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1.
Vasc Endovascular Surg ; 54(1): 36-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31570064

RESUMO

OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.


Assuntos
Veias Hepáticas/lesões , Veia Porta/lesões , Lesões do Sistema Vascular/epidemiologia , Adolescente , Adulto , Criança , Bases de Dados Factuais , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
2.
Vasc Health Risk Manag ; 15: 409-418, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571892

RESUMO

Introduction: Previous studies have shown that veterans with lower limb amputation have a higher risk for cardiovascular disease (CVD) compared with population-based controls. American veterans who have served in Iraq and Afghanistan with lower limb amputation may be at a similarly higher risk. Patients and methods: The Navel Health Research Center (NHRC) maintains the Expeditionary Medical Encounter Database (EMED) of military personnel who have sustained combat limb amputation or serious limb injury during the conflicts in Iraq and Afghanistan. Department of Veterans Affairs data from 2003 to April 2015 was used to analyze CVD risk factors in this cohort. Veterans with either unilateral (n=442) or bilateral (n=146) lower limb amputation were compared to those with serious lower limb trauma without amputation (n=184). Multivariate regression was used to measure associations between lower limb amputation and CVD risk factors over an average of 8 years of follow-up. Outcomes included mean arterial pressure (MAP), low-density lipoprotein, high-density lipoprotein (HDL), and serum triglycerides (TG). Results: Compared with the limb injury group, those with unilateral lower limb amputation had significantly lower HDL (p<0.05) and higher TG (p<0.05). Those with bilateral lower limb amputation had significantly higher MAP (p<0.05), lower HDL (p<0.01), and higher TG (p<0.001). The prevalence of metabolic syndrome, defined as type 2 diabetes or a constellation of blood pressure and lipid changes consistent with metabolic syndrome, was 8.7%, 14.9%, and 21.9% for limb injury, unilateral amputation, and bilateral amputation groups, respectively. Veterans with bilateral lower limb amputation had a 2.25-increased odds ratio (95% confidence interval 1.19-5.05) of type 2 diabetes or blood pressure and lipid changes consistent with metabolic syndrome compared to those with limb injury. Conclusions: Results suggest that veterans with lower limb amputation have a higher risk for metabolic syndrome. Primary care interventions to manage weight, blood pressure, and lipid levels are fundamental in order to reduce cardiac risk in this relatively young cohort.


Assuntos
Amputação/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Extremidade Inferior/irrigação sanguínea , Síndrome Metabólica/epidemiologia , Lesões do Sistema Vascular/cirurgia , Saúde dos Veteranos , Adulto , Campanha Afegã de 2001- , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Bases de Dados Factuais , Feminino , Hemodinâmica , Humanos , Guerra do Iraque 2003-2011 , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/fisiopatologia
3.
EuroIntervention ; 15(9): e804-e811, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31217142

RESUMO

AIMS: The aim of this study was to describe the epidemiology, mechanisms, management, and outcomes of coronary artery perforation during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS AND RESULTS: We included 1,811 consecutive patients undergoing CTO PCI at five centres between 2011 and 2018. Coronary perforation was observed in n=99 (5.5%). Patients with perforation were older, had a higher J-CTO score, more often required antegrade dissection/re-entry and the retrograde approach, and had lower success rates. The frequency of Ellis type I, II, III and III "cavity spilling" perforations was 11%, 46%, 28%, and 14%, respectively. In 48% of cases, perforation involved the CTO vessel, while the retrograde approach was responsible for 46% of cases. In 53% of cases perforations required intervention. The most frequently applied management strategies included clinical observation (47%), covered stent implantation (25%), balloon occlusion (9%), and coil/fat embolisation (9%). Tamponade was observed in 20/99 (20%) perforation cases. Ellis type III perforations were most frequently observed at the CTO site. These were accountable for 16/20 tamponades and 3/5 deaths. In-hospital mortality was 5.1% vs 0.3% in patients with versus those without perforation (p<0.001). Older age, occlusion length >20 mm, rotational atherectomy, antegrade dissection/re-entry, and the retrograde approach were independently associated with coronary perforation. Patients with perforation suffered an increased incidence of target vessel failure on short-term follow-up. CONCLUSIONS: Coronary perforation is observed in a non-negligible proportion of CTO PCIs, often requires intervention, and is associated with tamponade and mortality in a minority of patients. CTO vessel-related perforations are associated with the highest burden of morbidity and mortality.


Assuntos
Oclusão Coronária/cirurgia , Vasos Coronários/lesões , Intervenção Coronária Percutânea/efeitos adversos , Lesões do Sistema Vascular/epidemiologia , Idoso , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/epidemiologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Intervenção Coronária Percutânea/métodos , Derrame Pericárdico , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico
4.
Hypertension ; 74(1): 137-144, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104566

RESUMO

Morning blood pressure (BP) is recommended to be assessed by either 24-hour ambulatory or home BP monitoring. By which methods morning BP assessed is more reproducible and more closely associated with vascular injury remains unknown. We, therefore, addressed this issue in 1049 referred untreated outpatients (51.9% women; average age, 51 years) who had performed 24-hour ambulatory and 7-day home BP monitoring and vascular evaluations. Irrespective of the assessment methods, morning BPs were all significantly ( P≤0.027) associated with the arterial measures. The partial correlation coefficients of carotid-femoral pulse wave velocity and urinary albumin-to-creatinine ratio with home morning BPs were greater than those with the ambulatory morning pressures among the first 2 hours after awakening (0.21-0.37 versus 0.15-0.24; P<0.05). The associations with home morning systolic BP remained significant ( P≤0.002) after full adjustment for evening BP, whereas those with ambulatory morning BPs became nonsignificant after full adjustment for 24-hour BP except that of the carotid-femoral pulse wave velocity with ambulatory morning (6:00-10:00) systolic BP. Of the 135 subjects who had both home and repeated 24-hour ambulatory BP monitoring within 1 month, the coefficients of variation were ≈11% for ambulatory morning BPs and 5% for home self-measurements. In conclusion, morning BP, irrespective of the assessment methods and definitions, was generally reproducible and significantly associated with vascular indices. Nevertheless, home morning BP might be preferred than ambulatory measurements because of better reproducibility and stronger correlation with vascular indices.


Assuntos
Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/diagnóstico , Lesões do Sistema Vascular/fisiopatologia , Adulto , Fatores Etários , Idoso , China , Ritmo Circadiano/fisiologia , Estudos de Coortes , Feminino , Assistência Domiciliar , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Lesões do Sistema Vascular/epidemiologia
5.
Int Angiol ; 38(3): 250-255, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30994319

RESUMO

BACKGROUND: Pediatric peripheral vascular trauma carries significant risk of complications including limb loss and long-term invalidity. Mechanisms and types of morphological lesions are very diverse. The objectives of this study are to present the experience of a single vascular center in the surgical approach to pediatric vascular injuries, and to analyze the main challenges related to this clinical entity. METHODS: Over a period of 25 years, 17 pediatric peripheral vascular injuries were treated in our institution. Patient's age ranged between one day (newborn) and 15 years (mean: 10.7 years). There were five injuries of upper and 12 injuries of the lower extremity. Preoperative diagnosis was established by clinical examination (N.=4), ultrasonography (N.=1) and angiography (N.=12). Blunt trauma mainly caused arterial thrombosis while penetrating trauma caused arterial laceration or complete transection. Five patients had associated orthopedic injuries (29,4%). There were two posttraumatic pseudoaneurysms and two arterio-venous fistulas. RESULTS: There was no perioperative mortality. Vascular reconstructions included arterial suture (N.=4), thrombectomy + patch angioplasty (N.=1), termino-terminal anastomosis (N.=3), venous anatomic bypass (N.=6), PTFE graft reconstruction (N.=2), and venous extra-anatomic reconstruction (N.=1). Two patients had associated venous injury demanding both arterial and venous reconstruction. In the only case of war trauma treatment ended with limb loss. Other reconstructions presented good early and long-term patency. CONCLUSIONS: Pediatric vascular injuries are extremely challenging issues. Treatment includes broad spectrum of different types of vascular reconstructions. It should be performed by vascular surgeon trained in open vascular treatment or pediatric surgeon with significant experience in vascular surgery.


Assuntos
Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/cirurgia , Adolescente , Amputação , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Salvamento de Membro , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sérvia/epidemiologia
6.
Am Surg ; 85(3): 292-293, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30947777

RESUMO

The aim of this study was to characterize the outcomes of traumatic abdominal and pelvic vascular injuries. Using the 2012 National Trauma Data Bank, we identified 5858 patients with major abdominal and/or pelvic vascular injury. Patients were stratified by age group, gender, race, Injury Severity Score (ISS), and mechanism of injury. We evaluated the percentage of patients with blunt and penetrating trauma by demographic and correlated the mechanism of injury to the ISS score, emergency room disposition, and hospital disposition. We performed a logistic regression analysis to calculate predictors of death. In the final cohort, 1458 patients (25%) with abdominal/pelvic vascular injury died of trauma. In total, 3368 patients (57%) had a blunt mechanism of injury, whereas 2353 (40%) were victims of a penetrating trauma. Patients with penetrating injuries were 1.72 times more likely to die from their injuries than those with blunt traumas. Patients with higher ISS scores (>16) were more likely to die from their injuries than patients with lower ISS scores. Men were more likely to experience a penetrating vascular injury than women (48% vs 17%). Similarly, 77 per cent of black patients had a penetrating mechanism of injury compared with 20 per cent of white patients. There were 1910 patients with penetrating injuries (81%) that went immediately from the emergency room to the OR, compared with 1287 patients with blunt injuries (38%). Of the patients with blunt injuries, 695 (21%) died, whereas 727 (31%) patients with penetrating injuries died. Abdominal and pelvic traumatic vascular injuries carry a high mortality rate. Penetrating mechanism of injury, ISS score, and race are independent predictors of mortality.


Assuntos
Traumatismos Abdominais/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Adulto Jovem
7.
Eur J Orthop Surg Traumatol ; 29(5): 1119-1124, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30864017

RESUMO

BACKGROUND: Tibial fractures have an incidence of 15% of all adult fractures. They have been shown to have the highest incidence of non-union in long bone fractures and the highest incidence of vascular injury. Evidence from the literature suggests that a good vascular supply is important to ensure bone union. The aim of our study was to prospectively assess the incidence of vascular injuries in open tibial fractures and determine whether they were associated with an increased risk of non-union. METHODS: We performed a prospective study to investigate the incidence of arterial injuries with computed tomography angiography (CTA) in patients with Gustilo-Anderson grade I-III open tibial fractures between 2013 and 2015. CTA was performed with the trauma series at acute admission and reported by two independent musculoskeletal radiologists. Patients were followed up with clinical and radiographic assessment for 1 year. RESULTS: We recruited 77 patients into the study, and 56 patients (47 males, 9 females) were available for the final analysis, between 16 and 90 years of age. At the initial assessment, 29% had signs of arterial injury with active extravasation in 5%. The most common site of injury was in the diaphysis (87.5%), and the commonest mechanism was a road traffic accident. We found no significant relation between occult vascular injury and non-union (p > 0.05). CONCLUSION: The incidence of vascular injury in open tibial fractures is 29%, and CTA is therefore a useful test in identifying vascular injuries that may require vascular intervention.


Assuntos
Fixação Interna de Fraturas , Fraturas Expostas , Fraturas não Consolidadas , Complicações Pós-Operatórias , Fraturas da Tíbia , Lesões do Sistema Vascular , Angiografia por Tomografia Computadorizada/métodos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Expostas/complicações , Fraturas Expostas/epidemiologia , Fraturas Expostas/cirurgia , Fraturas não Consolidadas/etiologia , Fraturas não Consolidadas/prevenção & controle , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Fraturas da Tíbia/complicações , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/etiologia
8.
Int J Cardiol ; 281: 42-46, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30711261

RESUMO

AIMS: Stent graft placement is a safe and effective treatment option for vascular complications in the context of transcatheter aortic valve implantation (TAVI). This study aimed to provide long-term angiological follow-up of stent grafts used for this indication. METHODS AND RESULTS: Seventy-one patients (64.8% female, log EuroScore 14.7 ±â€¯6.8%) who had undergone TAVI between March 2010 and October 2015 with implantation of a Viabahn or Fluency stent graft to treat access-site or access-related vascular injury (ASARVI) were analyzed. Implantations were mostly due to access-site bleeding complications (83.1%) in the common femoral artery (97.1%). Follow-up was performed with duplex sonography in all patients after a median of 3.9 years after TAVI (interquartile range [IQR]: 895-1749 days). Ultrasound revealed tri- or biphasic flow patterns in 16.9% and 77.6%, respectively. Stent graft patency was 100% without signs of stent graft stenosis (mean peak velocity ratio 1.0 ±â€¯0.2). Pseudo-aneurysms or endoleaks were diagnosed in 5.6% of patients. Additional fluoroscopic and/or computed tomography (CT)-imaging was available in 36.6% of patients and did not reveal any stent fracture. CONCLUSION: Self-expanding stent grafts provide excellent long-term function with few complications when implanted in the context of TAVI-related ASARVI.


Assuntos
Prótese Vascular/tendências , Stents/tendências , Substituição da Valva Aórtica Transcateter/tendências , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular/efeitos adversos , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Stents/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X/tendências , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
9.
Eur J Surg Oncol ; 45(5): 857-862, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30661924

RESUMO

OBJECTIVES: Vascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. METHODS: The Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. RESULTS: Ten institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. CONCLUSION: Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons' seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/métodos , Lesões do Sistema Vascular/epidemiologia , Idoso , Feminino , Humanos , Doença Iatrogênica , Itália , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Vascular ; 27(3): 252-259, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30426848

RESUMO

OBJECTIVE: Axillosubclavian vessel injury is rare, with most cases occurring after penetrating trauma. A prior database (2002-2006) analysis demonstrated an overall limb loss rate of 2.9%, with no difference between isolated arterial axillosubclavian vessel injury and combined artery/vein axillosubclavian vessel injury. Given increases in advanced vascular surgical techniques, as well as improved multidisciplinary care and expeditious diagnosis with computed tomography angiography, we hypothesized the national rate of limb loss in patients with arterial axillosubclavian vessel injury has decreased. In addition, we attempted to identify current predictors for limb loss in arterial axillosubclavian vessel injury. Finally, we hypothesized that combined artery/vein axillosubclavian vessel injury, as well as associated brachial plexus injury will have a higher risk for limb-loss and mortality compared to isolated arterial axillosubclavian vessel injury. METHODS: A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. All patients ≥ 18 years of age with arterial axillosubclavian vessel injury were included. The primary outcome was limb loss. After a univariable logistic regression model identified significant covariates, we performed a multivariable logistic regression for analysis. RESULTS: Of the total 5,494,609 trauma admissions, 3807 patients had arterial axillosubclavian vessel injury (<0.1%). Of these, 3137 (82.4%) had isolated arterial axillosubclavian vessel injury and 670 (17.6%) had combined artery/vein axillosubclavian vessel injury. The overall limb loss rate was 2.4% (from 2.9% in 2006, p = 0.47). After adjusting for covariates, independent risk factors for limb loss included a combined artery/vein axillosubclavian vessel injury (odds ratio = 3.54, confidence interval = 2.06-6.11, p < 0.001), blunt mechanism (odds ratio = 7.81, confidence interval = 4.21-14.48, p < 0.001), open repair (odds ratio = 2.37, confidence interval = 1.47-3.82, p < 0.001), and open proximal humerus fracture (odds ratio = 8.50, confidence interval = 4.97-14.54, p < 0.001). An associated brachial plexus injury was not associated with limb loss ( p = 0.37). Combined artery/vein axillosubclavian vessel injury was associated with higher risk for mortality compared to isolated arterial axillosubclavian vessel injury (odds ratio = 2.17, confidence interval = 1.73-2.71, p < 0.001). CONCLUSIONS: The national rate of limb loss in trauma patients with arterial axillosubclavian vessel injury has not changed in the past decade. A combined artery/vein axillosubclavian vessel injury is an independent risk factor for limb loss, as well as open repair. However, the strongest risk factor is an open proximal humerus fracture. An associated brachial plexus injury is not associated with increased risk of limb loss. Patients with combined artery/vein axillosubclavian vessel injury have a twofold increased risk of death compared to patients with isolated arterial axillosubclavian vessel injury.


Assuntos
Amputação , Artéria Axilar/lesões , Fraturas do Úmero/epidemiologia , Traumatismo Múltiplo/epidemiologia , Artéria Subclávia/lesões , Lesões do Sistema Vascular/epidemiologia , Veias/lesões , Adulto , Amputação/efeitos adversos , Amputação/mortalidade , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/cirurgia , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Procedimentos Endovasculares , Feminino , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/mortalidade , Fraturas do Úmero/cirurgia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/cirurgia , Estudos Retrospectivos , Fatores de Risco , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Veias/diagnóstico por imagem , Veias/cirurgia , Adulto Jovem
11.
Ann Vasc Surg ; 56: 52-61, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30476614

RESUMO

BACKGROUND: According to the Center for Disease Control and Prevention, trauma is the leading cause of death in children aged >1 year in the United States (US). Although vascular injuries occur in only 0.6-1% of pediatric patients with trauma, they are a major mortality contributor. This study aims to examine epidemiology and outcomes after pediatric vascular injuries (PedVIs) in the US. METHODS: The National Trauma Data Bank (2002-2012) was queried to identify children (0-16) with PedVIs. Patients were categorized based on their demographics, location, and mechanism and presenting trauma severity (injury severity score [ISS] and shock). Study was divided into two 5-year periods (P1: 2002-2006; P2: 2007-2012) to study the trends in pediatric vascular trauma presentation and outcomes (hospital death and extended length of stay [LOS > 8 days]) using adjusted analyses. RESULTS: Analyses were performed on 3,408 cases; who were male (73.7%) and Caucasian (52.8%) with a mean age of 10.5 ± 4.5 years. The Southern region of the US saw the highest increase in PedVIs (P2 versus P1: 38.3% vs. 25.0%, P < 0.05). Blunt injuries constituted most of these injuries (57%). Firearm (36.9%) and motor vehicle crash (MVC) (34%) were the most common lethal mechanisms of injury. Despite the significant decrease in MVC rates (P2 versus P1: 17.4% vs. 22.6%, P < 0.05), firearm rates were unchanged. Upper extremity injuries were the most common anatomically (34.9%). ISS and shock were significantly decreased during P2. Mortality occurred in 7.9% of patients, which significantly decreased (P2 versus P1: 6.3% vs. 10.9%, P < 0.001) without a significant change in LOS. Odds of mortality decreased by 32% during P2 (P = 0.08) and was independently associated with penetrating mechanism of injury (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.22-3.19, P = 0.006), shock at presentation (OR: 5.48; 95% CI: 3.55-8.46, P < 0.001); ISS (OR: 1.08; 95% CI: 1.06-1.27, P < 0.001), and Glasgow Coma Score < 9 (OR: 11.21; 95% CI: 7.18-17.49, P < 0.001). CONCLUSIONS: We observed a significant decrease in the overall severity of injury and in-hospital mortality concurrent with the observation of a significant decrease in the rates of pediatric MVC vascular injuries. Public health policies directed toward firearm safety may further decrease PedVIs and mortality among this vulnerable population.


Assuntos
Mortalidade Hospitalar/tendências , Tempo de Internação/tendências , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/terapia , Adolescente , Distribuição por Idade , Causas de Morte , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade
12.
J Stroke Cerebrovasc Dis ; 28(2): 288-294, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391330

RESUMO

BACKGROUND: Previous studies have described ischemic stroke temporally related to specific triggers, but only 1 series collected patients with acute ischemic stroke (AIS) following downhill skiing and all caused by cervical artery dissections. Here we describe our series of AIS temporally associated to ski practice, focusing on the frequency, pathogenesis, clinical presentation, and prognosis. METHODS: We maintained a prospective list of Skiing Associated Strokes (SASs) from 2003 to 2017. From all AIS patients included in our stroke registry Acute Stroke Registry and Analysis of Lausanne (ASTRAL) over the same period, we identified a comparison group of non-SAS patients, matched for age and gender. RESULTS: In the 12-year observation period, we identified 17 SASs (4 females, median age 51 years) and 51 matched control patients with nonski-associated strokes. Vascular risk factors, stroke features, and outcome were similar between the 2 groups. Stroke mechanism was arterial dissection in 11 of 17 SASs (65%) and in 7 of 51 control patients (14%, chi-square test: P < .05). In the other 6 cases of ski-associated stroke, etiology was cardiac embolism from atrial fibrillation in 2 patients, large vessel atherosclerosis with stenosis >50% in 1 patient, and undetermined in 3. Among the 11 patients with SAS caused by dissection, 8 reported minor falls while skiing, 1 had a major head trauma without loss of consciousness, and 2 had no traumatism (compared to preceding trauma in 29 of 147 [20%] of all other AIS caused by arterial dissection in ASTRAL, P < .01). CONCLUSIONS: Arterial dissection was a significantly more frequent stroke mechanism in SAS compared to matched controls, but other mechanisms occurred as well. Minor or moderate skiing-related trauma preceded most SAS with dissections.


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/terapia , Esqui/lesões , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Acidentes por Quedas , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/terapia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Estudos de Casos e Controles , Feminino , Humanos , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/terapia , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Suíça/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/terapia
13.
J Cardiovasc Electrophysiol ; 30(1): 92-101, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30288838

RESUMO

INTRODUCTION: Catheter ablation (CA) has emerged as the preferred modality of treatment for many cardiac arrhythmias. Anatomical sites of ablation are often located in close proximity to coronary arteries. However, the incidence of CA-related coronary injury has not been well studied. We sought to systematically evaluate all cases of CA-related coronary injuries. METHODS AND RESULTS: A PubMed search was conducted from inception until May 1, 2017 using the keywords "coronary artery" and "ablation." We identified 2817 published articles of which 43 articles met our inclusion criteria representing 61 cases of coronary artery injury attributed to CA procedures from 1992 to 2017. Posteroseptal accessory pathway ablation was associated with the highest incidence of coronary injury (35.6% of cases), followed by cavotricuspid isthmus-dependent flutter (19.3%). The right coronary artery was the site of injury in over two-thirds of all reported cases. Coronary injury was detected intraprocedurally in about half of the cases (43.1%), whereas it was a delayed presentation in the other half. Coronary intervention was performed in a third of all cases (32.7%). There were a total of three deaths attributed to coronary artery injury. CONCLUSIONS: Most (91.8%) coronary injuries are a result of anatomic proximity to the site of ablation. Awareness of the relation between coronary artery course and anatomical site of ablation could prevent myocardial damage and improve procedural safety.


Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/efeitos adversos , Vasos Coronários/lesões , Traumatismos Cardíacos/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Adulto , Idoso , Arritmias Cardíacas/mortalidade , Ablação por Cateter/mortalidade , Vasos Coronários/diagnóstico por imagem , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade
14.
Heart Vessels ; 34(3): 419-426, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30264266

RESUMO

Transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, however, femoral access remains necessary for numerous procedures, including complex high-risk interventions, structural procedures, and procedures involving mechanical circulatory support. Optimising the safety of this approach is crucial to minimize costly and potentially life-threatening complications. We initiated a quality improvement project recommending routine fluoroscopic guidance (femoral head), and upfront femoral angiography should be performed to assess for location and immediate complications. We assessed the effect of these measures on the rate of vascular complications. Data were collected prospectively on 4534 consecutive patients undergoing femoral coronary angiographic procedures from 2015 to 2017. The primary end-point was any access complication. Outcomes were compared pre and post introduction including the use of an Interrupted Time-Series (ITS) analysis. 1890 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 2644 post. All operators adopted these approaches. Baseline characteristics, including large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. Fluoroscopy-enabled punctures were made in the 'safe zone' in over 91% of cases and upfront femoral angiography resulted in management changes i.e. procedural abandonment prior to heparin administration in 21 patients (1.1%). ITS analysis demonstrated evidence of a reduction in femoral complication rates after the introduction of the intervention, which was over and above the existing trend before the introduction (40% decrease RR 0.58; 95% CI: 0.25-0.87; P < 0.01). Overall these quality improvement measures were associated with a significantly lower incidence of access site complications (0.9% vs. 2.0%, P < 0.001). Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates. Thus, study shows that femoral intervention can be performed safely with very low access-related complication rates when fluoroscopic guidance and upfront angiography is used to obtain femoral arterial access.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Fluoroscopia/métodos , Intervenção Coronária Percutânea/métodos , Cirurgia Assistida por Computador/métodos , Lesões do Sistema Vascular/prevenção & controle , Idoso , Doença da Artéria Coronariana/diagnóstico , Feminino , Artéria Femoral , Seguimentos , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Reino Unido/epidemiologia , Lesões do Sistema Vascular/epidemiologia
15.
Arch Orthop Trauma Surg ; 139(3): 339-345, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30560290

RESUMO

BACKGROUND: Dynamic hip screw (DHS) osteosynthesis represents one of the most frequently performed fixation methods in orthopedic practice. The purpose of this study was to determine the potential risk of vascular damage by DHS side-plate screws (PS) and plunging instruments for individual femoral vessels and screw positions. METHODS: In ten hemipelvic/leg specimens mounted with a large femur distractor, a DHS system with a four-hole side-plate was inserted. PS were inserted in 3 consecutive courses with different inclinations in the frontal plane of 0° (group 1), - 30° posterior (group 2) and + 30° anterior (group 3) in relation to the side-plate's surface, resulting in 120 PS positions. After screw tightening, the soft tissues on the medial side of the femur were dissected and investigated for vascular compromise; in each course, the effect of overshot instruments within a range of 50 mm beyond the side-plate's surface was also tested. RESULTS: Totally, 37/120 screw positions (31%) revealed potential vascular compromise which comprised of 15/120 (13%) direct hits by screw tips and 22/120 (18%) potential impacts by plunging instruments. The deep femoral artery system (DFA) was significantly (p = 0.007) most often affected but no significant differences for individual vascular structures were seen. Direct vascular impacts occurred significantly more often (p = 0.0047) in screws with 0° inclination compared to + 30° inclination (p = 0.017). Significant differences among individual screw positions were only found in group - 30° with direct vessel contacts (p = 0.038). CONCLUSIONS: The DFA system is significantly more at risk while significant preference of a certain vessel is missing. Our data indicate that more than 30% of 120 screw positions in DHS osteosynthesis revealed a potential danger of vascular compromise, when surgical principles are denied in hip fracture fixation. CLINICAL RELEVANCE: Though vascular complications are infrequently encountered in DHS osteosynthesis they have to be considered as a potential complication when surgical principles are not followed in this anatomic area.


Assuntos
Parafusos Ósseos/efeitos adversos , Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Humanos
16.
Ann Vasc Surg ; 57: 1-9, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30053552

RESUMO

BACKGROUND: Popliteal arterial injury (PAI) is the second most common infrainguinal arterial injury after femoral artery injury with an incidence < 0.2%. A 2003 analysis of the National Trauma Data Bank (NTDB) reported a below the knee amputation (BKA) rate of 7.1% in patients with PAI as well as higher risk in those with an associated fracture or nerve injury. Given advances in vascular surgical techniques, improved multidisciplinary care, and expeditious diagnosis with computed tomography angiography, we hypothesized that the national rate of BKA in patients with PAI has decreased and sought to identify risk factors for BKA in patients with PAI. METHODS: A retrospective analysis of the NTDB was performed from 2007 to 2015. Patients ≥15 years of age with PAI were included and grouped by mechanism of injury (blunt versus penetrating). Interfacility transfers were excluded. The primary outcome of interest was BKA. Univariable and multivariable analyses were performed to identify predictors of BKA in patients with PAI. RESULTS: From 4,385,698 patients, 5,143 were identified with PAI (<0.2%) with most involved in a blunt mechanism (56.8%). The overall limb loss rate was 5.1% (decreased from 7.1% in 2003, P = 0.0037). After adjusting for covariates, a blunt mechanism (odds ratio [OR] = 3.53, confidence intervals [CI] = 2.49-5.01, P < 0.001) and open proximal tibia/fibula fracture or dislocation (OR = 2.71, CI = 2.08-3.54, P < 0.001) were independent risk factors for BKA in patients with PAI. A combined popliteal vein injury (PVI) did not increase the risk for BKA (P = 0.64). CONCLUSIONS: The national rate of limb loss in trauma patients with PAI has decreased from 7.1 to 5.1%. A blunt mechanism of injury as well as proximal open tibia/fibula fracture or dislocation continue to be the independent risk factors for BKA. Confirming a previous report, we found a combined PVI not to be associated with higher risk for BKA. Future prospective research to determine other possible contributing factors such as intraoperative hemodynamics and utilization of vascular shunt and fasciotomy appears warranted.


Assuntos
Amputação/tendências , Artéria Poplítea/cirurgia , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Amputação/efeitos adversos , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Feminino , Humanos , Incidência , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/lesões , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/epidemiologia , Adulto Jovem
17.
Catheter Cardiovasc Interv ; 93(1): 48-56, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30312992

RESUMO

OBJECTIVES: We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. BACKGROUND: Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. METHODS: Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk-adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One-year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. RESULTS: Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22-13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in-hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. CONCLUSIONS: Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in-hospital mortality, highlighting the importance of prevention.


Assuntos
Vasos Coronários/lesões , Traumatismos Cardíacos/epidemiologia , Doença Iatrogênica/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Lesões do Sistema Vascular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/terapia , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/terapia
18.
Ann Vasc Surg ; 56: 87-96, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30342206

RESUMO

BACKGROUND: The radial approach to cardiac procedures has become increasingly common. Although previous studies have suggested a favorable risk profile, serious complications can occur. The purpose of this study is to examine the incidence, subsequent treatment, and outcome of all suspected significant neurovascular complications following transradial cardiac procedures at a large US hospital. METHODS: We reviewed all patients who underwent a left heart catheterization, coronary angiogram, or percutaneous coronary intervention via the transradial approach at a single large academic medical center in the United States between 2010 and 2016. Consultations to the vascular and hand surgery services were examined to assess demographic variables, risk factors, presenting symptoms, subsequent treatment, and outcome of all serious complications. RESULTS: A total of 9,681 radial access cardiac procedures were performed during the study period. Twenty-four cases (0.25%) were suspected to have major complications and subsequently received consults. A total of 18 complications were diagnosed, including 8 vascular injuries or perforations, 4 hematomas, 4 radial artery occlusions, 1 case of compartment syndrome, and 1 severe radial artery spasm. Of the complications noted, 3 (16.7%) required operative interventions, but all recovered neurovascular function. CONCLUSIONS: Radial artery access for cardiac procedures has become increasingly common and has been associated with a low rate of major peripheral neurovascular complications. The majority (83.3%) of complications were successfully treated with a nonoperative management algorithm.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Angiografia Coronária/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Traumatismos dos Nervos Periféricos/epidemiologia , Artéria Radial , Encaminhamento e Consulta , Lesões do Sistema Vascular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Boston/epidemiologia , Cateterismo Periférico/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/terapia , Punções , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapia
19.
West J Emerg Med ; 19(6): 961-969, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30429928

RESUMO

Introduction: Computed tomography angiography (CTA) is used to screen patients for cerebrovascular injury after blunt trauma, but risk factors are not clearly defined in children. This modality has inherent radiation exposure. We set out to better delineate the risk factors associated with blunt cervical vascular injury (BCVI) in children with attention to the predictive value of seatbelt sign of the neck. Methods: We collected demographic, clinical and radiographic data from the electronic medical record and a trauma registry for patients less than age 18 years who underwent CTA of the neck in their evaluation at a Level I trauma center from November 2002 to December 2014 (12 years). The primary outcome was BCVI. Results: We identified 11,446 pediatric blunt trauma patients of whom 375 (2.7%) underwent CTA imaging. Fifty-three patients (0.4%) were diagnosed with cerebrovascular injuries. The average age of patients was 12.6 years and included 66% males. Nearly half of the population was white (52%). Of those patients who received CTA, 53 (14%) were diagnosed with arterial injury of various grades (I-V). We created models to evaluate factors independently associated with BCVI. The independent predictors associated with BCVI were Injury Severity Score >/= 16 (odds ratio [OR] [2.35]; 95% confidence interval [CI] [1.11-4.99%]), infarct on head imaging (OR [3.85]; 95% CI [1.49-9.93%]), hanging mechanism (OR [8.71]; 95% CI [1.52-49.89%]), cervical spine fracture (OR [3.84]; 95% CI [1.94-7.61%]) and basilar skull fracture (OR [2.21]; 95% CI [1.13-4.36%]). The same independent predictors remained associated with BCVI when excluding hanging mechanism from the multivariate regression analysis. Seatbelt sign of the neck was not associated with BCVI (p=0.68). Conclusion: We have found independent predictors of BCVI in pediatric patients. These may help in identifying children that may benefit from screening with CTA of the neck.


Assuntos
Lesões do Pescoço/epidemiologia , Fratura da Base do Crânio/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Ferimentos não Penetrantes/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Análise Multivariada , Lesões do Pescoço/diagnóstico por imagem , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fratura da Base do Crânio/diagnóstico por imagem , Texas/epidemiologia , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Lesões do Sistema Vascular/diagnóstico por imagem
20.
J Vasc Surg ; 68(6): 1880-1888, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30473029

RESUMO

OBJECTIVE: Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such as to the inferior vena cava (IVC) and aortic injuries remain responsible for a significant proportion of early trauma deaths in modern trauma care. The purpose of this study was to explore patterns in epidemiology and mortality after IVC and aortic injuries in the United States. METHODS: A 13-year analysis of the National Trauma Databank (2002-2014) was performed to extract all patients who sustained IVC, abdominal aortic, or thoracic aortic injuries. Demographics, clinical data, and outcomes were extracted. Patients were analyzed according to injury mechanism. RESULTS: A total of 25,428 patients were included in this analysis. Overall, the mean age was 39.8 ± 19.1 years, 70.3% were male, and 14.1% sustained a penetrating trauma. Although the incidence of all three injuries remained constant throughout the study period, for blunt trauma, mortality decreased over the study period (from 48.8% in 2002 to 28.7% in 2014; P < .001), in particular for thoracic aortic injuries (from 46.1% in 2002 to 23.7% in 2014; P < .001) and abdominal aortic injuries (from 58.3% in 2002 to 26.2% in 2014; P < .001). This decrease in mortality after blunt trauma was accompanied by an increase in endovascular procedures over the study period (from 1.0% in 2002 to 30.4% in 2014; P < .001), in particular for blunt thoracic aortic injuries (from 0.7% in 2002 to 41.4% in 2014; P < .001). When penetrating trauma patients were analyzed, overall there was an increase in mortality (from 43.8% in 2002 to 50.6% in 2014; P < .001), in particular after abdominal aortic injury (from 30.4% in 2002 to 66.0% in 2014; P < .001). Similar trends were observed for IVC injuries. No increase in endovascular use in penetrating trauma was identified (from 0.1% in 2002 to 3.4% in 2014; P < .001). CONCLUSIONS: The present study demonstrates an overall decrease in mortality after blunt aortic injuries in the United States. This decrease was accompanied by an increase in the use of endovascular procedures. After penetrating trauma, however, despite contemporary advances in trauma care, mortality has increased over the study period, in particular after abdominal aortic injury. No increase in endovascular use in penetrating trauma was demonstrated.


Assuntos
Traumatismos Abdominais/epidemiologia , Aorta Abdominal/lesões , Aorta Torácica/lesões , Traumatismos Torácicos/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Veia Cava Inferior/lesões , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Procedimentos Endovasculares/tendências , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/cirurgia , Fatores de Tempo , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares/tendências , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/cirurgia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia , Adulto Jovem
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