Diagnosis and Treatment of Traumatic Vascular Injury

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (20 May 2024) | Viewed by 12815

Special Issue Editors


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Guest Editor
Operative Unit of Vascular and Endovascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
Interests: vascular surgery; endovascular surgery; aortic aneurysm; aortic arch anomalies and repair; thoracoabdominal aneurysm; aortic dissection; peripheral artery disease; angiology

E-Mail Website
Guest Editor
Operative Unit of Vascular and Endovascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
Interests: vascular surgery; endovascular surgery; great vessels; aortic arch anomalies; cardiovascular surgery; aortic dissection; aortic arch repair

E-Mail Website
Guest Editor
1. Chief, Operative Unit of Vascular and Endovascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
2. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
Interests: vascular surgery; endovascular therapy and surgery; endovascular aneurysms; cardiovascular surgery; angiology

Special Issue Information

Dear Colleagues,

The management of traumatic vascular injuries is one of the most challenging topics in modern vascular and endovascular surgery due to the complexity of the clinical presentation of a patient, who is often in a life-threatening situation. A multidisciplinary approach with the combined efforts of different specialists appears mandatory to ensure the correct timing and treatment priorities in order to ensure the best results.

Vascular lesions may involve all body areas, and present as penetrating and/or blunt arterial injuries. More often, penetrating vascular injuries involve neck and limbs, while blunt traumas are more frequent in abdominal vessels and thoracic and abdominal aorta, especially in patients involved in traffic accidents.

After patient stabilization, prompt diagnosis and correct therapeutic strategy are key for solving both life-threatening aortic lesions or limb salvage in peripheral artery injuries. In the endovascular era, thoracic endovascular repair (TEVAR) has become the therapy of first choice for the treatment of blunt thoracic aortic injury over the last decades for traumatic aortic grade III and IV lesions at CT scan, while open surgery often remain the best approach for managing penetrating neck and limb vascular lesions. Nevertheless, selective embolization end covered stents could represent an important adjunct to resolve traumatic vascular bleeding.

This Special Issue aims to provide an update on different guidelines in this complex field and to present research on clinical data and share the experiences of different specialists involved in the diagnosis, treatment and follow-up of traumatic vascular lesions.

Dr. Paolo Righini
Dr. Daniela Mazzaccaro
Prof. Dr. Giovanni Nano
Guest Editors

Manuscript Submission Information

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Keywords

  • blunt trauma
  • vascular injuries
  • TEVAR
  • thoracic aorta
  • abdominal aorta
  • limb salvage
  • endovascular repair
  • management
 
 

Published Papers (4 papers)

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Research

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10 pages, 1783 KiB  
Article
Penetrating Vascular Injuries of the Lower Limbs after Stab Wounds: Predictive Factors of Limb Loss and Mortality
by Bilel Derbel, Daniela Mazzaccaro, Nidhal Krarti, Rim Miri, Yassine Khadhar, Melek Ben Mrad, Paolo Righini, Giovanni Nano and Raouf Denguir
J. Clin. Med. 2023, 12(10), 3476; https://doi.org/10.3390/jcm12103476 - 15 May 2023
Cited by 1 | Viewed by 1270
Abstract
Background: Penetrating vascular injuries (PVIs) of the lower limbs due to stab wounds are associated with high mortality and limb loss rates. We analyzed the outcomes of a series of patients who underwent surgical treatment of these lesions, assessing the presence of any [...] Read more.
Background: Penetrating vascular injuries (PVIs) of the lower limbs due to stab wounds are associated with high mortality and limb loss rates. We analyzed the outcomes of a series of patients who underwent surgical treatment of these lesions, assessing the presence of any factor associated with limb loss and mortality; (2) Methods: Data of patients admitted from 01/2008 to 12/2018 were retrospectively analyzed. Primary outcomes were the limb loss and the mortality rate at 30 days postoperatively. Univariate and multivariate analyses were performed as appropriate. p values < 0.05 were considered significant; (3) Results: Data of 67 male patients were analyzed. Two died (3%) and three (4.5%) had a lower limb amputation after failed revascularization. In the univariate analysis, the clinical presentation significantly affected the risk of postoperative mortality and limb loss. The location of the lesion at the superficial femoral artery (OR 4.32, p = 0.001) or at the popliteal artery (OR 4.89, p = 0.0015) also increased the risk. In the multivariate analysis, the need for a vein graft bypass was the only significant predictor of limb loss and mortality (OR 4.58, p < 0.0001); (4) Conclusions: PVIs of lower limbs due to stab wounds were lethal in 3% of cases and lead to a secondary major amputation in 4.5% more cases. The need for a vein bypass grafting was the strongest predictor of postoperative limb loss and mortality. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Traumatic Vascular Injury)
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Review

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11 pages, 2828 KiB  
Review
Current Opinions in Open and Endovascular Treatment of Major Arterial Injuries in Pediatric Patient
by Marco Franchin, Paolo Righini, Mario D’Oria, Daniela Mazzaccaro, Giovanni Nano, Matteo Tozzi, Gabriele Selmo and Gabriele Piffaretti
J. Clin. Med. 2023, 12(15), 4906; https://doi.org/10.3390/jcm12154906 - 26 Jul 2023
Cited by 1 | Viewed by 786
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Traumatic Vascular Injury)
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12 pages, 1639 KiB  
Review
Blunt Thoracic Aortic Injury
by Daniela Mazzaccaro, Paolo Righini, Fabiana Fancoli, Matteo Giannetta, Alfredo Modafferi, Giovanni Malacrida and Giovanni Nano
J. Clin. Med. 2023, 12(8), 2903; https://doi.org/10.3390/jcm12082903 - 17 Apr 2023
Cited by 3 | Viewed by 2075
Abstract
Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, [...] Read more.
Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Traumatic Vascular Injury)
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25 pages, 1660 KiB  
Review
Controls of Central and Peripheral Blood Pressure and Hemorrhagic/Hypovolemic Shock
by Amaresh K. Ranjan and Anil Gulati
J. Clin. Med. 2023, 12(3), 1108; https://doi.org/10.3390/jcm12031108 - 31 Jan 2023
Cited by 4 | Viewed by 8133
Abstract
The pressure exerted on the heart and blood vessels because of blood flow is considered an essential parameter for cardiovascular function. It determines sufficient blood perfusion, and transportation of nutrition, oxygen, and other essential factors to every organ. Pressure in the primary arteries [...] Read more.
The pressure exerted on the heart and blood vessels because of blood flow is considered an essential parameter for cardiovascular function. It determines sufficient blood perfusion, and transportation of nutrition, oxygen, and other essential factors to every organ. Pressure in the primary arteries near the heart and the brain is known as central blood pressure (CBP), while that in the peripheral arteries is known as peripheral blood pressure (PBP). Usually, CBP and PBP are correlated; however, various types of shocks and cardiovascular disorders interfere with their regulation and differently affect the blood flow in vital and accessory organs. Therefore, understanding blood pressure in normal and disease conditions is essential for managing shock-related cardiovascular implications and improving treatment outcomes. In this review, we have described the control systems (neural, hormonal, osmotic, and cellular) of blood pressure and their regulation in hemorrhagic/hypovolemic shock using centhaquine (Lyfaquin®) as a resuscitative agent. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Traumatic Vascular Injury)
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