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Purpose: Incidence, management, and outcomes of pediatric vascular injuries secondary to non-iatrogenic trauma were reviewed over a decade in our institution. Methods: A retrospective review of medical records (2013–2022) of major traumatic vascular injuries, focusing on injury profiles, treatment modalities, and clinical outcomes. Results: Thirty patients with 48 vessel injuries were included. Firearms were the leading mechanism, accounting for 43.3% (n = 13) of cases. We identified 29 arterial injuries and 19 venous injuries, with 30 (62.5%) of the overall injuries occurred in the lower extremities. Shock (17; 56.7%) and associated injuries (25; 83.3%) were common. Surgery was the most common management strategy. Autologous bypass graft was the most frequently performed procedure for arterial injuries (8; 42.1%), while ligation dominated in venous injuries (9; 64.3%). Blood transfusion requirements (24; 82.7%) and post-operative prescription of anticoagulant and antiplatelet agents (12; 41.4%) were similar for arterial and venous injuries (p > 0.05). Three patients demised, resulting in a 90% survival rate. Neither the mechanism of injury, anatomical location, and presence of shock on arrival nor the baseline hemoglobin level served as predictors of mortality. Conclusion: Intensive resuscitation with blood transfusion and prompt surgical intervention achieve favorable survival rates for pediatric traumatic vascular injuries. Optimal post-operative anticoagulant and antiplatelet regimens remain unclear. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to determine the incidence, necessity for neurosurgical intervention, and overall results of the treatment of pediatric peripheral nerve injuries associated with dislocated supracondylar fractures of the distal humerus. Method: A retrospective analysis of pediatric patients with supracondylar fractures treated from April 2019 to April 2022 with a minimum follow-up of 3 months was conducted. Results: Of 453 included patients, there were 51 recorded peripheral nerve injuries. The ulnar nerve was the most frequently injured nerve. Nine patients required neurosurgical intervention, with the most common procedure being the release of entrapped nerves. The combination of a supracondylar fracture and arterial injury was identified as a significant risk factor for peripheral nerve injury (p < 0.001). Only one patient experienced an unsatisfactory outcome. Conclusion: Although the prognosis for peripheral nerve injuries in children with supracondylar fractures is generally favorable, these injuries must be properly identified. We recommend an active neurosurgical approach in children with persisting neurological deficits to minimize the risk of permanent neurological impairment. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the macro- and microstructural features of language in patients with ischemic stroke without aphasia. Method: Participants were grouped according to arterial system damage and given the Aphasia Language Assessment Test (ADD) to detect aphasia. A narrative sample was obtained and analyzed for macrostructural and microstructural features of the language. The study sample consisted of 31 participants with ischemic stroke (15 vertebrobasilar system [VBS] involvement and 16 carotid system [CS] involvement) and 31 healthy participants, totaling 62 individuals. Results: The healthy control group scored higher than the stroke group on the microstructural feature type–token ratio and mean length of utterance in the narrative analysis and on the auditory comprehension, repetition, naming, grammar, speech act, and writing subtests in ADD. Effort behavior, errors, edits, repetitions, and pauses among microstructural features and uncertainty, filler expression, and anomia among macrostructural features were significantly higher in the vertebrobasilar and CS groups than in the healthy control group. The total ADD score and speech fluency and reading subtest scores were significantly higher in individuals with VBS damage than in individuals with CS lesions (p < .05). Conclusions: Language components may be impaired differently in patients with carotid and vertebrobasilar lesions. Speech and language disorders in individuals who have experienced cerebrovascular accidents should be evaluated in the subacute and chronic phases, and the therapeutic needs of patients with ischemic stroke should be determined, regardless of the presence of a clinical aphasia diagnosis. [ABSTRACT FROM AUTHOR]

Hand compartment syndrome is a rare condition due to trauma and vascular obstruction or injury, such as fluid extravasation, vascular obstruction, or arterial injury from arterial line insertion during anesthesia. However, perioperative hand compartment syndrome with no apparent preexisting cause during anesthesia that requires fasciotomy is extremely rare. We report a case on a 54‐year‐old male with history significant for stage IIIA moderately differentiated adenocarcinoma of the rectum who was scheduled for ultralow rectal resection and cystourethroscopy with insertion of urethral stent. Following surgery, in which he was in a safe‐T‐Secure positioner in a prolonged Trendelenburg position, the patient developed compartment syndrome of the right hand. This case and literature review highlights the risk for hand compartment syndrome when patients have increased Body Mass Index, positioning involves tucking of the arms, and the procedure duration is prolonged. [ABSTRACT FROM AUTHOR]

Mild hyperbaric oxygen therapy (mHBOT) is an adjuvant therapy used in conditions where tissue oxygenation is reduced and is implemented using pressures less than 1.5 ATA and 100% O2 (instead of the classical HBOT at 1.9–3 ATA) which results in cheaper, easier to implement, and equally effective. mHBOT is offered for wellness and beauty and as an anti-aging strategy, in spite of the absence of studies on the cardiovascular system. Consequently, we investigated the impact of mHBOT on the cardiovascular system. Mechanical and energetic parameters of isolated heart submitted to ischemia/reperfusion injury and arterial contractile response from mHBOT-exposed rats were evaluated. In the heart, mHBOT increased pre-ischemic velocity of contraction and ischemic end-diastolic pressure and developed pressure and contractile economy during reperfusion. mHBOT decreased infarct size and increased the plasma nitrite levels. In the artery, mHBOT increased acetylcholine sensitivity. mHBOT protects the heart during ischemia/reperfusion and affects vascular relaxation. [ABSTRACT FROM AUTHOR]

Identification of vascular injuries is crucial for complete postmortem evaluation and understanding of trauma deaths by the Medical Examiner. Some vascular injuries are difficult to evaluate due to challenging anatomic locations, especially in the head and neck. Documenting injuries of the facial and vertebral arteries is challenging and necessitates time‐consuming dissections that can create artifacts and disfigurement. In busy medical examiner offices with a significant number of traumatic injuries, finding a creative solution to employ reliable postmortem angiography is desirable. At the Office of the Chief Medical Examiner for the State of Maryland (OCME), we created and effectively implemented a selective angiography procedure using traditional indwelling Foley catheters and water‐soluble barium swallow contrast to evaluate arterial injuries using either digital radiography or computed tomography imaging modalities. This technique and imaging interpretation can be performed by a medical examiner or forensic pathology fellow after basic technical training and basic radiology training. This study outlines the technique, methods, and utilization of the procedure and describes the findings of six deaths due to vascular lesions from different injury mechanisms and disease processes and describes the ease of implementation on a broader scale in busy Medical Examiner's offices. [ABSTRACT FROM AUTHOR]

Background Intracranial vascular injury (VI) due to surgery is a critical complication that can lead to serious neurologic deficits. To our knowledge, only a few review articles on VI during an operation have been published so far. We retrospectively investigated the type, cause, and measurement of VI during surgery at our institution. Methods Unexpected VI cases occurred in 18 of 2,228 craniotomy procedures, including 794 aneurysm clippings and 357 tumor resections. We investigated the causes and coping techniques of the VI cases, as well as their full details. Results There were six cases of aneurysm neck tear, one case of sylvian vein injury, and one case of superior trunk perforation during direct clipping. Regarding tumor resection procedures, nine cases of arterial injury and one case of cortical vein injury were extracted. Almost all VIs were caused by carelessness or basic manipulation mistakes. We repaired all these cases with simple placement of suture threads with or without pinch clips, flow alteration using bypass techniques, and in 16 cases no neurologic deficit or deterioration on imaging occurred; however, 3 patients were verified to have ischemic changes on postoperative imaging. Conclusions Most VIs were directly caused by a simple error and carelessness of an operator or an assistant. Many of these injuries can be avoided if a basic set of rules are followed and remembered during the surgical procedure. However, the surgical procedure involves human work, and errors cannot be eradicated even upon maximum concentration levels. Neurosurgeons should be prepared for an eventual quick repair of an unexpected cerebral VI. [ABSTRACT FROM AUTHOR]

Traumatic injury leading to arterial damage has traditionally been repaired using autologous vein graft from the contralateral limb. This often requires a secondary surgical site and the potential of prolonged operative time for patients. We sought to assess the use of ipsilateral vs contralateral vein grafts in patients who experienced traumatic extremity vascular injury. A multicenter database was queried to identify arterial injuries requiring operative intervention with vein grafting. The primary outcome of interest was need for operative reintervention. Secondary outcomes included risk of thrombosis, infection, and intensive care unit length of stay. 358 patients (320 contralateral and 38 ipsilateral) were included in the analysis. The ipsilateral vein cohort did not display a statistically significant decrease in need for reoperation when compared to the contralateral group (11% vs 23%; OR 0.41, 95% CI −0.07-1.3; P =.14). Contralateral repair was associated with longer median intensive care unit (ICU) LOS (4.3 vs 3.1 days; P <.01). [ABSTRACT FROM AUTHOR]

Currently, there is a decreasing trend in the utilization of central venous catheters among medical practitioners. However, the continued relevance of central venous catheters persists, particularly in scenarios involving emergent or critically ill patients where peripheral venous access proves challenging. The insertion of central venous catheters facilitates rapid delivery of fluids and pharmacotherapy crucial for resuscitative efforts. Employing real-time ultrasound guidance enhances procedural safety from mechanical injuries, increases success rate with limited attempt and diminishes associated risks like pneumothorax, arterial puncture, and hemorrhage. Emphasizing infection prevention remains paramount. The present article underscored contemporary and safer procedural methodologies for central venous catheterization, alongside adept management of procedural complications. [ABSTRACT FROM AUTHOR]

Introduction: Surgical management of intertrochanteric hip fractures is a common surgery with low rates of intraoperative complications. Vascular injuries are exceptionally rare when placing an intramedullary nail without open reduction. There are very few reported cases of direct arterial injury and active bleed at the level of the distal interlocking screw following closed reduction and intramedullary nailing of a hip fracture. We report one such case. Case Presentation: An 88‐year‐old female presented to the emergency department with a left intertrochanteric hip fracture. Closed reduction with a cephalomedullary nail fixation of the left hip fracture occurred as planned without any obvious intraoperative technical issues. The patient remained stable intraoperatively. No open reduction was required. Postoperatively, the patient developed hemorrhagic shock and required massive transfusion protocol. Angiography demonstrated an intramuscular hematoma at the level of the distal intramedullary nail interlocking screw with active extravasation. The patient subsequently required embolization. Nine days following surgery, she began Eliquis for DVT prophylaxis and was ambulating independently with signs of hematoma resolution. Discussion: Profunda femoris artery injury can stem from various mechanisms during surgery. Atherosclerosis places patients at a higher risk of complication due to rigid vessels. In this case, it is believed that drilling beyond the medial femoral cortex led to the arterial injury. Conclusion: Care should be taken to prevent drills from plunging beyond the medial femoral cortex during surgery. Cautious observation of patient's vitals and clinical course can allow for early detection of vascular complication. [ABSTRACT FROM AUTHOR]

Background and aims: One of the primary causes of lumen narrowing is vascular injury induced during medical procedures. Vascular injury disrupts the integrity of the endothelium, triggering platelet deposition, leukocyte recruitment, and the release of inflammatory factors. This, in turn, induces the proliferation of vascular smooth muscle cells (VSMCs), leading to neointima formation. However, the molecular mechanism underlying VSMC proliferation following injury remains unknown. KIF11 is critical in regulating the cell cycle by forming bipolar spindles during mitotic metaphase. This process may contribute to VSMCs proliferation and neointima formation following vascular injury. Yet, the function of KIF11 in VSMCs has not been elucidated. This study aims to investigate the role and mechanisms of KIF11 in regulating VSMCs cycle progression and proliferation. Methods: After conducting biological analysis of the transcriptome sequencing data from the mouse carotid artery injury model and the cell transcriptome data of PDGF-BB-induced VSMCs, we identified a potential target gene, KIF11, which may play a crucial role in vascular injury. Then we established a vascular injury model to investigate how changes in KIF11 expression and activity influence in vivo VSMCs proliferation and neointimal formation. In addition, we employed siRNA and specific inhibitors to suppress KIF11 expression and activity in VSMCs cultured in vitro to study the mechanisms underlying VSMCs cycle progression and proliferation. Results: The results of immunohistochemistry and immunofluorescence indicate a significant upregulation of KIF11 expression in the injured vascular. The intraperitoneal injection of the KIF11 specific inhibitor, K858, partially inhibits intimal hyperplasia in the vascular injury model. In vitro experiments further demonstrate that PDGF-BB upregulates KIF11 expression through the PI3K/AKT pathway, and enhances KIF11 activity. Inhibition of both KIF11 expression and activity partially reverses the pro-cycle progression and pro-proliferation effects of PDGF-BB on VSMCs. Additionally, KIF11 overexpression partially counteracts the proliferation arrest and cell cycle arrest induced by inhibiting the PI3K/AKT pathway in VSMCs. Conclusion: Our study highlights the crucial role of KIF11 in regulating the cycle progression and proliferation of VSMCs after vascular injury. A comprehensive understanding of these mechanisms could pave the way for potential therapeutic interventions in treating vascular stenosis. [ABSTRACT FROM AUTHOR]

Subclavian artery pseudoaneurysm is an uncommon entity caused by trauma or iatrogenic arterial injury. Endovascular management is the preferred treatment strategy but can be complicated by endoleaks. We report a case of type I endoleak occurring after endovascular covered stent placement to treat a traumatic pseudoaneurysm of proximal left subclavian artery. [ABSTRACT FROM AUTHOR]

Background: Iliac and femoral venous injuries represent a challenging dilemma in trauma surgery with mixed results. Venous restoration of outflow (via repair or bypass) has been previously identified as having higher rates of VTE (venous thromboembolism) compared to ligation. We hypothesized that rates of VTE and eventual amputation were similar whether restoration of venous outflow vs ligation was performed at initial operation. Methods: Patients in the 2019-2021 National Trauma Data Bank with iliac and femoral vein injuries were abstracted and analyzed. The primary outcomes of interest were in-hospital lower extremity amputation and VTE. Results: A total of 2642 patients with operatively managed iliac and femoral vein injuries were identified VTE was found in 10.8% of patients. Multivariable logistic regression was performed and identified bowel injury, higher ISS, older age, open repair, and longer time to VTE prophylaxis initiation as independent predictors of VTE. Amputation was required in 4.2% of patients. Multivariable logistic regression identified arterial or nerve injury, femur or tibia fracture, venous ligation, percutaneous intervention, fasciotomy, bowel injury, and higher ISS as independent factors of amputation. Conclusion: Venous restoration was not an independent predictor of VTE. Venous ligation on index operation was the only modifiable independent predictor of amputation identified on regression analysis. [ABSTRACT FROM AUTHOR]

Traumatic vascular injuries consist of direct or indirect damage to arteries and/or veins and account for 3% of all traumatic injuries. Typical consequences are hemorrhage and ischemia. Vascular injuries of the extremities can occur isolated or in association with major trauma and other organ injuries. They account for 1–2% of patients admitted to emergency departments and for approximately 50% of all arterial injuries. Lower extremities are more frequently injured than upper ones in the adult population. The outcome of vascular injuries is strictly correlated to the environment and the time background. Treatment can be challenging, notably in polytrauma because of the dilemma of which injury should be prioritized, and treatment delay can cause disability or even death, especially for limb vascular injury. Our purposes are to discuss the role of computed tomography angiography (CTA) in the diagnosis of vascular trauma and its optimized protocol to achieve a definitive diagnosis and to assess the radiological signs of vascular injuries and the possible pitfalls. [ABSTRACT FROM AUTHOR]

External iliac artery (EIA) injuries associated with pelvic fractures are uncommon yet serious. High mortality rates due to hemorrhage and the risk of necrosis from disrupted blood flow during hemostasis present significant challenges. Physicians often grapple with the choice between prioritizing life-saving measures and limb salvage. This study seeks to establish a treatment protocol for managing pelvic fracture-related EIA injuries that is both effective and readily implementable. In this retrospective case series and literature review, we examined patients who sustained pelvic fractures with EIA injuries from May 2008 to May 2021, using data from our trauma registry system. Additionally, we conducted a review of the available literature on the subject. We retrieved and analyzed the data regarding patient demographics, clinical presentation, associated injuries, pelvic fracture type, arterial injury location and management, salvage of limbs and mortality. Characteristics of survivors and patients with preserved limbs were analyzed. In the current study, we identified 5 patients from our institution and 22 patients from previous literature that suffered from pelvic fracture with EIA injuries. There was an overall mortality rate of 25.9%. Sixteen patients underwent revascularization of the injured vessels. Eight patients underwent ligation of injured vessels as part of the hemostasis or damage control procedure. The limb preservation rate in survivors was 45.0%. Compared with nonsurvivors, survivors had a significantly higher chance of undergoing revascularization (70.0% vs. 28.6%, p = 0.044). Among survivors, open fracture was associated with a 21.277-fold higher odds of need for amputation (p = 0.015, odds ratio = 21.277). When balancing life-saving efforts with limb preservation, the loss of limbs can sometimes seem unavoidable to save lives. Nevertheless, once hemostasis is attained, we recommend pursuing aggressive revascularization. We observed a poor prognosis in patients with open pelvic fractures and EIA injuries. [ABSTRACT FROM AUTHOR]

Microsurgical subinguinal varicocelectomy (MSV) is the gold standard for treating varicoceles. Preservation of the internal spermatic arteries (ISAs) during MSV is important for sperm production. This study aimed to evaluate the safety and efficacy of elevating systolic blood pressure (SBP) using MSV. Data from 252 consecutive adult male patients were retrospectively reviewed. The patients were divided into two groups: a traditional group that underwent conventional MSV (n = 134) and a modified group that underwent MSV with a transiently elevated SBP of 140–160 mm Hg (n = 118). Arterial identification time, unilateral operative time, number of ISAs, arterial injury rate, and other postoperative indicators, including postoperative complications and sperm parameters, were compared between the groups. All the procedures were successful. The arterial identification and unilateral operative times were significantly shorter in the modified group (31.34 ± 10.44 vs. 42.94 ± 12.39 min and 61.48 ± 8.78 vs. 76.35 ± 12.33 min, p <.01, respectively). Intraoperatively, the number of preserved ISAs was significantly higher in the modified group (1.92 ± 0.53 vs. 1.45 ± 0.32, p <.01). The arterial injury rate did not differ significantly between the groups (2.74% vs. 0%, respectively). Compared with preoperative values, sperm parameters improved significantly 6 months postoperatively. Significant differences in semen parameters or postoperative complications were not observed between the groups. Elevated intraoperative SBP can be used to rapidly, safely, and effectively identify ISAs, increase the number of retained spermatic arteries, and markedly reduce the operative time for MSV. [ABSTRACT FROM AUTHOR]

An iatrogenic vessel injury occurring during lumbar fusion is a rare but potentially serious complication. In this case report, we present a case of hypovolemic cardiac arrest attributable to an iatrogenic lumbar artery injury that occurred during posterior lumbar interbody fusion (PLIF), which is difficult to diagnose using CECT. A 70- year-old woman underwent PLIF surgery in a primary hospital for the treatment of degenerative spondylolisthesis (L2–L5). During the procedure, she experienced a blood loss of 3 liters, which necessitated the transfusion of packed red blood cells (6 units, about 200–250 mL per unit), fresh frozen plasma (6 units, about 150–170 mL per unit). Despite the transfusions, her vital signs remained unstable, leading to her transfer to our hospital. Upon arrival at our facility, the patient went into cardiac arrest, but spontaneous circulation was successfully restored after two cycles of cardiopulmonary resuscitation. In the emergency department, her hemoglobin level was measured at 2.7 g/dL, platelet level at 56,000/µL, and prothrombin international normalized ratio at 3.56. CECT did not indicate any active bleeding. For the initial 2 hours, her vital signs remained stable with a blood pressure of 92/53 mmHg, heart rate of 104 bpm, respiratory rate of 22 bpm. However, her blood pressure suddenly dropped to 78/43 mmHg. Subsequent angiography revealed active bleeding from the right fourth lumbar artery, prompting the performance of embolization. Following the procedure, the patient’s vital signs stabilized, and she was discharged on the 16th day of hospitalization. Iatrogenic vessel injuries during PLIF may pose challenges in their detection using CECT, especially when extravasation is not definitively visible or when artifacts are created by metal implants. Therefore, it is advisable for emergency physicians to consider emergency angiography in the diagnosis and treatment of such vessel injuries. [ABSTRACT FROM AUTHOR]

This document provides valuable information for researchers studying abdominal trauma. It discusses the computed tomography (CT) findings of bowel and mesenteric injuries in cases of blunt abdominal trauma. The authors emphasize the importance of timely diagnosis and provide imaging pearls to guide radiologists in identifying these injuries, which can be subtle and easily missed. The document also highlights specific signs to look for on CT scans and the need for careful evaluation of adjacent bowel loops. Additionally, it mentions the use of narrow window settings and Hounsfield unit measurements to detect subtle signs of injury. [Extracted from the article]

Deep and superficial parasternal intercostal plane blocks provide anterior chest wall analgesia for both breast and cardiac surgery. Our primary objective of this cadaveric study was to describe the parasternal spread of deep and superficial parasternal intercostal plane blocks. Our secondary objectives were to describe needle proximity to the internal mammary artery when performing deep parasternal intercostal plane blocks, and compare lateral injectate spread and extension into the rectus sheath. We performed ultrasound-guided deep and superficial parasternal intercostal plane blocks 2 cm from the sternum at the T3–4 interspace in four fresh frozen cadavers as described in clinical studies. Parasternal spread of injectate was greater with the deep parasternal intercostal plane injection than with the superficial parasternal intercostal plane injection. The internal mammary artery was ∼3 mm away from the needle trajectory in cadaver #1 and ∼5 mm from the internal mammary artery in cadaver #2. Lateral spread extended to the midclavicular line for all deep parasternal intercostal plane blocks and beyond the midclavicular line for all superficial parasternal intercostal plane blocks. Neither block extended to the rectus sheath. A greater number of parasternal interspaces were covered with the deep parasternal intercostal plane block than with the superficial parasternal intercostal plane block when one injection was performed at the T3–4 interspace. However, considering proximity to the internal mammary artery, and potential devastating consequences of an arterial injury, we propose that the deep parasternal intercostal plane block be classified as an advanced block and that future studies focus on optimising superficial parasternal intercostal plane parasternal spread. [ABSTRACT FROM AUTHOR]

Background and Objectives: Transarterial chemoembolization (TACE) is a widely accepted treatment for hepatocellular carcinoma (HCC). Regarding TACE, arterial injuries, such as hepatic artery spasm or dissection, can also occur, although pseudoaneurysms are rare. We report a case of pseudoaneurysm following TACE. Materials and Methods: A 78-year-old man had been undergoing TACE for HCC in segment 8 of the liver for the past 5 years, with the most recent TACE procedure performed approximately 1 month prior. He presented to the emergency department with melena that persisted for 5 days. Computed tomography revealed a pseudoaneurysm in the S8 hepatic artery with hemobilia. Results: the pseudoaneurysm was successfully treated by N-Butyl-cyanoacrylate glue embolization. Conclusions: In patients that have undergone TACE presenting with melena and hemobilia identified on CT, consideration of hepatic artery pseudoaneurysm is crucial. Such cases can be safely and effectively treated with endovascular managements. [ABSTRACT FROM AUTHOR]

Objective: For traumatic lower extremity artery injury, it is unclear whether it is better to perform endovascular therapy (ET) or open surgical repair (OSR). This study aimed to compare the clinical outcomes of ET versus OSR for traumatic lower extremity artery injury. Methods: The Medline, Embase, and Cochrane Databases were searched for studies. Cohort studies and case series reporting outcomes of ET or OSR were eligible for inclusion. Robins-I tool and an 18-item tool were used to assess the risk of bias. The primary outcome was amputation. The secondary outcomes included fasciotomy or compartment syndrome, mortality, length of stay and lower extremity nerve injury. We used the random effects model to calculate pooled estimates. Results: A total of 32 studies with low or moderate risk of bias were included in the meta-analysis. The results showed that patients who underwent ET had a significantly decreased risk of major amputation (OR = 0.42, 95% CI 0.21–0.85; I2=34%) and fasciotomy or compartment syndrome (OR = 0.31, 95% CI 0.20–0.50, I2 = 14%) than patients who underwent OSR. No significant difference was observed between the two groups regarding all-cause mortality (OR = 1.11, 95% CI 0.75–1.64, I2 = 31%). Patients with ET repair had a shorter length of stay than patients with OSR repair (MD=-5.06, 95% CI -6.76 to -3.36, I2 = 65%). Intraoperative nerve injury was just reported in OSR patients with a pooled incidence of 15% (95% CI 6%–27%). Conclusion: Endovascular therapy may represent a better choice for patients with traumatic lower extremity arterial injury, because it can provide lower risks of amputation, fasciotomy or compartment syndrome, and nerve injury, as well as shorter length of stay. [ABSTRACT FROM AUTHOR]

This article provides a review on the evaluation and management of orbital penetrating injuries, which are rare but can have serious consequences. It discusses the epidemiology of these injuries, different types of injuries, and the importance of thorough examination and evaluation. Medical and surgical management options are discussed, emphasizing the need for multidisciplinary care and individualized treatment plans. The article also highlights potential complications associated with these injuries. Additionally, a document of references related to penetrating orbital injuries is provided, covering various types of injuries and diagnostic methods, management strategies, and complications. [Extracted from the article]

Canonical Wnt and sphingosine-1-phosphate (S1P) signaling pathways are highly conserved systems that contribute to normal vertebrate development, with key consequences for immune, nervous, and cardiovascular system function; despite these functional overlaps, little is known about Wnt/β-catenin-S1P cross-talk. In the vascular system, both Wnt/β-catenin and S1P signals affect vessel maturation, stability, and barrier function, but information regarding their potential coordination is scant. We report an instance of functional interaction between the two pathways, including evidence that S1P receptor 1 (S1PR1) is a transcriptional target of β-catenin. By studying vascular smooth muscle cells and arterial injury response, we find a specific requirement for the β-catenin carboxyl terminus, which acts to induce S1PR1, and show that this interaction is essential for vascular remodeling. We also report that pharmacological inhibition of the β-catenin carboxyl terminus reduces S1PR1 expression, neointima formation, and atherosclerosis. These findings provide mechanistic understanding of how Wnt/β-catenin and S1P systems collaborate during vascular remodeling and inform strategies for therapeutic manipulation. [ABSTRACT FROM AUTHOR]

Introduction: Trauma to the pelvic ring and associated haemorrhage represent a management challenge for the multidisciplinary trauma team. In up to 10% of patients, bleeding can be the result of an arterial injury and mortality is reported as high as 89% in this cohort. We aimed to assess the mortality rate after pelvic trauma embolisation and whether earlier embolisation improved mortality. Methods: Retrospective study at single tertiary trauma and referral centre, between 1 January 2009 and 30 June 2022. All adult patients who received embolisation following pelvic trauma were included. Patients were excluded if angiography was performed but no embolisation performed. Results: During the 13.5‐year time period, 175 patients underwent angiography and 28 were excluded, leaving 147 patients in the study. The all‐cause mortality rate at 30‐days was 11.6% (17 patients). The median time from injury to embolisation was 6.3 h (range 2.8–418.4). On regression analysis, time from injury to embolisation was not associated with mortality (OR 1.01, 95% CI 0.952–1.061). Increasing age (OR 1.20, 95% CI 1.084–1.333) and increasing injury severity score (OR 1.14, 95% CI 1.049–1.247) were positively associated with all‐cause 30‐day mortality, while non‐selective embolisation (OR 0.11, 95% CI 0.013–0.893) was negatively associated. Conclusion: The all‐cause mortality rate at 30‐days in or cohort was very low. In addition, earlier time from injury to embolisation was not positively associated with all‐cause 30‐day mortality. Nevertheless, minimising this remains a fundamental principle of the management of bleeding in pelvic trauma. [ABSTRACT FROM AUTHOR]

Background: The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury. Methods: We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan–Meier analysis. Results: Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43–1093]. Primary patency rate was 97% (95% CI: 94–100) in year 1, and 92% (95% CI: 86–98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94–100) from years 1 to 6. Conclusion: Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates. [ABSTRACT FROM AUTHOR]

Pediatric oro-pharyngeal trauma is a common observation in hospital accidents & emergencies reception. Immense responsibility rests with specialized health care providers to instantly diagnose and manage a rather small proportion of life-threatening complication associated with such injuries. Postero-lateral oropharyngeal trauma carries a significant risk of major neurovascular insult. More-over such patients are exposed to high radiation exposure to face, head & neck regions. A multi-disciplinary approach involving high dependency nursing, neuro-observation, meticulous imaging, prompt surgical exploration where indicated and a cautious follow-up must be considered as neurovascular manifestation may become apparent after some days of initial injury. [ABSTRACT FROM AUTHOR]

This article discusses the use of different surgical approaches for enhanced endoscopic petrosectomy safety in addressing lesions in the petrous apex and petroclival region of the skull base. The traditional transtemporal and middle fossa transpetrosal strategies have been effective, but the endoscopic endonasal approach has shown promise. The study compares the ipsilateral transpterygoid (ITP) approach and the contralateral transmaxillary (CTM) approach, evaluating their visualization, angle of attack, reach, and safety. Both approaches demonstrated extensive reach and equivalent visualization capabilities, but the CTM approach was perceived to have heightened safety in drilling certain segments due to a reduced angle of attack and less retraction on the carotid artery. The choice between the two approaches should be based on intraoperative assessments rather than preoperative imaging alone. [Extracted from the article]

Introduction: Traumatic vascular injury is a significant cause of morbidity and sometimes mortality, depending on the associated mode and level of injury; hence should be dealt with on an emergency basis considering hemodynamic status of the patient and the level of expertise available at the center. Most common forms of vascular injury include penetrating trauma and blunt trauma. Nowadays iatrogenic arterial injury is another emerging cause of vascular trauma. Vascular injuries, such as vasospasm, contusion, intimal flaps, intimal disruption or hematoma, external compression, laceration, transection and focal wall defects with pseudoaneurysm etc are different types of vascular injuries. Case report: A 23 year old male was referred to EMD 8 hours after a motorcycle collision. On arrival, the patient's vitals were stable, and he complained of right shoulder pain and an absence of motor and sensory functions below the right shoulder. On examination, his right upper limb was cold, pale, pulseless with saturation < 80% and no withdrawal reflex upon painful stimulation. The injury was associated with swelling, tenderness, crepitus, abnormal mobility and deformity in the right mid arm with a subcutaneous hematoma of 10x4cm in the same region. Conclusion: For selective cases in emergency conditions, especially where ischemic time is already prolonged, in a case of subclavian artery trauma or occlusion, carotid to axillary/brachial bypass is less time-consuming and less risky by avoiding time and efforts necessary for exposure of the proximal part of the subclavian artery, which is required for subclavian to brachial artery anastomosis. Hence in this case jump graft is a comparatively preferred choice than interposition graft for earliest reperfusion of the limb. [ABSTRACT FROM AUTHOR]

To summarize the experience of identifying and caring for a stroke patient with ruptured internal iliac artery branch bleeding. The experience was summarized in 3 aspects, including how to recognize the presence of active bleeding in the patient, confirmation of the diagnosis and treatment of the bleeding point, prevention of postoperative complications, and rehabilitation care. After aggressive treatment and care, the patient was discharged after 30 days of hospitalization and improved. [ABSTRACT FROM AUTHOR]

Background. The surgical treatment of venous injuries is examined in this work, with particular attention to the brachial vein and its prevalence, methods, and results. Purposes. It assesses surgical techniques, issues that arise after surgery, and the significance of developments in venous repair. In these complicated instances, the research aids in better decision-making and patient care. Methods. A study at the Advanced Vascular Institute and Al-Hashed military hospitals between 2017 and 2018 involved 150 patients with acute venous injuries, predominantly males aged 3-65 years. The study observed a change in the causes of venous injury, with a rise in cases of blunt trauma, particularly in metropolitan areas, but penetrating trauma remains the most common cause. Diagnosis is mainly reached clinically by looking for signs and symptoms, and surgical plans can be made without the Doppler study, which is now available in all casualty wards. Results. To treat hypovolemia and shock, two bilateral wide-bore cannulas with rapid cross-matched blood (rapid method) and ringers or normal saline fluid. The most common injury was to the brachial vein, which was repaired primarily by ligation and, after that, by various techniques, including venography. Follow-ups were difficult for those from other governments, especially our soldier's surgery done at Al-Hashed hospitals, where we advised them to consult vascular surgeons near their residences. Ten individuals had their venous ligation and fasciotomy complications-often accompanied by concomitant artery trauma-required an amputation. Conclusions. The use of fasciotomies varied and did not significantly correlate with the kind of operation. Doppler study checked the patency of the repaired veins, and the follow-up revealed no signs of thrombotic problems. Four patients, all in critical hemodynamic conditions with significant arterial and venous injuries, died during surgery from irreversible shock, accounting for the study's 2.7% fatality rate. [ABSTRACT FROM AUTHOR]

In response to injury, vascular smooth muscle cells (VSMCs) of the arterial wall dedifferentiate into a proliferative and migratory phenotype, leading to intimal hyperplasia. The ERK1/2 pathway participates in cellular proliferation and migration, while dual-specificity phosphatase 6 (DUSP6, also named MKP3) can dephosphorylate activated ERK1/2. We showed that DUSP6 was expressed in low baseline levels in normal arteries; however, arterial injury significantly increased DUSP6 levels in the vessel wall. Compared with wild-type mice, Dusp6-deficient mice had smaller neointima. In vitro, IL-1β induced DUSP6 expression and increased VSMC proliferation and migration. Lack of DUSP6 reduced IL-1β-induced VSMC proliferation and migration. DUSP6 deficiency did not affect IL-1β-stimulated ERK1/2 activation. Instead, ERK1/2 inhibitor U0126 prevented DUSP6 induction by IL-1β, indicating that ERK1/2 functions upstream of DUSP6 to regulate DUSP6 expression in VSMCs rather than downstream as a DUSP6 substrate. IL-1β decreased the levels of cell cycle inhibitor p27 and cell–cell adhesion molecule N-cadherin in VSMCs, whereas lack of DUSP6 maintained their high levels, revealing novel functions of DUSP6 in regulating these two molecules. Taken together, our results indicate that lack of DUSP6 attenuated neointima formation following arterial injury by reducing VSMC proliferation and migration, which were likely mediated via maintaining p27 and N-cadherin levels. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA). Retrospective review of medical data of children who underwent ASO in 2019–2020 in the Ukrainian Children's Cardiac Center. 76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 – had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61–127) versus 73.5 (53–136) in the non-severe AKI group (p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 (95% CI: 1.5 – 13, p = 0.01). Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 (95% CI: 1.0 − 2.0, p = 0.03). Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis. In our study, 51.7% of patients developed AKI after ASO, 25.8%–severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score. [ABSTRACT FROM AUTHOR]

Background: Percutaneous balloon compression is a safe and effective treatment for trigeminal neuralgia. Current technique consists of penetrating the foramen ovale using a sharp 14G needle with a stylet. Difficulty of cannulation of the foramen ovale, failures of cannulation and major neurovascular complications of the procedure, although rare, may be due to the relatively large caliber of this needle and its sharp tip. Objective: To present a novel technique to facilitate and make the cannulation of the foramen ovale with a 14G cannula safer. Methods: A rigid blunt-tip guide of 1.2 or 1.5 mm is used to penetrate the foramen ovale under lateral fluoroscopic control. Once the guide enters the foramen it is advanced further to the clival line, and a 14G cannula is then advanced over the guide to engage the foramen, at which point the guide is withdrawn and replaced with the balloon catheter. Results: The technique was employed to deliver a 4F balloon catheter to Meckel's cave successfully in 500 consecutive procedures performed on 416 trigeminal neuralgia patients. None of the patients had neurovascular complications like facial hematoma, arterial injury, carotid-cavernous fistula or cranial nerve palsies. Conclusion: A novel technique for cannulation of the foramen ovale is described. The use of blunt tip guides of smaller diameters instead of sharp 14G needles considerably facilitated cannulation of the foramen ovale and enabled cannulation in all cases. Absence of complications of cannulation such as facial hematoma, carotid-cavernous fistula or intracranial hemorrhage in this series of patients suggests that the technique may be safer than the use of conventional sharp tipped 14G needles in terms of avoiding neurovascular complications. [ABSTRACT FROM AUTHOR]

Introduction: Real-time ultrasound-guided percutaneous kidney biopsy is essential for diagnosis and treatment planning; nonetheless, the optimal puncture approach has yet to be established. In vivo, performing different approaches on the same patient at once is not possible. This study aimed to determine the impact of different approaches on the number of obtained glomeruli and their potential to cause arterial injury using pig kidneys, which are similar to humans. Methods: A total of 120 pig kidneys (60 right-sided kidneys and 60 left-sided kidneys) for research were obtained from a slaughterhouse. The specimens were collected from the lower pole on the sagittal plane of the kidney using three different approaches on the same kidney: caudocranial approach, caudal to cranial; craniocaudal approach, cranial to caudal; and vertical approach, through the surface cortex. Five blinded pediatric nephrologists assessed the number of glomeruli and arterial injuries. Results: Overall, 360 specimens were collected from the kidneys through biopsy using a 16-gauge needle (mean vertical kidney length, 11.2 ± 0.7 cm; mean depth, 3.47 ± 0.23 cm). No significant difference in the incidence of arterial injury was observed between the three approaches (caudocranial vs. craniocaudal vs. vertical approaches: 78% vs. 87% vs. 87%, p = 0.14). In contrast, the vertical approach retrieved significantly more glomeruli than the caudocranial and craniocaudal approaches (caudocranial approach: 7.5 ± 2.8, craniocaudal approach: 7.8 ± 2.7, and vertical approach: 8.9 ± 3.3, p < 0.001). Conclusions: Considering its efficacy and safety profile, the vertical approach may be preferred, as more glomeruli can be obtained without increasing the incidence of arterial injury. Although the results cannot be directly extrapolated to humans due to the differences between species, they still offer important insights into the characteristics of each approach. [ABSTRACT FROM AUTHOR]

Vascular reconstruction requires technical expertise and is often time consuming. As a novel alternative to traditional hand-sewn vascular anastomoses, the VasoLock (VL), is a nonabsorbable, sutureless anastomosis device with traction anchors designed to hold free artery ends together. These anchors do not penetrate the vessel wall but adhere by leveraging the elasticity of the vessels to fasten blood vessels together. This pilot study assesses the performance and patency of this novel device in a porcine model of femoral artery injury. Female swine (n = 7) underwent femoral artery exposure for a total of 10 VL implanted. Study animals underwent hemodilution to a target hematocrit of 15% and ROTEM was used to assess coagulopathy, followed by an arterial injury via transection. The VL was inserted without any sutures. Flow-probe monitors were positioned proximal and distal to the device and flow rates were measured continuously for a total of 90 min. Flow was analyzed and presented as a ratio of distal to proximal flow with the slope of this ratio across time subsequently determined. Angiographic assessment was completed to evaluate for patency and technical complications after 90 min of implant. The average animal weight was 44.1 ± 3.2 kg. The average mean arterial pressure at the time of implant was 51.2 ± 7.8 mmHg, median heart rate was 77.4 (IQR = 77.25-157.4) beats per minute, and average temperature was 36.1 ± 1.5°C. The baseline hematocrit was 13.5 ± 3.0%, average pH was 7.20 ± 0.1, average clotting time was 154.1 ± 58.7 s and average clot formation time was 103.4 ± 10.9 s all demonstrating the acidotic, hypothermic, and coagulopathic state of the swine at the time of insertion. During the 90-min observation period, the average flow gradient identified across the VL was 0.99 ± 0.24, indicating no significant change in flow across the VL. The average slope of the gradients was 0.0005 (P = 0.22), suggesting the ratio of proximal and distal flow did not change over the 90 min. Following 90 min of dwell time, all VL were patent without technical complication. Angiographic assessment at 90 min demonstrated no evidence of dissection, device migration, arterial extravasation, or thromboembolism with any of the 10 devices. This pilot study demonstrated technical feasibility of the novel VL device over a 90-min observation period. All VL were patent and no negative events or complications were identified. This technology demonstrated significant promise in a coagulopathic state: additional investigation, involving long-term survival, is warranted for further validation. [ABSTRACT FROM AUTHOR]

We evaluated the safest approach to treat catheter-related cervicothoracic arterial injuries by reviewing two inadvertent arterial injury cases during central venous catheter insertion and their related complications at an intensive care unit. In the first case, Carm angiography confirmed accidental catheter placement in the right subclavian artery (SCA). In the second case, accidental catheter placement in the right common carotid artery was confirmed via computed tomography angiography of the neck and chest. The catheter was connected to a high-pressure arterial bag in both cases. The Perclose ProGlide Suture-Mediated Closure System (Abbott Laboratories, IL, USA) was used and successfully operated the two cases of iatrogenic SCA and carotid artery injuries. A follow-up bedside ultrasound at 2 and 6 hours postoperatively revealed normal Doppler waveforms in the inadvertent arterial injury and distal arteries without hematoma at the puncture site in both cases. In conclusion, for inadvertent artery puncture, which occurs in <12% of jugular and subclavian venous procedures, the endovascular approach using a covered stent appears to be safe for treating the accidental catheter placement in the carotid artery, although some cases of post-procedure stroke have been reported. In this regard, the percutaneous arterial suture device (Perclose ProGlide) offers an almost 100% success rate and lowers morbidity and mortality rates compared with open surgical and endovascular approaches for treating iatrogenic SCA and carotid artery injuries. These two cases highlight the effectiveness of minimally invasive percutaneous arterial closure devices in treating this infrequent but potentially lethal injury. [ABSTRACT FROM AUTHOR]

Introduction: Lower extremity vascular injuries have significant implications for trauma patients with regards to morbidity from limb loss. There is limited evidence on outcomes for patients with injuries to tibial arteries. Our study focuses on defining outcomes of traumatic vascular injury to vessels below the knee. Methods: A retrospective review using ICD-9 and 10 codes of all patients with below knee vascular injuries was performed at a Level 1 trauma center from November 2014 to June 2022. Interventions, outcomes, and complications were assessed. Results: Seventy-six patients were identified fitting inclusion criteria. The mean age was 35.3 +/− 15.2 years and 67 (88%) patients were male. Thirty-nine suffered penetrating trauma, 37 suffered blunt trauma. The most injured artery was posterior tibial artery (40%) followed by anterior tibial artery (36%). Injuries included 51 transections, 22 occlusions and 4 pseudoaneurysms. Forty-five (59%) patients underwent operative intervention. Thirty (67%) operations were performed by trauma surgery. Arterial ligation was performed in 30 cases (67%), arterial bypass in 12 (27%), and 2 (4%) primary amputations. Vascular surgery performed all bypasses. Overall amputation rate was 8% (n = 6) with 3 for mangled extremity and 3 due to failed bypass graft. All amputations were associated with open fracture and amputations for failed bypass had multiple arterial injuries. Conclusion: The management of below knee vascular trauma requires a multidisciplinary approach. Patients requiring reconstruction are more likely to have multiple vessel injuries and may have significant risk of graft failure. These patients as well as those with extensive soft tissue injury and/or multi-vessel injuries are at increased risk for amputation [ABSTRACT FROM AUTHOR]

While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma. [ABSTRACT FROM AUTHOR]

This paper investigates the performance of two commercial stent designs inside the normal artery for induced Von Mises Stress and radial displacement pattern. Investigation focuses on identifying the key design feature of the stent structure responsible for varied stress and displacement pattern. Two commercial stent designs, Supraflex (Stent S) and Yukon Choice (Stent T),are modeled using micro CT images and MIMICS® while idealized models are used for investigation. ANSYS Workbench is used to numerically expand the stent inside an idealized normal artery with inflation pressure. The stent and the artery are modeled using elastic-plastic and hyperelastic material models, respectively. The results suggest crucial influence of the link positioning in inducing an area of higher Von Mises Stress and stress gradient. The locations of a higher stress gradient are those in line with unbound stent crowns. Also, higher and uniform arterial displacement can be observed in the locations in line with the bound crown. Results also suggested a considerable difference in arterial distortion induced by two designs, causes for which can also be attributed to the differences in the link placement. The study suggests that the link connections play a crucial role in setting up stress field/radial displacement. Suitable modification of the link positioning can reduce the higher stress gradient and arterial distortion, which probably can reduce arterial injury. [ABSTRACT FROM AUTHOR]

Surgical procedures can result in unforeseen vascular injuries. In cases of severe vascular injuries, the involvement of an experienced vascular surgeon in the operation can be life-saving. The aim of this study is to elucidate the surgical approaches and outcomes in vascular injuries that occurred during elective operations of various branches within our institution. Between October 2014 and June 2018, 18 patients required surgery due to unexpected severe vascular injuries. Gender, age, injury site, elective operation, intervention to vascular injury, hemodynamic status, type of anesthesia, mean operation time, and postoperative status of the patients were retrospectively obtained from hospital database. Diagnostic tests and imaging methods were recorded, and the utilization of blood products used during the operation has been investigated. The intensive care unit and service follow-ups of the patients as well as their post-discharge controls were collected from hospital records. Among the patients undergoing vascular intervention, 60% (n=11) experienced arterial injuries, while 40% (n=7) had venous injuries. When examining the type of intervention, all patients, except for one, underwent intervention by placing a side or cross-clamp on the vascular structure. Primary repair was performed in 11 patients, end -to-end repair in 2 patients, PTFE graft placement in 1 patient, saphenous vein interposition in 3 patients, and ligation in 1 patient. Two patients (11%) died during the surgery. As a result, the surgeon should accurately and quickly evaluate findings such as unexplained hypotension, tachycardia, loss of pulse or heat loss during the operation, and should suspect vascular injury. It is possible to reduce mortality and morbidity rates when iatrogenic vascular injuries are diagnosed early. [ABSTRACT FROM AUTHOR]

Background: Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity associated with surgery and can swiftly access and control bleeding sites. Despite international guidelines and widespread awareness of the role of angioembolization in clinical practice, robust evidence comparing the outcomes of angioembolization in hemodynamically stable and unstable patients is still lacking. This study aims to directly compare the outcomes of angioembolization for the treatment of pelvic traumatic arterial injury in patients with hemodynamic stability vs. hemodynamic instability. Methods: In our multicenter retrospective investigation, we analyzed data from consecutive patients who underwent, from January 2020 to May 2023, angioembolization for traumatic pelvic arterial injury. Results: In total, 116 angioembolizations were performed. Gelatin sponges (56.9%) and coils (25.9%) were the most widely used embolic agents. The technical and clinical success rates were 100% and 91.4%, respectively. No statistically significant differences were observed between the two groups in terms of technical success, clinical success, procedure-related complication rate, or 30-day bleeding-related mortality. Conclusions: Angioembolization is an effective and safe option for the management of traumatic pelvic arterial lesions even in hemodynamically unstable patients, despite technical variations such as greater use of prophylactic angioembolization. [ABSTRACT FROM AUTHOR]

Introduction: Thrombotic microangiopathy (TMA) on kidney biopsy shows a variable combination of features: arterial mucoid intimal thickening, acellular closure of glomerular capillary loops, fragmented red blood cells, fibrin thrombi, and arterial fibrinoid necrosis. However, some early post‐transplant kidney biopsies show only arterial mucoid intimal thickening. We aimed to elucidate the importance of this finding. Methods: We identified 19 biopsies showing isolated arterial mucoid intimal thickening and compared them with 22 bona fide TMA biopsies identified based on the pathological findings (excluding rejection) (2011‐2020). Additionally, delayed graft function (DGF) (n = 237), and no DGF (control, n = 1314) groups were included for survival analysis. Results: Seven of 19 cases with isolated arterial mucoid intimal thickening showed peripheral blood schistocytes but no other systemic features of TMA. Eight patients underwent adjustments in maintenance immunosuppression (mainly calcineurin inhibitors). None of the cases progressed to full‐blown TMA on consecutive biopsies. The overall and death‐censored graft survival rates in this group were comparable to the DGF group, but significantly better than the TMA group (P =.005 and.04, respectively). Conclusions: Isolated arterial mucoid intimal thickening in early post‐transplant biopsies may be an early/mild form of TMA, probably requiring adjustment in immunosuppressive regimen. Careful exclusion of known causes of TMA, and donor‐derived arterial injury are important. [ABSTRACT FROM AUTHOR]

Models of arterial injury in rodents have been invaluable to our current understanding of vessel restenosis and play a continuing role in the development of endovascular interventions for cardiovascular disease. Mechanical distention of the vessel wall and denudation of the vessel endothelium are the two major modes of vessel injury observed in most clinical pathologies and are critical to the reproducible modelling of progressive neointimal hyperplasia. The current models which have dominated this research area are the mouse wire carotid or femoral injury and the rat carotid balloon injury. While these elicit simultaneous distension of the vessel wall and denudation of the luminal endothelium, each model carries limitations that need to be addressed using a complementary injury model. Wire injuries in mice are highly technical and procedurally challenging due to small vessel diameters, while rat balloon injuries require permanent blood vessel ligation and disruption of native blood flow. Complementary models of vascular injury with reproducibility, convenience, and increased physiological relevance to the pathophysiology of endovascular injury would allow for improved studies of neointimal hyperplasia in both basic and translational research. In this study, we developed a new surgical model that elicits vessel distention and endothelial denudation injury using sequential steps using microforceps and a standard needle catheter inserted via arteriotomy into a rat common carotid artery, without requiring permanent ligation of branching arteries. After 2 weeks post-injury this model elicits highly reproducible neointimal hyperplasia and rates of re-endothelialisation similar to current wire and balloon injury models. Furthermore, evaluation of the smooth muscle cell phenotype profile, inflammatory response and extracellular matrix within the developing neointima, showed that our model replicated the vessel remodelling outcomes critical to restenosis and those becoming increasingly focused upon in the development of new anti-restenosis therapies. [ABSTRACT FROM AUTHOR]

Arterial thrombosis is the main underlying mechanism of acute atherothrombosis. Combined antiplatelet and anticoagulant regimens prevent thrombosis but increase bleeding rates. Mast cell-derived heparin proteoglycans have local antithrombotic properties, and their semisynthetic dual AntiPlatelet and AntiCoagulant (APAC) mimetic may provide a new efficacious and safe tool for arterial thrombosis. We investigated the in vivo impact of intravenous APAC (0.3–0.5 mg/kg; doses chosen according to pharmacokinetic studies) in two mouse models of arterial thrombosis and the in vitro actions in mouse platelets and plasma. Platelet function and coagulation were studied with light transmission aggregometry and clotting times. Carotid arterial thrombosis was induced either by photochemical injury or surgically exposing vascular collagen after infusion of APAC, UFH or vehicle. Time to occlusion, targeting of APAC to the vascular injury site and platelet deposition on these sites were assessed by intra-vital imaging. Tissue factor activity (TF) of the carotid artery and in plasma was captured. APAC inhibited platelet responsiveness to agonist stimulation (collagen and ADP) and prolonged APTT and thrombin time. After photochemical carotid injury, APAC-treatment prolonged times to occlusion in comparison with UFH or vehicle, and decreased TF both in carotid lysates and plasma. Upon binding from circulation to vascular collagen-exposing injury sites, APAC reduced the in situ platelet deposition. Intravenous APAC targets arterial injury sites to exert local dual antiplatelet and anticoagulant actions and attenuates thrombosis upon carotid injuries in mice. Systemic APAC provides local efficacy, highlighting APAC as a novel antithrombotic to reduce cardiovascular complications. [Display omitted] • APAC is an antiplatelet agent and inhibits platelet aggregation to collagen and ADP in mice. • APAC is an anticoagulant and prolongs coagulation times in plasma. • Intravenous APAC decreases platelet-driven thrombi by targeting to arterial injury sites. • APAC decreases circulating and vascular tissue factor activity after arterial injury. • Systemic APAC acts as a local antithrombotic to reduce cardiovascular complications at injury sites. [ABSTRACT FROM AUTHOR]

Pediatric major arterial vascular injuries may belong to the same principal categories as adults, but have been poorly documented, with an estimated overall incidence of <2% of all vascular traumas. Open surgery has been the mainstay of treatment, but no clear guidelines have been developed to recommend the best practice patterns in terms of strategy or repair as well as postoperative pharmacological regimen. Herein, we report three cases and a narrative review of the available literature regarding the main aspects when dealing with pediatric arterial injuries based on the predominant series available from the most recent published literature. [ABSTRACT FROM AUTHOR]

Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%-54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%-20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques. [ABSTRACT FROM AUTHOR]

Vascular injuries of the extremities are associated with a high mortality rate. Conventionally, open surgery is the treatment of choice for peripheral vascular injuries. However, rapid development of devices and techniques in recent years has significantly increased the utilization and clinical application of endovascular treatment. Endovascular options for peripheral vascular injuries include stent-graft placement and embolization. The surgical approach is difficult in cases of axillo-subclavian or iliac artery injuries, and stent-graft placement is a widely accepted alternative to open surgery. Embolization can be considered for arterial injuries associated with active bleeding, pseudoaneurysms, and arteriovenous fistula and in patients in whom embolization can be safely performed without a risk of ischemic complications in the extremities. Endovascular treatment is a minimally invasive procedure and is useful as a simultaneous diagnostic and therapeutic approach, which serve as advantages of this technique that is widely utilized for vascular injuries of the extremities. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively evaluate the safety, efficacy, and late clinical outcome of coronary covered stent placement for the treatment of late-onset arterial complications after hepato-pancreato-biliary surgery. Materials and methods: Consecutive patients presenting with post-hepato-pancreato-biliary surgery-related arterial lesions and subsequently treated with a covered coronary stent in the authors institution between January 2012 and November 2021 were included. Primary endpoints were technical and clinical success; secondary endpoints were covered stent patency and end-organ perfusion of the affected artery. Results: The study included 22 patients (13 men and 9 women) with a mean age of 67 years ± 9.6 years. Initial surgery included pancreaticoduodenectomy (n = 15; 68%), liver transplantation (n = 2; 9%), left hepatectomy (n = 1; 5%), bile duct resection (n = 1; 5%), hepatogastrostomy (n = 1; 5%), and segmental enterectomy (n = 1; 5%). Technically, coronary covered stents were successfully placed in n = 22 patients (100%) without immediate complication. Definitive bleeding control was observed in n = 18 patients (81.1%) with recurrent bleeding within 30 days postintervention in n = 5 patients (23%). No ischemic liver or biliary complications occurred during the follow-up period. The 30-day mortality rate was 0%. Conclusion: Coronary covered stents are a safe and efficient treatment option in most of the patients presenting with late-onset postoperative arterial injuries following hepato-pancreato-biliary surgery and are associated with an acceptable recurrent bleeding rate and no late, ischemic, parenchymal complications. [ABSTRACT FROM AUTHOR]

The analysis of damage to the main vessels of the limbs was considered for the formation of further organizational and tactical instructions for the provision of emergency medical care at the stages of evacuation of the injured to specialized wartime departments. It was determined that with the help of MSCT-angiography, signs of damage to main vessels can be accurately diagnosed, and additional information about damage to bone structures, neighbouring organs and tissues can be obtained. It is emphasized that MSCT is an effective and accurate method in the assessment of clinically significant arterial injuries of the lower extremities in case of gunshot injury. It was noted that timely diagnosis of vessels gunshot wounds can contribute to the preservation of the functionality of the limbs and the life of patients, reducing the risk of bleeding, infections and other complications. It was noted that the correct medical decisions, in particular, the correct diagnosis of gunshot injuries to blood vessels will help doctors make informed decisions regarding emergency surgical care, the choice of treatment methods and preoperative preparation. The aim. The aim of the work is the theoretical substantiation of gunshot injuries of the main vessels of the limbs and the definition of practical diagnostic methods. Materials and methods: analysis of theoretical sources, comparison, induction of isolated analytical data. The study was conducted based on the database of the State institution "National Institute of Cardiovascular Surgery named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine". Results. It was determined that with the help of MSCT-angiography, signs of damage to main vessels can be accurately diagnosed, and additional information about damage to bone structures, neighboring organs and tissues can be obtained. Conclusions. Radiological diagnosis of gunshot injuries of the main vessels of the limbs demonstrates the importance of using radiological diagnostics in the detection and analysis of vascular injuries in gunshot injuries of the extremities. The study confirms the high efficiency of this method, its accuracy and reliability in determining the nature of damage. In addition, radiological diagnostics allows timely and accurate determination of the extent and nature of injuries, which is important for making informed clinical decisions and providing adequate medical care to the injured [ABSTRACT FROM AUTHOR]

• Multicenter analysis of endovascular procedures and implants from major trauma centers. • Most common procedures in thoracic aorta and axillosubclavian vessels. • Predominantly femoral access - broad range of stents/stent grafts and sizes used. • Reintervention rare and typically endovascular. Endovascular techniques are increasingly used to repair major traumatic vascular injuries, but most endovascular implants are not designed/approved for trauma-specific indications. No inventory guidelines exist for the devices used in these procedures. We aimed to describe the use and characteristics of endovascular implants used for repair of vascular injuries to allow for better inventory management. This CREDiT study is a six-year retrospective cohort analysis of endovascular procedures performed for repair of traumatic arterial injuries at five participating US trauma centers. For each treated vessel, procedural and device details were recorded and outcomes assessed with the aim of defining the range of implants and sizes used for these interventions. A total of 94 cases were identified; 58 (61%) were descending thoracic aorta, 14 (15%) axillosubclavian, 5 carotid, 4 abdominal aortic, 4 common iliac, 7 femoropopliteal, and 1 renal. Vascular surgeons performed 54% of cases, trauma surgeons 17%, IR/CT Surgery 29%. Systemic heparin was administered in 68% and procedures were performed a median of 9 h after arrival (IQR 3–24 h). Primary arterial access was femoral in 93% of cases, 49% were bilateral. Brachial/radial access was used primarily in 6 cases, and secondary to femoral in 9. The most common implant was self-expanding stent graft; 18% used >1 stent. Implants ranged in diameter and length based on vessel size. Five of 94 implants underwent reintervention (1 open surgery) at a median of 4d postop (range 2–60d). Two occlusions and 1 stenosis were present at follow-up at a median of 1 month (range 0–72 m). Endovascular reconstruction of injured arteries requires a broad range of implant types, diameters, and lengths which should be readily available in trauma centers. Stent occlusions/stenoses are rare and can typically be managed by endovascular means. [ABSTRACT FROM AUTHOR]