Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Gilbert, Fabian; Schneemann, C.; Scholz, Claus‐Jürgen; Kickuth, Ralph; Meffert, Rainer H.; Wildenauer, René; Lorenz, Udo; Kellersmann, Richard; Busch, Albert

doi:10.1186/s12891-018-2333-y

Cited by 14 publications

(24 citation statements)

References 26 publications

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“…Multiple pathways for the assessment and management of pelvic trauma have been suggested (49) with recent guidelines also being published, such as those previously described by WSES (3) and Hornez et al (24). Departmental consideration should be given to adaptation of such management pathways as rapid, appropriate treatment and multidisciplinary care have been shown to decrease mortality and improve outcomes (3,8,49). Careful assessment of non-vascular structures on CT is also essential in the setting of vascular trauma as small and large bowel, bladder, ureteric, urethral, and gynecologic injuries can coexist, and a coordinated approach is required for optimal patient outcome.…”

Section: Contrast Enhanced Ctmentioning

confidence: 99%

“…Arterial phase imaging is most likely to show a vascular blush or active hemorrhage and delayed phase imaging provides a second opportunity to demonstrate low flow hemorrhage or contrast pooling. It is noted, however, that not all patients with contrast blush on CT require endovascular management and conversely some patients without blush being identified on CT may still require endovascular intervention if clinically indicated (8). This paper will discuss different types of vascular injury and their etiologies, while examining different imaging techniques and pathways for management of pelvic vascular injury.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular management of pelvic trauma

Weir¹,

Kennedy²,

Joyce³

et al. 2021

Ann Transl Med

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Traumatic pelvic injuries are an important group of acquired pathologies given their frequent association with significant vascular compromise. Potentially fatal as a consequence of rapid hemorrhage, achievement of early hemostasis is a priority; endovascular management of traumatic pelvic arterial injuries is an important potential option for treatment. Precipitated by any number of mechanisms of trauma, pelvic vascular injury necessitates timely patient assessment. Variable patterns of arterial injury may result from blunt, penetrating or iatrogenic trauma. Selection of the most appropriate imaging modality is a priority, ensuring streamlined access to treatment. In the case of CT, this is complemented by acquisition of the most appropriate phase of imaging; review of both arterial and delayed phase imaging improves the accuracy of detection of low-flow hemorrhage. In cases where surgical intervention is not deemed appropriate, endovascular treatment provides an alternative means for cessation of hemorrhage associated with pelvic injuries. This may be achieved in a selective or nonselective manner depending on the patient's clinical status and time constraints. Consequently, a detailed understanding of vascular anatomy is essential, including an appreciation of the normal variant anatomy between males and females. Additional consideration must be given to variant anatomy which may co-exist in both sexes. This review article aims to provide a synopsis of endovascular management of pelvic vascular injury. Through case examples, available treatment options will be discussed, including thrombin injection and transcatheter arterial embolization. Furthermore, potential adverse complications of pelvic arterial embolization will be highlighted. Finally, in view of the potential severity of these injuries, a brief overview of initial management of the hemodynamically unstable patient is provided.

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Section: Contrast Enhanced Ctmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endovascular management of pelvic trauma

Weir¹,

Kennedy²,

Joyce³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…5 Patients with pelvic vascular injury have a high immediate mortality rate (≤24 hours) of 13.3% and overall mortality rate of 20%. 6 Other studies report the mortality rate at around 16%, with increased rate to 60% in patients with closed pelvic ring fractures and associated hemodynamic instability, and 70% in open pelvic fractures with hemodynamic instability. 4 When the pelvic ring is disrupted, a 5 cm diastasis of the pubic symphysis can correspond to a 20% increase in volume, 4 and up to 15% percent of patients with pelvic fractures arrive in shock [10].…”

Section: Introductionmentioning

confidence: 97%

“…Among patient with pelvic fractures, 7% have associated vascular injury. 6 These vascular injuries can include arterial occlusion (20%), pseudoaneurysm, stenosis, dissection, arteriovenous fistula, and isolate venous bleeding (20%). 1 Arterial injuries occur most frequently following APC types II and III, LC type III, vertical shear, and combination injury.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in Blunt vs Penetrating Pelvic Vascular Injuries

Evans

Guiab

Roberts

et al. 2022

The American Surgeon™

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Objectives The purpose of this study is to determine if there is a difference in outcomes for patients with blunt and penetrating vascular injuries of the pelvis. Methods Data were abstracted from the Trauma Quality Improvement Program database from 2011 to 2015. Patients >18 years with hypogastric, iliac, uterine, or ovarian arterial or venous injuries were included. Individuals with an AIS head or chest score >3 were excluded. Results Of the 2559 patients included, the mean age was 43 years (±19), 75.25% were male, and 32.6% had a comorbidity. 64.9% presented with blunt injury (mean ISS of 23 (±12)). 74.9% experienced a complication. The median hospital length of stay (LOS) and ICU LOS were 10 days and 4 days, respectively. 6.7% had an adverse discharge. Mortality occurred in 8.3%. On bivariate analysis, patients who sustained blunt trauma were older (51 vs 31 years), female (32.7% vs 10.1%), had a higher ISS (25.71 vs 17.65), and had a longer hospital LOS (16.65 vs 13.88). Patients with penetrating trauma had an increased chance of complications (78.4% vs 73.0%) and mortality (10.7% vs 7.0%). Multivariate analysis revealed in patients with blunt injuries have more complications (OR: 1.950 CI: 0.886-4.291 P = .097), a lower ISS (OR: 0.919, CI: 0.908-0.930, P < .001, were more likely to have an adverse discharge (OR: 2.05, CI: 1.62-2.60, P = .000), and had a higher risk of mortality (OR: 4.08 CI: 2.78-6.41 P < .000). Conclusion Patients with blunt pelvic vessel injuries are at risk for an increased number of complications and have a higher risk of mortality. Those who survive are more likely to have an adverse discharge.

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“…Trauma is among the leading causes of death; among the types of trauma, vascular injuries can be among the most important causes of patients' death [15,16]. The causes of VT can be attributed to blunt or penetrating; the prevalence and mechanisms of which vary across the world.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Vascular Trauma and Related Factors in Iran: A Systematic Review

Karimian

Okhli

Noormohammadi-Dehbalaee

et al. 2021

IJMTFM

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Background: Managing patients with Vascular Trauma (VT) is essential. This study aimed to determine the prevalence of VT and its related factors in Iran. Methods: This systematic review was performed by two skilled researchers. To access all the Persian and English articles on VT and its influencing factors (from 2000 to August 2019), in addition to Google Scholar search engine, other international databases, such as PubMed/ Medline, Scopus, Embase, Cochrane Library, Science Direct, Web of Science (ISI), and domestic databases, such as Magiran, IranDoc, National Library of Iran Organization, SID, and Barakatkns were used. Data analysis was conducted by MA (CMA) software. Results: The incidence of lower Lower Vascular Trauma (LVI) trauma was equal to 58.4 (95%CI: 41.1-73.8) (I2= 94.67, Q=112.57, P<0.001); the prevalence of upper LVI trauma was measured to be 31.5 (95%CI: 17.7-49.7) (I2=94.48, Q=108.70, P<0.001); the prevalence of penetrating trauma was calculated as 61.3 (95% CI: 49.5-71.9); the prevalence of ulnar nerve injury equaled 9.8 (95%CI: 2.8-28.6); the prevalence of radial nerve trauma was equal to 7.7 (95%CI: 1.2-35.4); the prevalence of death cases was reported as 12.3 (95%CI: 5.1-26.9); the prevalence of amputation rate was observed as 8.8 (95%CI: 5.7-13.4); the prevalence of fasciotomy rate was equal to 22.2 (95%CI: 13.2-34.5); the prevalence of complete artery cutting equaled 55.7 (95% CI: 35.4-74.3),and the prevalence of incomplete artery cutting was measured as 25.5 (95%CI: 12.1-45.9). Conclusion: According to the study results, VT has led to various complications in patients; thus, it is critical to provide the necessary conditions to preserve the patient’s life and prevent life-threatening complications. Such goals could be achieved by preventing this type of trauma and its related complications.

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Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Cited by 14 publications

References 26 publications

Endovascular management of pelvic trauma

Endovascular management of pelvic trauma

Outcomes in Blunt vs Penetrating Pelvic Vascular Injuries

Prevalence of Vascular Trauma and Related Factors in Iran: A Systematic Review

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