. Its associated hypovolemic shock-related symptoms and signs, including syncope and hypotension, have been observed in most of these cases. Successful transcatheter venous embolization for massive bleeding due to spontaneous rupture of the external iliac vein was herein reported. Case presentation An 82-year-old female patient developed sudden left lower abdominal and back pain. Immediately, she lost consciousness and went into shock. CT images of her abdomen revealed a huge retroperitoneal hematoma, with leakage of contrast medium in the hematoma in the left flank. These findings suggested left external iliac vein rupture. Open surgery was considered; however, since the patient’s condition may have deteriorated further due to the time needed to prepare for surgery, including general anesthesia, transcatheter venous embolization of the left iliac vein was selected. A 5.2-Fr compliant balloon catheter (nominal diameter of 10 mm) was inflated at the distal site of the external iliac vein to reduce extravasation. N-butyl-2-cyanoacrylate (NBCA) was mixed with Lipiodol at a ratio of 1:2. The left Iliac vein was filled and completely embolized with the NBCA/Lipiodol mixture (total injected volume, 5 mL) using a 1.8-Fr microcatheter. After embolization, the patient quickly. An inferior vena cava filter was placed 1 day after embolization. Conclusion Spontaneous rupture of the iliac vein is a very rare and lethal condition. Transcatheter venous embolization may control potentially life-threatening bleeding. Rapid bleeding control in a critical condition is facilitated by this minimally invasive approach.

scholarly journals In-hospital outcomes of patients with non-iatrogenic civilian vascular trauma

VASA ◽  
2020 ◽  
Vol 49 (3) ◽  
pp. 225-229
Author(s):  
Alexander Meyer ◽  
Viola Huebner ◽  
Werner Lang ◽  
Veronika Almasi-Sperling ◽  
Ulrich Rother
Keyword(s):  
Postoperative Complication ◽  
Blunt Trauma ◽  
Complication Rate ◽  
Injury Severity ◽  
Vascular Complications ◽  
Penetrating Trauma ◽  
Vascular Reconstruction ◽  
Vascular Trauma ◽  
Vascular Lesions ◽  
Lesion Pattern

Summary: Background: Morbidity, lesion pattern, management and short-term outcomes of civilian vascular trauma are rarely evaluated. Therefore, analysis of in hospital results in patients with non-iatrogenic vascular trauma in a tertiary referral hospital was performed. Patients and methods: Retrospective evaluation of patients with vascular trauma from 2007–2017 was done. 48 patients (34 male, 14 females, mean age 56 years) were included. Excluded were patients with iatrogenic vascular complications. Major cause of vascular trauma were traffic accidents in 43.8 %, fall from great heights in 27.1 %, sport and home related injuries in 16.8 %, suicidal injuries in 4.2 % and gunshot wounds in 2.1 % (other 6.3 %). 60.4 % of patients presented with blunt, 39.6 % of patients with penetrating vascular trauma. More than half of the cases included polytraumatized patients (54.4 %). Results: Most commonly affected were the popliteal (25.0 %) and the axillar artery (18.8 %). Aortic injuries were present in 14.6 % of cases, whereas the femoral and subclavian artery were involved in 12.6 % and 10.4 %. Vascular reconstruction was performed by interposition graft in 45.9 %, direct suture in 18.8 %, patchplasty in 10.4 %, ligation in 12.4 %, and implantation of stentgraft in 12.5 %. Postoperative complication rate was 54.2 %. Rate of in-hospital major amputation was 14.6 % and in-hospital mortality was 14.6 % as well. Comparison between blunt and penetrating trauma as to postoperative complication (p = 0.322), blood transfusion (p = 0.452) and amputation (p = 0.304) showed no significant differences, whereas lethality in blunt trauma was 20.6 % vs. 5.2 % in penetrating trauma. Injury severity score (ISS) was significantly elevated for blunt trauma patients (mean ISS Score blunt 32 vs 21 penetrating, p = 0.043). Conclusions: The majority of vascular lesions is caused by blunt trauma. Blunt lesions do also show a severe injury pattern, compared to penetrating trauma, and the complication rate remains high. However, by means of vascular reconstruction, limb salvage is feasible in a high percentage of cases.

Traumatic arteriovenous fistula with serious haemodynamic repercussions: endovascular treatment

2020 ◽  
Vol 13 (4) ◽  
pp. e234220
Author(s):  
Selma Regina de Oliveira Raymundo ◽  
Roana Lacerda Tavares Leite ◽  
Luiz Fernando Reis ◽  
Gleison Juliano da Silva Russeff
Keyword(s):  
Arteriovenous Fistula ◽  
Vena Cava ◽  
Penetrating Trauma ◽  
External Iliac Artery ◽  
Iliac Vein ◽  
Vascular Lesions ◽  
Occlusion Device ◽  
High Output Heart Failure ◽  
Endovascular Approach ◽  
And Control

Major abdominal arteriovenous fistula (AVF) is a rare clinical condition defined as an abnormal communication between the aorta or iliac arteries and the inferior vena cava or the iliac or renal veins. Penetrating trauma, including iatrogenic injuries, accounts for less than 20% of these AVFs. Endovascular techniques were useful in the management of vascular lesions. The authors report the case of a patient with high-output heart failure and high-flow AVF between the left external iliac artery and the left external iliac vein manifested 17 years after a gunshot wound. Endovascular approach was satisfactorily performed with the implantation of a septal occlusion device to interrupt abnormal vascular communication and preserve artery and vein patency. There were improvement of symptoms and control images showed arteriovenous communication closure.

scholarly journals Early Palma procedure after iliac vein injury in abdominal penetrating trauma

2008 ◽  
Vol 48 (3) ◽  
pp. 745-748 ◽  
Author(s):  
Francisco Alcocer ◽  
Jesus Aguilar ◽  
Salvador Agraz ◽  
William D. Jordan
Keyword(s):  
Penetrating Trauma ◽  
Iliac Vein ◽  
Vein Injury

scholarly journals Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae

2013 ◽  
Vol 12 (3) ◽  
pp. 257-259
Author(s):  
Juan Marin ◽  
Beatriz Retamales ◽  
Camila Onetto ◽  
Enrique Ceroni ◽  
Cristian Marin
Keyword(s):  
Gunshot Wound ◽  
Hypovolemic Shock ◽  
External Iliac Artery ◽  
Vascular Trauma ◽  
Arteriovenous Fistulae ◽  
Iliac Vessel ◽  
Satisfactory Outcome ◽  
Severe Hemorrhage ◽  
External Iliac Vessel ◽  
Late Postoperative Period

A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.

Trauma to the Abdomen and Pelvis

2018 ◽  
Author(s):  
Zahir Basrai ◽  
Timothy Jang ◽  
Manuel Celedon
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Peritoneal Lavage ◽  
Penetrating Trauma ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Abdominal Organs ◽  
Fast Exam ◽  
Definitive Management ◽  
Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.   This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

scholarly journals Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study

2008 ◽  
Vol 7 (3) ◽  
pp. 275-277 ◽  
Author(s):  
Somayaji Nagabhooshana ◽  
Venkata Ramana Vollala ◽  
Vincent Rodrigues ◽  
Seetharama Bhat ◽  
Narendra Pamidi ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Anatomical Variation ◽  
External Iliac Artery ◽  
Iliac Vein ◽  
Inferior Epigastric Artery ◽  
Undergraduate Medical Students ◽  
Obturator Artery ◽  
External Iliac Vein ◽  
Epigastric Artery ◽  
Internal Iliac

Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.

A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

2017 ◽  
Vol 32 (6) ◽  
pp. 631-635 ◽  
Author(s):  
Joshua Nackenson ◽  
Amado A. Baez ◽  
Jonathan P. Meizoso
Keyword(s):  
Emergency Medical Services ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Femur Fracture ◽  
Descriptive Analysis ◽  
Penetrating Trauma ◽  
Physical Exam ◽  
Medical Services ◽  
Prehospital Treatment ◽  
Emergency Medical

AbstractStudy ObjectivesTraction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).MethodsThis is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.ResultsThere were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).ConclusionAlthough signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.NackensonJ, BaezAA, MeizosoJP. A descriptive analysis of traction splint utilization and IV analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Meike Schuster ◽  
Natasha Becker ◽  
Amanda Young ◽  
Michael J Paglia ◽  
A Dhanya Mackeen
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Systems ◽  
Severely Injured Patients ◽  
Vaginal Deliveries ◽  
Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

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