endovascular management of traumatic vascular injury in ... · restoration of perfusion to an...
TRANSCRIPT
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Endovascular Management of
Traumatic Vascular Injury in
Lower Extremities
Chang Won Kim
Department of Radiology
Pusan National University Hospital
Busan, Korea
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Disclosure
Speaker name: Chang Won Kim
.................................................................................
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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Traumatic Vascular Injury
• 0.2% to 4% of all traumatic injuries
• Peripheral vascular injury: 80%
• Lower extremities
• Western countries
• 75% secondary to gunshot
• 15% secondary to stabbings
• 10% secondary to blunt trauma
• Korea
• Mainly due to blunt trauma
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Extremity Arterial Injury
• The main mechanisms of vascular lesions
• laceration or rupture of the vessel, hematoma development, dissection, pseudoaneurysm or arteriovenous fistula formation, and distal acute ischemia
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62/M
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56/M
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38/M
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Extremity Arterial Injury
• Patients with hard signs of arterial injury (pulse deficit, pulsatile bleeding, bruit, thrill, expanding hematoma) should be surgically explored. There is no need for arteriogram in this setting unless the patient has an associated skeletal or shotgun injury. Restoration of perfusion to an extremity with an arterial injury should be performed in less than 6 hours to maximize limb salvage (2002): Level 2
• There are no data to support the routine use of endovascular therapies following infrainguinaltrauma.: Level 3
Penetrating Lower Extremity Arterial Trauma,
Evaluation and Management of
J Trauma 2012 73(5):S315-S320
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M/47
Pedestrian TA
GCS 12Hb 10.9 g/dL
Right thigh swelling, color change
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CTA lower extremity
5min delayArterial
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TC visit +2h
Direct venography Isolated iliac vein injury
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Stent-graft deployment
12Fr 13mm-10cm GORE VIABAHN®Balloon tamponade
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30th day follow up CT
Completion venography
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Traumatic Iliac Vein Rupture
In spontaneous rupture of the iliac vein, open surgical procedures were associated with high mortality and morbidity.
Endovascular intervention may help to improve follow-up outcomes.
Surgical repair for blunt iliac vein injury as a traditional treatment
(after surgical repair) development of deep vein thrombosis and pulmonary emboli is possible
use of anticoagulants is often contraindicated as a result of other injuries
Endovascular approach to life-threatening venous rupture
immediate cessation of extravasation and restoration of venous patency
Stent-graft could seal across the rupture and create a new intact lumen
Zieber S et al. J Vasc Interv Radiol 2004;15:853–856
Jiang J et al. J Vasc Surg 2010;52:1278–1282
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Conclusions
• The endovascular approach can be a feasible, safe, and effective option to treat the vascular injuries, both arteries and veins, in the lower extremities.
• Large group study is needed for the evidence of endovascular treatment in traumatic vascular injury and for strong recommendation to clinicians.