Journal of Trauma and Injury

Original Article

Experience of vascular injuries at a military hospital in Korea: Doohun Kim, Soyun Nam, Yoon Hyun Lee, Hojun Lee, Hyun Chul Kim; Received August 7, 2022 Accepted February 1, 2023 Published online May 19, 2023; DOI: https://doi.org/10.20408/jti.2022.0041 [Epub ahead of print]

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Abstract PDF: Purpose
Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons.
Methods
We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes.
Results
Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed.
Conclusions
There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.; Summary

Case Reports

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report: Chung-Eun Lee, In-Seok Jang, Sang-Yoon Song, Jung-Woo Lim, Kun-Tae Kim; J Trauma Inj. 2023;36(2):142-146. Published online December 6, 2022; DOI: https://doi.org/10.20408/jti.2022.0064

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Abstract PDF: The popliteal artery damage is present to range from 1.6% to 64% of patients with knee dislocation, and it is crucial to evaluate vascular damage even if there are no prominent ischemic changes in the distal area. The injury of the popliteal artery by high-energy forces around the knee caused by a fall or traffic accident is a potentially limb-threatening complication in traumatic knee dislocation. The popliteal artery injury by blunt trauma has a high risk of limb amputation because the initial symptoms can show normal vascular circulation without urgent ischemia or obvious vascular injury signs. Since the collateral branches can delay the symptoms of decisive ischemia or pulseless extremity, the vascular damage is a major cause of limb amputation. In the present study, we describe a rare case of delayed diagnosis of popliteal artery injury after traumatic knee dislocation, requiring urgent limb revascularization surgery. After revascularization of the occluded popliteal artery, graft interposition was performed, and successful restoration was confirmed. This case illustrates that, even if ankle-brachial index >0.9 or equal pedal pulse to the uninjured extremity, serial vascular evaluation is required if there are soft signs such as diminished pulses, neurologic signs, or high-energy damage such as multiple ligament ruptures since delayed diagnosis of artery injury can be the major cause of limb amputation. The clinicians need to regard high-energy trauma such as multiple ligament rupture around the knee as a hard sign, and immediate computed tomography angiography can be helpful for accurate diagnosis and treatment.; Summary

External iliac artery injury with posterior pelvic ring injury in Korea: a report of two cases: Joosuk Ahn, Ji Wan Kim; J Trauma Inj. 2023;36(2):137-141. Published online December 1, 2022; DOI: https://doi.org/10.20408/jti.2022.0046

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Abstract PDF: Pelvic ring injuries associated with external iliac artery injuries are rare and may be life-threatening condition. The most important factors in the managements are the immediate bleeding control and restoration of distal blood flow. We report two cases of pelvic ring injuries with external artery injuries. One case was occlusion of external iliac artery with concomitant rupture of internal iliac artery. The other case was ruptured external iliac artery. Every surgeon must understand the possibility of hidden lesions—for example, arterial rupture and thrombus—and should consider the need for embolization or thrombectomy when treating this type of injury.; Summary

Delayed Subclavian Vein Stenosis without Thrombosis Following Clavicle Fracture: Do Wan Kim, In Seok Jeong, Kook Joo Na; J Trauma Inj. 2019;32(4):243-247. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.024

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Abstract PDF: Subclavian vein injuries occasionally occur as a sequela of penetrating trauma or vascular access, but have rarely been reported to occur after clavicle fracture. The subclavian vessels are mainly enclosed by the subclavius muscle, the first rib, and the costocoracoid ligament. Therefore, in such cases, subclavian vein injury is rare because of the strcutures surrounding the subclavian vessels. Nevertheless, subclavian vein injuries occasionally show thrombotic manifestations, and thrombosis of the upper limbs constitutes 1–4% of cases of total deep vein thrombosis. Furthermore, to the best of the authors’ knowledge, although vessel injuries have been reported after clavicle or rib fractures and nerve injuries to regions such as the brachial plexus, no case involving delayed presentation of isolated subclavian vein stenosis after clavicle fracture due to blunt trauma has yet been reported.; Summary

Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature: Ahram Han, Jihun Gwak, Gangkook Choi, Jae Jeong Park, Byungchul Yu, Gil Jae Lee, Jin Mo Kang; J Trauma Inj. 2017;30(4):220-226. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.220

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7 Citations

Abstract PDF

Traumatic dissection of the celiac artery without aortic dissection is a rare event. Here we describe two cases of celiac artery dissection after blunt abdominal trauma managed conservatively without surgical or endovascular intervention.

Summary

Citations

Citations to this article as recorded by

Isolated celiac artery injury: Brief report, review of literature, and suggested grading guidelines
Kanani Fahim, Neeman Uri, Hashavia Eyal, Timor Idit, Soffer Dror, Shimonovich Shachar
Trauma.2024;[Epub] CrossRef
Endovascular Stenting in a Rare Case of Multiple Spontaneous Visceral Arterial Dissections
Jacxelyn Moran, Naveen Galla, Mona Ranade
Vascular and Endovascular Surgery.2021; 55(3): 269. CrossRef
Evaluation of isolated abdominal visceral artery dissection with multi-scale spiral computed tomography: a retrospective case series
Qizhou He, Fei Yu, Yajun Fu, Bin Yang, Ran Huo, Rong Xian, Shulan Liu, Kali Liang, Guangcai Tang
Journal of Cardiothoracic Surgery.2021;[Epub] CrossRef
Diagnosis and treatment of isolated celiac artery dissection following blunt trauma: A case report
Tohru Ishimine, Takahiro Ishigami, Kohei Chida, Kyohei Kawasaki, Naoki Taniguchi, Toshiho Tengan
International Journal of Surgery Case Reports.2021; 89: 106617. CrossRef
Retrospective Analysis and Systematic Review of Isolated Traumatic Dissections of the Celiac Artery
Jens Birkl, Thomas Kahl, Henryk Thielemann, Sven Mutze, Leonie Goelz
Annals of Vascular Surgery.2020; 66: 250. CrossRef
Traumatic dissection of the coeliac artery and splenic injury following blunt trauma
Bobby Vincent Li, Ramesh Damodaran Prabha, Maruthi Narra, Hung Nguyen
BMJ Case Reports.2019; 12(8): e229405. CrossRef
Symptomatic Isolated Celiac Artery Dissection following Blunt Trauma
Sang Bong Lee, Hyuk Jae Jung, Jae Hun Kim
Journal of Acute Care Surgery.2019; 9(2): 76. CrossRef

Original Article

Peripheral Arterial Injuries in Pediatric Age Group: Ahmed A R Ammar; J Trauma Inj. 2016;29(2):37-42. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.37

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6 Citations

Abstract PDF

PURPOSE
Arterial injury in children is a challenging problem for its special characteristics. It is rare even during warfare. This review described a personal experience in the management and outcome of acute pediatric arterial injuries of extremities.
METHODS
Thirty-six children below age of 13 years were studied during period from 2004 through 2014 in Iraq.
RESULTS
Male patients were 27 (75%) and female were 9 (25%). Seven to twelve years old was the most affected age group. The incidence of iatrogenic injuries was greater in infants and toddlers while penetrating injuries were the most common in older children. Upper limbs arteries were affected in 17 (47.2%) and lower limb in 19 (52.8%) patients. Hard signs were the commonest mode of presentation (83.3%). Lateral wall tear and complete transection were the most frequent types of arterial injury (36.1% and 27.8% respectively). The most frequent procedures performed were end-to-end anastomosis and lateral arteriorrhaphy. Surgical outcome was good. In 27 cases distal pulsations were regained. Seven cases had impalpable distal pulses but still viable limbs. Limb length discrepancy was detected in one case. One case was complicated with limb loss. No death was recorded.
CONCLUSION
Arterial injuries in children are age related. The proper treatment of arterial injuries in children requires high index of suspicion, early operative intervention and continuous postoperative follow-up throughout years of active growth. Angiogram has a limited role as a diagnostic tool in acute arterial injuries.

Summary

Citations

Citations to this article as recorded by

Traumatic brachial artery dissection in a pediatric patient: An interdisciplinary approach to care
Katherine Kazen, Jeremy Powers, Steven Hopkins, Brad Feltis
Journal of Pediatric Surgery Case Reports.2022; 85: 102403. CrossRef
Operative management and outcomes of peripheral vascular trauma in pediatric and adolescent population
Madhur Kumar, Subrata Pramanik, Anubhav Gupta
Indian Journal of Vascular and Endovascular Surger.2021; 8(5): 66. CrossRef
TREATMENT OF ARTERIAL TRAUMA IN PATIENTS OF VARIOUS AGES
Vitaliy Petrov, Roman Trutiak, Boris Dyachushun, Roksolana Yaremkevych, Ihor Kobza
Proceedings of the Shevchenko Scientific Society. .2021;[Epub] CrossRef
Peripheral Arterial Injuries in Children: An Audit at a University Hospital in Developing Country
Zia Ur Rehman, Amna Riaz, Zafar Nazir
Annals of Vascular Diseases.2020; 13(2): 158. CrossRef
Age differences of arterial trauma – Selection of the most appropriate age classification
Vitaliy Petrov
Polish Annals of Medicine.2020;[Epub] CrossRef
Operative management of non-iatrogenic pediatric and adolescence peripheral arterial trauma: An experience from a resource challenged setting
Ahmed Mousa, Ossama M. Zakaria, Ibrahim Hanbal, Tamer A. Sultan, Amr M. El-Gibaly, Mohamed Y. Zakaria, Mohammed A. Nasr, Bosat E. Bosat, Alaa Sharabi, Mohamed Neinaa, Mohamed Abd El-Hamid, Mohamed Y. Daoud, Mahsoub M. Amin, Ahmed M. Odeh, Omer M. Alhaieg,
Asian Journal of Surgery.2019; 42(7): 761. CrossRef

Case Reports

Delayed Presentation of a Post-traumatic Mesenteric Arteriovenous Fistula: A Case Report: Jayun Cho, Heekyung Jung, Hyung Kee Kim, Kyoung Hoon Lim, Jae Min Chun, Seung Huh, Jinyoung Park; J Trauma Inj. 2013;26(3):248-251.

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Abstract PDF: INTRODUCTION: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare.
CASE
REPORT: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period.
CONCLUSION
Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.; Summary

Treatment of Subclavian Artery Injury in Multiple Trauma Patients by Using an Endovascular Approach: Two Cases: Jayun Cho, Heekyung Jung, Hyung Kee Kim, Kyoung Hoon Lim, Jinyoung Park, Seung Huh; J Trauma Inj. 2013;26(3):243-247.

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Abstract PDF: INTRODUCTION: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique.
CASE
1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent(8 mmx40 mm in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period.
CASE
2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period.
CONCLUSION
The challenge of repairing an SA injury can be overcome by using an endovascular approach.; Summary

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