Vascular
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The purpose of this study was to assess the role of arteriography (AG) in the diagnosis and treatment of vascular trauma in patients with zone 3 penetrating neck injuries. The records of all cases of penetrating neck trauma for the past 14 years at a level 1 trauma center were reviewed retrospectively. Eight hundred forty-four penetrating neck injuries were documented, of which 72 (8.5%) traversed zone 3 of the neck (gunshot, 35; stab, 32; shotgun, 5). ⋯ Nine patients had ultrasonography performed, but these examinations did not yield any useful information. The absence of hard signs reliably excludes surgically significant vascular injuries in penetrating zone 3 neck trauma, suggesting that AG is not necessary. Hard signs in stable patients should mandate AG because these vascular injuries may be amenable to endovascular therapy.
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The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. ⋯ There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Hemorrhagic complications during long-term postoperative warfarin administration in patients undergoing lower extremity arterial bypass surgery.
Lower extremity bypass procedures restore function and prevent amputation in many patients with severe peripheral arterial occlusive disease. The regular postoperative use of aspirin offers the dual benefit of extending bypass patency and patient survival. Previous trials of adjunctive oral anticoagulant therapy with warfarin have infrequently combined warfarin with aspirin. ⋯ Compliance with warfarin was maintained in 65% of the patients after the first year of observation. In patients with elective lower extremity bypass procedures, the postoperative adjunctive use of warfarin with aspirin increased the risk of major hemorrhagic events. Most of these events occurred when the INR was in the target range.
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Case Reports
Abdominal aortic aneurysm with aortocaval fistula and a separate retroperitoneal rupture.
The occurrence of an aortocaval fistula (ACF) secondary to an abdominal aortic aneurysm (AAA) is uncommon and is often undiagnosed prior to AAA repair. Clinical signs may be subtle or absent; therefore, diagnosis requires a high suspicion and knowledge of this phenomenon. We present a case of the rarest form of ACF (type 4) in which an AAA and an occult ACF were associated with a second site of retroperitoneal rupture. The ruptured AAA and ACF were successfully managed with fistula ligation and aortic graft placement.
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Deep venous thrombosis with or without subsequent pulmonary embolism is a common preventable cause of hospital death. Although anticoagulation is the accepted standard therapy for thromboembolic disease, in situations in which anticoagulation is contraindicated, interruption of the inferior vena cava (IVC) by means of percutaneous placement of a filter has become a widely used alternative. We report our initial experience with two retrievable IVC filters. ⋯ Neither filter migration nor caval injury was observed. Temporary IVC filters are effective and are associated with a high retrieval success rate. Further study is warranted to determine the maximal duration of implantation and whether retrievable IVC filters should expand the indications for IVC filter placement.