Browse > Article

Clinical Characteristics of Patients Treated in an Emergency Center for Vascular Trauma  

Park, Yong Myeon (Department of Emergency Medicine, Pusan National University Hospital)
Yeom, Seok Ran (Department of Emergency Medicine, Pusan National University Hospital)
Jeong, Jin Woo (Department of Emergency Medicine, Pusan National University Hospital)
Han, Sang Kyun (Department of Emergency Medicine, Pusan National University Hospital)
Jo, Suck Ju (Department of Emergency Medicine, Pusan National University Hospital)
Ryu, Ji Ho (Department of Emergency Medicine, Pusan National University Yangsan Hospital)
Kim, Yong In (Department of Emergency Medicine, Pusan National University Yangsan Hospital)
Chung, Sung Woon (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University)
Publication Information
Journal of Trauma and Injury / v.22, no.1, 2009 , pp. 5-11 More about this Journal
Abstract
Purpose: The mortality and the amputation rates due to vascular trauma remain high despite advanced vascular surgical techniques and supportive management. The clinical features of patients with vascular trauma have not been well studied in the Korean population. The aim of this study was to analyze the clinical characteristics of patients with vascular trauma and to develop a database and guidelines for improving the outcomes of treatment. Methods: The medical records of 37 patients with traumatic vascular injuries who had visited in an emergency center between January 2002 and December 2006 were retrospectively reviewed and statistically analyzed. Results: The mean age was 37.8 years, and the male-to-female ratio was 5.2 : 1. The mechanism of vascular trauma was penetrating in 18 patients and blunt in 19 patients. Upper extremities were most frequently injured (39.4%). The treatment methods were primary repair in 21 patients, exploratory laparotomies in 7, radiological interventions in 3, resections and graft interpositions of the pseudoaneurysm in 3, observations in 3 and a bypass graft in 1. Four out of the 37 patients died, and three of these who died had injuried abdominal vessels. Twenty-five of the patients recovered completely, four expired, seven had neuropathy in the course of treatement, one had his limb amputated, and one experienced wound necrosis. Conclusion: Peripheral vessel injuries are commonly accompanied by nerve, muscle, or tendon injuries. Patients without associated fractures or compartment syndrome had good prognosis. Although the time intervals from hospital arrival to definite treatment were the shortest among patients with blunt abdominal vascular injuries, three expired. Therefore, we offer a 'ritical pathway'to improve the outcomes of patients with blunt abdominal vascular injury.
Keywords
Vascular trauma; Emergency treatment; Critical pathway;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Simmons JD, Schmieg RE Jr, Porter JM, D'Souza SE, Duchesne JC, Mitchell ME. Brachial artery injuries in a rural catchment trauma center: Are the upper and lower extremity the same? J Trauma. 2008;65:327-30   DOI
2 Rozycki GS, Tremblay LN, Feliciano DV, McClelland WB. Blunt vascular trauma in the Extremity: diagnosis, management, and outcome. J Trauma. 2003 Nov;55:814-24   DOI
3 Hobson RW 2nd, Yeager RA, Lynch TG, Lee BC, Jain K, Jamil Z, et al. Femoral venous trauma: techniques for surgical management and early results. Jr. Am J Surg. 1983 Aug;146:220-4   DOI   ScienceOn
4 Busqu$\acute{e}$ts AR, Acosta JA, Col$\acute{o}$n E, Alejandro KV, Rodr¡guez P. Helical computed tomographic angiography for the diagnosis of traumatic arterial injuries of the extremities. J Trauma. 2004 Mar;56:625-8   DOI
5 Duwayri Y, Abbas J, Cerilli G, Chan E, Nazzal M. Outcome after thoracic aortic injury: experience in a level-1 trauma center. Ann Vasc Surg. 2008 May-Jun;22:309-13   DOI   ScienceOn
6 Canaud L, Alric P, Branchereau P, Marty-An$\acute{e}$ C, Berthet JP. Lessons learned from midterm follow-up of endovascular repair for traumatic rupture of the aortic isthmus. J Vasc Surg. 2008 Apr;47:733-8   DOI   ScienceOn
7 Wei B, Hemmila MR, Arbabi S, Taheri PA, Wahl WL. Angioembolization reduces operative intervention for blunt splenic injury. J Trauma. 2008 Jun;64:1472-7   DOI
8 Modrall JG, Weaver FA, Yellin AE. Diagnosis and management of penetrating vascular trauma and the injured extremity. Emerg Med Clin North Am. 1998 Feb;16:129-44   DOI   ScienceOn
9 Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001 Jun;33:1212-9   DOI   ScienceOn
10 Brisbin RL, Geib PO, Eiseman B. Secondary disruption of vascular repair following war wounds. Arch Surg. 1969 Dec;99:787-91   DOI   ScienceOn
11 Nichols JS, Lillehei KO. Nerve injury associated with acute vascular trauma. Surg Clin North Am. 1988 Aug;68:837-52
12 Pr$\hat{e}$tre R, Bruschweiler I, Rossier J, Chilcott M, Bednarkiewicz M, K?rsteiner K, et al. Lower limb trauma with injury to the popliteal vessels. J Trauma. 1996 Apr;40:595-601   DOI
13 Canaud L, Alric P, Branchereau P, Marty-An? C, Berthet JP. Lessons learned from midterm follow-up of endovascular repair for traumatic rupture of the aortic isthmus. J Vasc Surg. 2008 Apr;47:733-8   DOI   ScienceOn
14 Abu-Zidan FM, Zayat I, Sheikh M, Mousa I, Behbehani A. Role of ultrasonography in blunt abdominal trauma: a prospective study. Eur J Surg. 1996 May;162:361-5
15 L$\ddot{o}$nn L, Delle M, Karlstr$\ddot{o}$m L, Risberg B. Should blunt arterial trauma to the extremities be treated with endovascular techniques? J Trauma. 2005 Nov;59:1224-7
16 Maggisano R, Nathens A, Alexandrova NA, Cina C, Boulanger B, McKenzie R, et al. Traumatic rupture of the thoracic aorta: should one always operate immediately? Ann Vasc Surg. 1995 Jan;9:44-52   DOI   ScienceOn
17 Elliott SP, Olweny EO, McAninch JW. Renal arterial injuries: a single center analysis of management strategies and outcomes. J Urol. 2007 Dec;178:2451-5   DOI   ScienceOn
18 N$\acute{u}$$\tilde{n}$ez D Jr, Rivas L, McKenney K, LeBlang S, Zuluaga A. Helical CT of traumatic arterial injuries. AJR Am J Roentgenol. 1998 Jun;170:1621-6   DOI   ScienceOn
19 Hoit DA, Schirmer CM, Weller SJ, Lisbon A, Edlow JA, Malek AM. Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient. J Spinal Disord Tech. 2008 Jun;21:259-66   DOI   ScienceOn
20 Monnin V, Sengel C, Thony F, Bricault I, Voirin D, Letoublon C, et al. Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Intervent Radiol. 2008 Sep-Oct;31:875-82   DOI   ScienceOn
21 Humphrey PW, Nichols WK, Silver D. Rural vascular trauma: a twenty-year review. Ann Vasc Surg. 1994 Mar;8:179-85   DOI   ScienceOn
22 James CA. Magnetic resonance angiography in trauma. Clin Neurosci. 1997;4:137-45
23 JAHNKE EJ Jr, SEELEY SF. Acute vascular injuries in the Korean War. Ann Surg. 1953 Aug;138:158-77   DOI   ScienceOn
24 Shaw AD, Milne AA, Christie J, Jenkins AM, Murie JA, Ruckley CV. Vascular trauma of the upper limb and associated nerve injuries. Injury. 1995 Oct;26:515-8   DOI   ScienceOn
25 Soto JA, M$\acute{u}$nera F, Cardoso N, Guar$\acute{i}$n O, Medina S. Diagnostic performance of helical CT angiography in trauma to large arteries of the extremities. J Comput Assist Tomogr. 1999 Mar-Apr;23:188-96   DOI   ScienceOn
26 Buz S, Zipfel B, Mulahasanovic S, Pasic M, Weng Y, Hetzer R. Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture. Eur J Cardiothorac Surg. 2008 Feb;33:143-9   DOI   ScienceOn
27 Brenchley J, Walker A, Sloan JP, Hassan TB, Venables H. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J. 2006 Jun;23:446-8   DOI   ScienceOn
28 Eastman AL, Chason DP, Perez CL, McAnulty AL, Minei JP. Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? J Trauma. 2006 May;60:925-9   DOI