Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.023
Filtrar
1.
Zhongguo Gu Shang ; 33(12): 1142-7, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369322

RESUMO

OBJECTIVE: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures. METHODS: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury. RESULTS: The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(t=7.21, P=0.033). The ODI decreased from preoperative (36.5±7.7)% to (9.4±3.6)% at the latest follow-up, which was statistically difference (t=8.11, P=0.025). CONCLUSION: Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Lesões do Sistema Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle , Lesões do Sistema Vascular/cirurgia
2.
J Med Vasc ; 45(5): 254-259, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862982

RESUMO

INTRODUCTION: Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. METHODS: This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. RESULTS: Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. CONCLUSION: TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/fisiopatologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hemodinâmica , Humanos , Escala de Gravidade do Ferimento , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Adulto Jovem
3.
Niger J Clin Pract ; 23(9): 1221-1228, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913160

RESUMO

Background: : Vascular injuries are commonly seen in both emergency services and forensic medicine practise. They are often life-threatening, with high morbidity and mortality rates. Aims: This study aimed to retrospectively evaluate extremity vascular injuries and the associated treatment approaches. Methods: After obtaining approval from the ethics committee of the university, those patients admitted to the emergency department of Adiyaman between 1 February 2013 and 31 August 2018 were included in this study. The patients' data were obtained through the electronic records system, and the cases were evaluated according to the age, gender and cause of injury, including blunt force trauma injuries (accidents, traffic accidents, crush injuries and occupational accidents) and penetrating injuries (stabbing, gunshot wounds, suicide attempts and assaults). Additionally, the injuries were evaluated based on the extremity, according to the anatomical location and whether the injury was life-threatening. Results: This study included 76 patients with extremity vascular injuries; 65 were males (85.52%), 11 were females (14.48%) and their average age was 33.24 ± 15.85 years. Forty-five (59.2%) of the patients had upper extremity vascular injuries, and 31 (40.3%) had lower extremity vascular injuries. In addition to arterial injuries, 26 (34.21%) of the patients had venous injuries and 22 (28.94%) had nerve injuries. Nine of these patients had neurological deficits due to their nerve injuries. All of the patients were revascularized within 3-5 hours, and none of the patients required amputations. Conclusion: The primary goals in extremity vessel injury cases are to prevent mortality, especially after major vascular injuries, and save the extremity from amputation. With a fast, effective and multi-disciplinary approach, an accurate diagnosis and effective surgical intervention can prevent morbidity and mortality as well as reduce the rate of undesirable complications.


Assuntos
Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Acidentes de Trânsito , Adolescente , Adulto , Artérias/diagnóstico por imagem , Artérias/lesões , Angiografia por Tomografia Computadorizada , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
4.
Am Surg ; 86(8): 1010-1014, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997952

RESUMO

INTRODUCTION: Failure to perform adequate fasciotomy for a presumed or diagnosed compartment syndrome after revascularization of an acutely ischemic limb is a potential cause of preventable limb loss. When required, outcomes are best when fasciotomy is conducted with the initial vascular repair. Despite over 100 years of experience with fasciotomy, the actual indications for its performance among acute care and trauma surgeons performing vascular repairs are unclear. The hypothesis of this study was that there are many principles of fasciotomy that are uniformly accepted by surgeons and that consensus guidelines could be developed. METHODS: A 20-question survey on fasciotomy practice patterns was distributed to trauma and acute care surgeons of a major surgical society which had approved distribution. RESULTS: The response to the survey was 160/1066 (15 %). 92.5% of respondents were fellowship trained in trauma and acute care surgery, and 74.9% had been in practice for fewer than 10 years. Most respondents (71.9%) stated that they would be influenced to perform a preliminary fasciotomy (fasciotomy conducted prior to planned exploration and arterial repair) based upon specific signs and symptoms consistent with compartment syndrome-including massive swelling (55.6%), elevated compartment pressures (52.5%), delay in transfer >6 hours (47.5%), or obvious distal ischemia (33.1%). 20.6% responded that they would conduct exploration and repair first, regardless of these considerations. Prophylactic fasciotomies (fasciotomy without overt signs of compartment syndrome) would be performed by respondents in the setting of the tense compartment (87.5%), ischemic time >6 hours (88.1%), measurement of elevated compartment pressures (66.9%), and in the setting of large volume resuscitation requirements (31.3%). 69.4% of respondents selectively measure compartment pressures, with nearly three-fourths utilizing a Stryker needle device (72.5%). The most common sequence of repairs following superficial femoral artery injury with a >6-hour limb ischemia was cited as the initial insertion of a shunt, followed by fasciotomy, then vein harvest, and finally interposition repair. CONCLUSIONS: While there is some general consensus on indications for fasciotomy, there is marked heterogeneity in surgeons' opinions on the precise indications in selected scenarios. This is particularly surprising in light of the long history with fasciotomy in association with major arterial repairs and strongly suggests the need for a consensus conference and/or meta-analysis to guide further care.


Assuntos
Artérias/lesões , Síndromes Compartimentais/cirurgia , Fasciotomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/complicações , Artérias/cirurgia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/prevenção & controle , Fasciotomia/métodos , Humanos , Inquéritos e Questionários , Traumatologia , Estados Unidos , Lesões do Sistema Vascular/cirurgia
5.
J Am Acad Orthop Surg ; 28(21): 874-883, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32796365

RESUMO

With an increasing number of total hip and knee arthroplasties being done at surgical centers and vascular surgeons often not immediately available in this setting, it is critical for orthopaedic surgeons to be comfortable with the acute surgical management of vascular injuries. Although they are fortunately uncommon in primary total hip and knee arthroplasties, damage to a major artery or vein can have potentially devastating consequences. Surgeons operating both in a hospital and an ambulatory surgical setting should be familiar with techniques to gain proximal control of massive bleeding because the principles can be helpful in primary and revision arthroplasties. In this study, we review the vascular anatomy around the hip and knee and the surgical management of these potentially catastrophic complications.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/etiologia , Amputação , Fasciotomia , Hemorragia/etiologia , Quadril/irrigação sanguínea , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Joelho/irrigação sanguínea , Lacerações/diagnóstico , Lacerações/patologia , Lacerações/cirurgia , Neuropatias Fibulares/etiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/patologia , Lesões do Sistema Vascular/cirurgia
6.
Ann Vasc Surg ; 69: 447.e9-447.e16, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32768538

RESUMO

BACKGROUND: "Seat belt-type" pediatric abdominal aortic trauma is uncommon but potentially lethal. During high speed motor vehicle collisions (MVCs), seat or lap belt restraints may concentrate forces in a band-like pattern across the abdomen, resulting in the triad of hollow viscus perforation, spine fracture, and aortoiliac injury. We report 4 cases of pediatric seat belt-type aortic trauma and review management strategies for the aortic disruption and the associated constellation of injuries. METHODS: -approved, retrospective review of all pediatric patients requiring surgical intervention for seat belt-type constellation of abdominal aortic/iliac and associated injuries over a 5-year period. Blunt thoracic aortic injuries were excluded. RESULTS: We identified 4 patients, ranging from 2 to 17 years of age, who required surgical correction of seat belt-type aortoiliac trauma and associated injuries: 3 abdominal aortas and 1 left common iliac artery. The majority (3/4 patients) were hemodynamically unstable at emergency room presentation, and all underwent computed tomography angiography of the chest/abdomen/pelvis during initial resuscitation. Injuries of the suprarenal and proximal infrarenal aorta were accompanied by unilateral renal artery avulsion requiring nephrectomy. Presumed or proven spinal instability mandated supine positioning and midline laparotomy, with medial visceral rotation utilized for proximal injuries. Aortoiliac injuries requiring repair were accompanied by significant distal intraluminal prolapse of dissected intima, with varying degrees of obstruction. Conduit selection was dictated by the presence of enteric contamination and the rapid availability of an autologous conduit. The sole neurologic deficit was irreparable at presentation. CONCLUSIONS: Seat belt aortoiliac injuries in pediatric patients require prompt multidisciplinary evaluation. Evidence of contained aortoiliac transection, major branch vessel avulsion, and bowel perforation mandates immediate exploration, which generally precedes spinal interventions. Lesser degrees of aortoiliac injuries have been managed with surveillance, but long-term follow-up is needed to fully validate this approach.


Assuntos
Traumatismos Abdominais/cirurgia , Acidentes de Trânsito , Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Contusões Miocárdicas/cirurgia , Cintos de Segurança/efeitos adversos , Lesões do Sistema Vascular/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Adolescente , Fatores Etários , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Bioprótese , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Criança , Pré-Escolar , Humanos , Contusões Miocárdicas/diagnóstico por imagem , Contusões Miocárdicas/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
7.
Khirurgiia (Mosk) ; (7): 97-101, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736472

RESUMO

Mine-explosive trauma is one of the most serious types of combat lesion and injuries in peacetime. We report a patient with mine-explosive trauma of the lower limbs followed by injury of the vascular bundle. Well-coordinated work of a multidisciplinary team of specialists at all stages of treatment is presented. The management was effective to save patient's life, avoid amputation and restore lower limb function.


Assuntos
Traumatismos por Explosões/cirurgia , Traumatismos da Perna/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/cirurgia , Lesões do Sistema Vascular/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Equipe de Assistência ao Paciente , Recuperação de Função Fisiológica , Resultado do Tratamento
8.
Vasc Endovascular Surg ; 54(8): 692-696, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32787694

RESUMO

OBJECTIVES: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. METHODS: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. RESULTS: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). CONCLUSION: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.


Assuntos
Traumatismos Abdominais/cirurgia , Aorta Abdominal/cirurgia , Certificação/normas , Técnicas Hemostáticas/normas , Centros de Traumatologia/normas , Procedimentos Cirúrgicos Vasculares/normas , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Bases de Dados Factuais , Feminino , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/mortalidade , Adulto Jovem
10.
Vasc Endovascular Surg ; 54(8): 741-746, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32729388

RESUMO

BACKGROUND: Pseudoaneurysms that develop after surgical repair of a patent ductus arteriosus (PDA) are more likely to rupture, but open surgery including a repeat thoracotomy would be highly invasive. We report 2 cases of thoracic endovascular aortic repair (TEVAR) for such pseudoaneurysms. METHODS/RESULTS: A 59-year-old woman who underwent PDA surgical ligation at 13 years of age presented with sudden hemoptysis. She was diagnosed with a ruptured distorted pseudoaneurysm sized 26 mm; emergency TEVAR was performed. A 23-year-old woman with a history of Down syndrome, endocardial cushion defect, and PDA underwent 2 thoracotomy surgeries including PDA ligation. During a medical checkup, an abnormal shadow was detected on chest radiography. She was diagnosed with a 15-mm pseudoaneurysm after PDA surgical repair; TEVAR was performed. In both cases, the postoperative course was uneventful. CONCLUSIONS: To the best of our knowledge, this is the first report of emergency TEVAR for ruptured pseudoaneurysms after PDA ligation. Thoracic endovascular aortic repair is an important therapeutic option for such cases as it eliminates the need for repeat thoracotomy.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Adulto Jovem
11.
Ann Vasc Surg ; 69: 451.e5-451.e10, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32615204

RESUMO

BACKGROUND: Acute aortic dissection rarely results in circumferential dissections of the aortic intima that may lead to intimo-intimal intussusception (IIS) with complete separation from the aortic wall. Circumferential dissection may then result in distal embolization of the involved intima and media, adding considerable complexity to the management of such cases. Despite the severity of this complication, the natural history of aortic disease following extensive intimal denuding and IIS is not well documented in the literature. Here we present a case with long-term follow-up of type B aortic dissection (TBAD) complicated by IIS and embolization of the intima into the distal aorta following thoracic endovascular aortic repair. METHODS: Medical records and imaging studies were retrospectively reviewed with the approval of the Institutional Review Board. A single patient underwent repair of a TBAD that was complicated by IIS, with follow-up for 6 years. Aortic recovery was monitored with serial computerized tomography scans. RESULTS: During endovascular stent deployment, the patient's dissection progressed circumferentially, leading to distal embolization of the intima and aortic occlusion. An open transabdominal aortic exploration was performed to extract the embolized intima. Despite this severe aortic structural disruption, the patient recovered well postoperatively and exhibited favorable aortic remodeling over long-term follow-up. The denuded aorta did not rupture or develop progressive worsening aneurysmal dilation and the diameter of the involved aortic segment remained stable during follow-up. CONCLUSIONS: Acute TBADs can progress to circumferential intimal separation and IIS when managed with endovascular stenting and balloon dilation. Continued endovascular management once IIS has occurred may lead to further intimal damage, resulting in distal embolization of the intima and aortic occlusion. Thus, IIS may require conversion to open repair. However, in the event that loss of the aortic intima does occur following IIS, it is possible for the denuded aorta to recover well and remain stable with favorable remodeling over long-term follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Angioplastia com Balão/efeitos adversos , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolia/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Angioplastia com Balão/instrumentação , Aorta/diagnóstico por imagem , Aorta/lesões , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Embolia/diagnóstico por imagem , Embolia/etiologia , Humanos , Masculino , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
13.
Ann Vasc Surg ; 69: 452.e5-452.e11, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32634560

RESUMO

Acute lower limb ischemia (ALLI) in the pediatric population is rare but may lead to limb loss and life-long complications. We report the technique and outcomes of microsurgical salvage of ALLI in a preterm newborn after open reduction of congenital hip dysplasia. A 2-month-old girl was born premature at week 36 with congenital bilateral hip dysplasia. The initial management attempted was conservative and entailed placement of bilateral Von Rosen splints. The treatment was successful on the left side, but the patient had recurrent unstable hip dislocation on the right side. Subsequently, 2 attempts at close reduction under general anesthesia were done and both were unsuccessful in maintaining the right hip in the acetabulum. Therefore, an open reduction of the right hip was planned through a medial/obturator approach. During the surgical procedure, the neurovascular femoral bundle (including the superficial femoral artery [SFA], femoral vein [FV], and femoral nerve) was accidently transected with subsequent development of ALLI. Therefore, the FV was harvested distally to the injury site and a 4-cm long healthy segment was obtained. It was reversed, flushed with heparin, spatulated at both extremities, and interposed to the SFA in end-to-end fashion using two 9/0 polypropylene interrupted sutures under microscope. Reperfusion of the limb was noted immediately after releasing the vascular clamps. The final ischemia time at completion of the surgical procedure was 6 hr. Thereby, prophylactic 4-compartment fasciotomies were performed in the right leg. The patient tolerated the procedure well and the postoperative clinical course was free from adverse events. Duplex ultrasound examination at 6 weeks after the intervention confirmed sustained clinical success and showed no signs of venous thromboembolism. At the same time, X-ray examination of the right hip confirmed adequate and stable reduction of the joint in the acetabulum. ALLI due to accidental arterial injury during orthopedic surgical procedures for congenital defects in newborns is a rare but potentially devastating complication. Microsurgical salvage is a safe, feasible, and effective option to restore limb flow. Multidisciplinary expertise and meticulous technique are mandatory in order to achieve satisfactory and durable outcomes.


Assuntos
Artéria Femoral/cirurgia , Veia Femoral/transplante , Luxação Congênita de Quadril/cirurgia , Doença Iatrogênica , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Microcirurgia , Procedimentos Ortopédicos/efeitos adversos , Lesões do Sistema Vascular/cirurgia , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Artéria Femoral/fisiopatologia , Humanos , Lactente , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/fisiopatologia , Fluxo Sanguíneo Regional , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia
14.
Ann Vasc Surg ; 69: 146-157, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32502675

RESUMO

BACKGROUND: Brachial artery injuries are rare. The objectives of the study are to report our experience and identify predictors of outcome. The hypothesis of the study is that maintaining ischemic times less than six hours results in improved outcomes. METHODS: This is a retrospective 118-month study. The outcome measure is total operative time from admission to restoration of blood flow, and outcomes are survival and limb salvage. Statistical analyses used in the study are univariate and multivariate stepwise logistic regression. RESULTS: There were 124 patients with 131 brachial artery injuries. Mechanism of injury (MOI) included the following: penetrating: 108 (87%) and blunt: 16 (13%). Operative management included the following: 77 (62%) reverse saphenous vein interposition grafts, 37 (29.8%) end-to-end anastomosis, and 4 (3.2%) ligation. Fasciotomies were performed in 23 (19.2%) patients. Outcomes of the study were as follows: 120 patients survived and the overall survival rate was 96.8%, adjusted survival rate excluding intraoperative deaths was 100%, overall limb salvage/amputation rate was 95.1%/4.9%, and adjusted limb salvage/amputation rates excluding intraoperative deaths were 98.3%/1.67%. Univariate analysis showed the mean ischemic times for survivors as 5 ± 3.1 hrs (300 ± 186 min) versus ischemic times for non survivors as 3 ± 2.2 hrs (180 ± 132 min) (P = 0.017); Injury Severity Score (ISS) (P = 0.002); and estimated blood loss (EBL) (P = 0.024). Logistic regression identified independent predictors of outcome for survival: MOI: penetrating [P = 0.015, RR - 4.29, 95% CI: 1.49-12.36]; Glasgow Coma Score < 7 [P < 0.001, RR - 21.71, 95% CI: 9.37-50.32]; ISS > 15 [P < 0.005, RR - 4.98, 95% CI: 1.68-14.73]; and patients not requiring ED thoracotomy [P = 0.009, RR - 7.48, 95% CI: 2.58-21.69]. CONCLUSIONS: Brachial artery injuries are rare. For patients not requiring ED thoracotomy, Glasgow Coma Score, ISS, and EBL predicted survival. The adjusted limb salvage rate was 98.3%. Patients with brachial artery injuries die from associated injuries, experiencing less ischemic times than survivors who are able to undergo repairs.


Assuntos
Artéria Braquial/cirurgia , Veia Safena/transplante , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Amputação , Anastomose Cirúrgica , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/lesões , Feminino , Humanos , Ligadura , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Adulto Jovem
15.
Ann Vasc Surg ; 69: 141-145, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32505682

RESUMO

BACKGROUND: The aim of this study is to compare wound infection, graft infection, and secondary amputation rates in patients who had popliteal artery injury repair with interposition vein versus prosthetic grafts. METHODS: This retrospective comparative study included all adult patients (>18 years) who had interposition grafting for popliteal artery injuries between January 2008 and August 2018 at a university hospital. Patients were divided into 2 groups. Popliteal arteries were repaired with venous graft in Group "A" and with prosthetic graft in Group "B." The outcome measures were wound infection, graft infection, and secondary amputation rates. RESULTS: Forty patients fulfilled the inclusion criteria. Twenty-two patients had arterial repair with venous while 18 with polytetrafluoroethylene grafts. All were male with median age of 32 (interquartile range [IQR] 19.5) years. Both groups were comparable in terms of median age (32.5 [19] vs. 30.5 [23]), Mangled Extremity Severity Score (6 [5] vs. 7 [7]), median hospital stay (7 [5] vs. 7 [9] days), and perioperative complications (2/22 vs. 3/18). In Group "A," no patient had graft infection or secondary amputation while in Group "B," 1 patient had secondary amputation and another had graft infection (P > 0.99). CONCLUSIONS: There is no statistical difference in secondary amputation rate, wound infection, or graft infection in patients undergoing popliteal artery repair with interposition vein versus prosthetic grafts in trauma setting.


Assuntos
Implante de Prótese Vascular , Artéria Poplítea/cirurgia , Lesões do Sistema Vascular/cirurgia , Veias/transplante , Adolescente , Adulto , Amputação , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/lesões , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto Jovem
16.
Semin Vasc Surg ; 32(3-4): 111-116, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32553123

RESUMO

We conducted an analysis to assess early and mid-term outcomes of patients after thoracic endovascular aortic repair (TEVAR) for type B thoracic aorta dissection, descending thoracic aneurysm, or traumatic aortic transection. From January 2016 through December 2018, twenty-seven patients (23 male, 4 female, mean age of 57 years) affected by type B dissection (n = 13 [48.2%]), thoracic aneurysm (n = 9 [33.3%]), and post-traumatic aortic isthmus rupture (n = 5 [18.5%]) were treated using TEVAR with and without left subclavian artery revascularization. All procedures were performed in a hybrid operating room using general (n = 12) or regional (n = 15) anesthesia. A combined brachial artery and bilateral femoral artery access was used in all patients. To achieve adequate proximal thoracic aorta landing zone length, coverage of the left subclavian artery with proximal endovascular plug occlusion was performed in 17 patients (62.9%); including 4 patients undergoing carotid-subclavian artery bypass before TEVAR stent-graft deployment. Primary procedural success rate was 96.3%; 1 patient had a Type Ib endoleak that was treated by distal stent graft extension. Four adverse outcomes occurred in the immediate postoperative period, including 2 cases of left upper arm acute ischemia (7.4%), ischemic stroke (3.7%), and asymptomatic iliac artery dissection (3.7%). During a mean follow-up of 18 months, no graft-related deaths or endoleak occurred. One patient developed symptomatic subclavian steal syndrome 1 month after operation and underwent a left carotid-subclavian artery bypass with symptom resolution. One patient died 6 months after TEVAR due to neoplasm. Our experience indicates TEVAR is a safe and less invasive alternative to open surgery for a spectrum of thoracic aorta diseases, especially for urgent conditions and in patients with high-risk surgical comorbidities.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto Jovem
19.
J Surg Res ; 255: 124-129, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543377

RESUMO

BACKGROUND: There is currently limited data assessing the long-term consequences of thoracic endovascular aortic repair (TEVAR) in otherwise healthy aortic segments remote from the site of endograft coverage. The aim of this study is to retrospectively evaluate aortic remodeling and long-term outcomes of blunt thoracic aortic injury (BTAI) patients treated with TEVAR. Our hypothesis is that significant changes to the aorta proximal to the graft-covered segment are suspected following TEVAR. METHODS: An institutional review board-approved retrospective review of patients who underwent TEVAR for BTAI at a level I trauma center from 2004 to 2018 was performed. Forty-six patients were identified and of these, 32 patients with high-resolution computed tomographic angiography imaging follow-up were included in the study. Computed tomographic angiography measurements of aortic dimensions and branch vessels proximal, distal, and adjacent to the stent grafted segment were recorded preprocedure and postprocedure and analyzed. Primary device-related outcomes such as birdbeaking, mural thrombus, stent migration, and persistent endoleak were assessed. Patient outcomes including mortality, graft-related morbidity, and need for secondary interventions were also analyzed. RESULTS: Mean follow-up of the selected patients in the study was 1.52 y (range, 0.06-8.0 y). Following TEVAR, the ascending aortic length increased significantly (mean 5.7 ± 4.6 mm, P < 0.001). The mean diameters of the ascending aorta (1.5 ± 1.5, P < 0.001 mm), the midaortic arch (1.3 ± 1.7 mm, P < 0.001), and proximal and the distal endograft landing zones (1.9 ± 2.1 mm and 2.2 ± 1.6 mm, respectively, P < 0.001) also increased significantly following TEVAR. Clinically relevant device-related outcomes occurred with the presence of endograft infolding and subsequent development of endograft mural thrombus (P < 0.001). The need for secondary intervention following TEVAR for BTAI was associated with endograft mural thrombus (P < 0.05). CONCLUSIONS: TEVAR for BTAI causes significant geometric changes in the aorta proximal to the stented grafted segment of the aorta. Direct consequences of the graft at the stented segment includes mural thrombus development within the endograft which was associated with the need for secondary intervention. Although clinical significance is yet to be determined, post-TEVAR changes in aortic architecture warrant continued aortic surveillance following BTAI.


Assuntos
Aorta Torácica/lesões , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Remodelação Vascular , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Colonografia Tomográfica Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Stents/efeitos adversos , Rigidez Vascular , Lesões do Sistema Vascular/patologia , Ferimentos não Penetrantes/patologia , Adulto Jovem
20.
Ann Vasc Surg ; 68: 468-475, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32422286

RESUMO

BACKGROUND: The spiral saphenous vein graft is an excellent choice for venous reconstruction after periphery vein injury, but only few cases have been reported. We implanted a segment of a single saphenous vein into both the popliteal vein as a venous vein graft and into the popliteal artery as an arterial vein graft at the same time in a trauma patient; we then had an extraordinary opportunity to harvest and examine both patent venous and arterial vein grafts at 2 weeks after implantation. METHODS: A spiral saphenous vein graft was made as previously described and implanted into the popliteal vein and artery as interposition grafts; because of the patient's serious injuries, an amputation was performed at day 18 after vascular reconstruction. The grafts were harvested, fixed, and examined using histology and immunohistochemistry. RESULTS: Both grafts were patent, and there was a larger neointimal area in the venous graft compared to the arterial graft. There were CD31- and vWF-positive cells on both neointimal endothelia, with subendothelial deposition of α-actin-, CD3-, CD45-, and CD68-positive cells. There were fewer cells in the venous graft neointima compared to the arterial graft neointima; however, there were more inflammatory cells in the neointima of the venous graft. Some of the neointimal cells were PCNA-positive, whereas very few cells were cleaved caspase-3 positive. The venous graft neointimal endothelial cells were Eph-B4 and COUP-TFII positive, while the arterial graft neointimal endothelial cells were dll-4 and Ephrin-B2 positive. CONCLUSIONS: The spiral saphenous vein graft remains a reasonable choice for vessel reconstruction, especially in the presence of diameter mismatch. Both the venous and arterial grafts showed similar re-endothelialization and cellular deposition; the venous graft had more neointimal hyperplasia and inflammation. At an early time, endothelial cells showed venous identity in the venous graft, whereas endothelial cells showed arterial identity in the arterial graft. CLINICAL RELEVANCE: Veins can be used as venous or arterial vein grafts but venous grafts have more neointimal hyperplasia and inflammation; vein grafts acquire different vessel identity depending on the environment into which they are implanted.


Assuntos
Plasticidade Celular , Células Endoteliais/patologia , Traumatismos da Perna/cirurgia , Artéria Poplítea/cirurgia , Veia Poplítea/cirurgia , Veia Safena/transplante , Enxerto Vascular , Lesões do Sistema Vascular/cirurgia , Amputação , Biomarcadores/metabolismo , Microambiente Celular , Células Endoteliais/metabolismo , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/metabolismo , Masculino , Pessoa de Meia-Idade , Neointima , Artéria Poplítea/lesões , Artéria Poplítea/metabolismo , Artéria Poplítea/patologia , Veia Poplítea/lesões , Veia Poplítea/metabolismo , Veia Poplítea/patologia , Veia Safena/metabolismo , Veia Safena/patologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Remodelação Vascular , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA