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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vascular accidents occurring in the course of hip surgery may reach potentially catastrophic dimensions by posing an immediate and sudden threat to life and limb. This is a report of 15 cases with severe arterial injury representing 0.2--0.3% of all reconstructive hip operations performed during an 8 year period. In 6 cases perforation of either the external iliac artery, the common femoral artery of main branches of the lateral and medial circumflex femoral artery were caused by the tip of a narrow-pointed Hohmann retractor used to expose the hip joint. Other mechanisms were: intimal tear with appositional thrombosis, probably caused by mechanical strain imposed on atherosclerotic arteries, giving rise to complete limb ischemia (2 cases); the dangers associated with the entry of bone cement through a defective acetabulum into the pelvis causing thrombotic occlusion due to polymerization heat (one case) or intimate adhesion of artificial bone to the external iliac artery subsequently being ripped open during replacement of the cup (one case); the increased hazards of replacing firmly embedded hip prosthesis (3 cases of direct arterial injury with chisel, knife and cutting edge of protruding bone); and the complications associated with the development of a false aneurysm (2 cases). Fourteen of the 15 extremities were salvaged. Above-knee amputation was unavoidable in one case owing to delay of vascular repair. There was no immediate operative mortality. Knowledge of the causative mechanisms prevents arterial injury during hip surgery. The relatively low rate of vascular complications in spite of vicinity of main vessels gives credit to the well standardized technique of hip surgery, especially hip replacement. However, it is suggested that the surgeon should be sufficiently acquainted with the exposure of the main vessels above and below the groin to be able to control life threatening hemorrhage at all times. A McBurney incision with retroperitoneal exposure and clamping of the external iliac artery will suffice to diminish bleeding considerably. Thereupon careful dissection and placement of snares around the common femoral artery, the arteria profunda femoris, and whenever necessary, the lateral or medial circumflex femoral artery will enable closure of the lacerated artery. For hemorrhage resulting during replacement of firmly embedded hip prosthesis it might become necessary to ligate the internal iliac artery. Reconstruction of obliterated arteries should call for the cooperation of the vascular surgeon for eventual angioplasty. Angiologic examination of the lower extremities is mandatory whenever severe arterial trauma has occurred in the course of hip surgery and is best performed by measuring the ankle blood pressure with a Doppler ultrasound probe.
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PMID:The mechanisms of severe arterial injury in surgery of the hip joint. 47 93

The authors report four cases of vascular complications of closed injuries of the shoulder, which appeared later, some time after the initial accident. There was one false aneurysm of the axillary artery at the forty sixth day after a fracture of the upper humeral diaphysis with elongation of the brachial plexus; one case of acute ischemia of the upper limb 3 years after a dislocation of the shoulder; one case of thrombosis with gangrene of the hand twelve years after a fracture-dislocation of the head of the humerus and one case of chronic ischemia of the forearm with severe changes in the vessels below one year after a fracture of the clavicle which had caused an aneurysm of the subclavian artery. The clinical, pathological and physiopathological study showed the enormous possibilities of the collateral circulation in the axilla. An arterial lesion may thus remain undiagnosed during the initial trauma. The authors emphasise the importance of the initial examination with a search for disappearance of the peripheral pulses. In the light of these four cases, it seems necessary to explore as a routine any arterial lesion complicating a shoulder injury.
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PMID:[Late signs of vascular complications of closed trauma of the shoulder (author's transl)]. 64 5

Between January 1974 and March 1977, arm bovine carotid heterograft arteriovenous fistulas were constructed in 75 patients. Twenty-six fistulas were established between the distal radial artery and an antecubital vein, and 49 fistulas used the brachial artery and the axillary vein. Thirty-eight heterografts have functioned without complication over a maximun interval of 29 months, including 15 of 26 radiobasilic fistulas and 23 of 49 brachioaxillary fistulas. Of the 37 heterograft failures, 28 were caused by thrombosis, six by infection, two by false aneurysm formation, and one by distal arm ischemia. Early postoperative thrombosis was associated with a higher subsequent failure rate after thrombectomy than was late thrombosis and it often required insertion of a new heterograft. Infected heterografts must be ligated and eventually replaced with another fistula at a distant site to avoid the potentially lethal complications of systemic sepsis and local hemorrhage.
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PMID:Venous access using the bovine carotid heterograft: techniques, results, and complications in 75 patients. 65 43

Ninety-four patients with peripheral arterial injuries were subjected to acute repair, negative exploration, or late repair of the complications of the arterial injury (false aneurysm, A-V fistula, and/or limb ischemia). The causes of failure after acute injury include extensive local soft tissue and bony damage, severe concomitant head, chest or abdominal wounding, stubborn reliance on negative arteriograms in patients with probable arterial injury, failure to repair simultaneous venous injuries, or harvesting of a vein graft from a severely damaged extremity. There is a positive correlation between non-operative expectant treatment and the incidence of late vascular complications requiring late arterial repair. Delayed complications of arterial injuries occurred most frequently in wounds below the elbow and knee.
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PMID:Peripheral arterial injuries: a reassessment. 97 57

Blunt injuries to branches of the aortic arch are not unusual and must be considered in any patient surviving deceleration or crush injury. Review of 36 case reports, including own own case, revealed 22 injuries to the innominate artery (4 with injuries to other arch branches), seven to the right subclavian, seven to the left subclavian, and eleven associated injuries to the thoracic aorta. Thirty patients (83 per cent) survived. Mediastinal widening (92 per cent) was the most frequent manifestation of vascular injury and is an indication for immediate aortography to delineate the entire thoracic aorta. Distal circulation was clinically decreased in less than 50 per cent, with symptomatic ischemia in only a few instances. Death was due to associated head injury in 3 of 6 cases. Earlier operation would have avoided exsanguination (one death) and late complications of false aneurysm or vascular insufficiency (10 patients).
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PMID:Blunt injuries to branches of the aortic arch. 109 Jul 87

Over a five-year period, 21 patients were seen with vascular injuries associated with fractures of the femur. In 19, vascular repair was performed at the time of the acute injury. The average interval from injury to repair was 15 hours. Arterial injuries included transection, intimal flap, laceration, avulsion, and false aneurysm. End-to-end repair was done in 11 cases, and autogenous vein grafting in nine. One artery was ligated for false aneurysm. In the 19 acute cases, internal fixation was used in eight; this method of immobilization resulted in two major amputations and three cases of anterior tibial compartment necrosis. Of 11 patients who had external immobilization, two eventually required amputation because of massive soft tissue injury. Internal bone fixation is not necessary for successful vascular repair and seemed to cause greater limb and tissue loss, probably due to prolonged ischemia time. If internal bone fixation is used, the artery should be repaired before the bone.
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PMID:Vascular injuries associated with fractures of the femur. 113 Sep 93

Forty-nine patients who sustained acute traumatic rupture of the aorta at the level of the isthmus were treated in our hospital between 1976 and 1990. Four patients died before surgery and 45 patients were operated upon using a pump oxygenator partial bypass in all but 2 cases (1 clamp and sew and 1 shunt). The tear was circumferential in 33 and partial in 12 cases. Direct suture was used in the 12 partial and in 21 of the circumferential tears. A dacron tube was used in 12 patients. Hospital mortality was 3 resulting from brain damage, prolonged shock before surgery and necrosis of the colon 4 weeks after operation. No paraplegia was observed. There were 2 cases of neurological disturbance (2 spinal cord dysfunction 5 and 8 days, respectively, after surgery). These complications were transient. Among the 42 survivors, 1 was lost to follow-up. The clinical aortic status of the remaining 41 was excellent. Aortic reconstitution as assessed by digital aortic angiography was excellent in the 33 cases examined with 2 exceptions (graft stenosis, false aneurysm). Our experience and review of a large series indicate: the use of a partial bypass with pump oxygenator decreases the probability of medullary ischemia, but the risk of spinal cord ischemia is not eliminated. When intra-abdominal lesions are life-threatening, laparotomy must preceed thoracotomy. Clinical results assessed in long-term survivors are excellent, especially after direct repair.
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PMID:Acute traumatic isthmic aortic rupture. Long-term results in 49 patients. 138 50

The incidence of vascular injury from external fixation of fractures was studied retrospectively in two surgical departments during the period 1985-1990. A total of 1231 fractures of the lower limb were treated. External fixation was used in the initial stabilization of 28 femoral and 93 tibial fractures. In this series of 121 fractures four iatrogenic vascular injuries were seen: two arterial thromboses with distal ischemia and two incidents of the formation of a false aneurysm with bleeding along a pin. The diagnosis was made by angiography. Surgical intervention was necessary in all four cases. In one patient the injury resulted in amputation of the distal portion of the foot.
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PMID:Vascular injury from external fixation: case reports. 147 41

This prospective randomized study of 50 patients compares the prevalence of complications between surgical and percutaneous methods of removal of intraaortic balloons. All patients who had percutaneous placement of a 9.5F intraaortic balloon during a 6-month period were eligible for the study. Patients were excluded if the intraaortic balloon was placed surgically, if a coagulopathy was present, or if acute leg ischemia developed at any time after insertion. After informed consent, 25 patients were randomized to each method of removal. Two complications occurred in the surgical group, including a wound infection and a lymph fistula. In one patient in the percutaneous group, a false aneurysm of the femoral artery developed. There was no significant difference between the mean of 59 minutes for percutaneous removal and 47 minutes for operative removal of the balloon (p = 0.74). The percutaneous method is therefore more cost-effective, because it does not require the use of operating room personnel or equipment necessary for surgical removal. The results of this study indicate that the majority of percutaneously placed intraaortic balloons may be safely removed percutaneously. Surgical removal of 9.5F intraaortic balloons is recommended for patients with bleeding diatheses, hemorrhagic or ischemic complications, or for those in whom the intraaortic balloon was inserted with a surgical procedure.
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PMID:A prospective randomized study comparing surgical and percutaneous removal of intraaortic balloon pump. 154 57

Between 1973 and 1989, 39 femorofemoral crossover bypasses were performed to treat unilateral noninfective complications of aortoiliac surgery. The initial revascularization procedure, performed an average of 79.5 months previously, was an aortobifemoral bypass in 29 cases, an aorto- or iliofemoral bypass in six cases, an inlay graft for abdominal aortic aneurysm and aortoiliac endarterectomy in two cases each. The indications for femorofemoral crossover bypass included prosthetic occlusion in 35 cases, thrombosed false aneurysm in two, and further degradation after endarterectomy (iliac stenosis and occlusion in one case each). There was no operative mortality. One patient with acute ischemia upon admission and another with distal gangrene required below-knee and forefoot amputations, respectively. No amputations were required during the rest of the follow-up period. Three repeat aortobifemoral bypasses were performed because of occurrence of aortic or inflow vessel lesions. Primary and secondary actuarial five year patency rates for femorofemoral crossover bypasses were 59.7% and 78.4%, respectively. Femorofemoral crossover bypass can extend the benefits derived from direct aortoiliac surgery with low mortality and morbidity in the absence of associated aortic pathology (false aneurysm at the aortic implantation site or severe obstructive lesions).
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PMID:Femorofemoral crossover bypass for noninfective complications of aortoiliac surgery. 199 75


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