Perspectives in vascular surgery and endovascular therapy最新文献

{"title":"A modern approach to cervical vascular trauma.","authors":"P Joshua O'Brien,&nbsp;Mitchell W Cox","doi":"10.1177/1531003511408337","DOIUrl":"https://doi.org/10.1177/1531003511408337","url":null,"abstract":"<p><p>Blunt or penetrating trauma to the major arteries of the neck are challenging problems, however, newer diagnostic and therapeutic modalities have simplified care and largely eliminated the need for diagnostic neck exploration. High-quality computed tomographic angiography is quick and sensitive, identifying the vast majority of injuries prior to any operative intervention. Even in cases where active exsanguination or impending airway compromise mandates immediate exploration, intraoperative imaging and endovascular interventions have largely supplanted relatively morbid exposures for open repair. Traditional open repair of carotid injuries with primary closure or interposition grafting is effective over the long term and is always recommended if proximal and distal control can be achieved in a safe and straightforward manner. Endovascular repair of the proximal carotid, proximal subclavian, and distal internal carotid arteries is increasingly accepted. However, vertebral trauma is dealt with almost exclusively by endovascular means. Recent military experiences in Iraq and Afghanistan highlight the imaging-intensive management of cervical vascular trauma and demonstrate the effectiveness of computed tomography angiography, selective arteriography, and endovascular interventions.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"90-7"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30198890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Venous trauma: new lessons and old debates\".","authors":"Thomas W Wakefield,&nbsp;Jonathan L Eliason","doi":"10.1177/1531003511408438","DOIUrl":"https://doi.org/10.1177/1531003511408438","url":null,"abstract":"","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30051142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foreword, part 2.","authors":"Todd E Rasmussen,&nbsp;Lorne H Blackbourne","doi":"10.1177/1531003511425212","DOIUrl":"https://doi.org/10.1177/1531003511425212","url":null,"abstract":"","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"73"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511425212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30198888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"A modern approach to cervical vascular injuries\".","authors":"John M Moos,&nbsp;Fred A Weaver","doi":"10.1177/1531003511413138","DOIUrl":"https://doi.org/10.1177/1531003511413138","url":null,"abstract":"Cervical vascular injuries, both penetrating and blunt, when not managed appropriately carry devastating consequences both in terms of mortality and debilitating neurologic sequelae. Drs Cox and O’Brien have provided an important update for those who care for patients with these injuries. We would like to focus on three specific aspects of diagnosis and treatment that are mentioned by the authors. First, the resurrection of the physical exam in diagnosis of penetrating cervical vascular injuries. As they detail, 3 major prospective studies encompassing more than 500 patients have validated the importance of a physical exam in guiding patient care. By moving from the traditional “zone”-based approach to a more logical exam-based approach, the rate of negative neck exploration has been dramatically reduced and the outcome of patients with injuries improved. In our opinion, the available data overwhelmingly support this approach. Second, the impact of computed tomography (CT) imaging on the overall diagnostic algorithm. This has been a real game changer. CT scans are now readily available in most major trauma centers. Patients can be rapidly and accurately evaluated for occult vascular injuries shortly after arrival to the emergency department. For patients with either a penetrating cervical injury or blunt trauma to the head and neck, the CT scan is invaluable in directing the next steps. With the current scanners the resolution of vascular structures is highly accurate and in most institutions, as the authors suggest, have made diagnostic angiography, the traditional gold standard, a rarely performed test in cervical vascular trauma. The impact of CT on our understanding of blunt carotid trauma and its management has been in our view its most significant contribution. Because of the rarity of these injuries, it has been difficult to establish evidence-based protocols for management. Because of the often high Injury Severity Scores and associated multisystem trauma, identification of blunt carotid injuries by physical exam alone is near impossible. Manifestation of ischemic cerebrovascular events can be immediate or delayed, masked by low Glasgow Coma Scale scores, or ignored in those patients deemed too unstable for evaluation/intervention. Based on what we have learned from CT imaging, Eastman et al 413138 PVS23210.1177/1531003511413138Moos and WeaverPerspectives in Vascular Surgery and Endovascular Therapy","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"98-9"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511413138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30198891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Advances in resuscitation in the setting of vascular injury\".","authors":"Michael J Sise","doi":"10.1177/1531003511408334","DOIUrl":"https://doi.org/10.1177/1531003511408334","url":null,"abstract":"The lessons of combat casualty care in Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) have special relevance in the care of civilian vascular injuries that result in hemorrhagic shock. These lessons begin in the field and proceed through each phase of care of these injuries. Although the severity and complexity of combat vascular injuries often far exceed those of the civilian trauma center experience, the measures perfected in combat care are totally relevant in the care of civilian vascular injuries. Once adopted, they result in significant changes in both the style and the tempo of care of these injuries. The ultimate outcome is improved survival. The best way to summarize the relevant advances in the care of vascular injuries resulting in shock is to focus on the following 4 components:","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"117-8"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular injuries in the young.","authors":"Jeremy W Cannon,&nbsp;Michael A Peck","doi":"10.1177/1531003511408439","DOIUrl":"https://doi.org/10.1177/1531003511408439","url":null,"abstract":"<p><p>Vascular injuries in children result from invasive procedures, penetrating trauma, and blunt injuries. Depending on local practice patterns, these injuries are managed by a range of subspecialists with little guidance from the literature on the optimal approach to diagnosis and management of these challenging injuries. Recently, more aggressive operative approaches to managing injuries in the young have been advocated and have been supported by recent reports from several series of wartime vascular injuries involving children. This review summarizes the scope of both iatrogenic and traumatic vascular injuries and the historic and current literature on these topics. Treatment strategies are also reviewed placing emphasis on the transition from ligation or heparinization to the current trend of managing suspected vascular injuries with operative exploration and repair, including, in some instances, endovascular diagnosis and intervention. Future directions for clinical research in this area are also discussed, which will hopefully promote more multidisciplinary collaboration in this area.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"100-10"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Compartment syndrome in the setting of vascular injury\".","authors":"Eric R Frykberg","doi":"10.1177/1531003511408330","DOIUrl":"https://doi.org/10.1177/1531003511408330","url":null,"abstract":"","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"125-7"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous trauma: new lessons and old debates.","authors":"Yanjie Qi,&nbsp;David L Gillespie","doi":"10.1177/1531003511408336","DOIUrl":"https://doi.org/10.1177/1531003511408336","url":null,"abstract":"<p><p>Historically, epidemiology, diagnosis, and management of venous trauma have not been well understood. Venous injuries often have subtle presentations, unclear consequences, and debatable treatment options. Many venous injuries are asymptomatic and are diagnosed only during surgical exploration for other injuries. The obvious venous injury is the one found during surgical exploration of an arterial trauma. Isolated venous injuries are difficult to diagnose and often only discovered if massive swelling or life-threatening hemorrhage occurs. Once discovered, the question is how to treat: ligation or repair. The answer is the prudent use of both methods. For patients at the brink of hemodynamic collapse, ligation is the best choice. For stable patients, an effort should be made to reestablish venous outflow. Definitive repair in unstable patients should not attempted, instead temporary solutions should be used that will allow the patient to leave the operating room quickly and began correction of hypothermia, acidosis, and coagulopathy.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"74-9"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30051136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ischemic threshold of the extremity.","authors":"Shaun M Gifford,&nbsp;Brandon W Propper,&nbsp;Jonathan L Eliason","doi":"10.1177/1531003511410356","DOIUrl":"https://doi.org/10.1177/1531003511410356","url":null,"abstract":"<p><p>Military efforts to limit ischemic time and reperfusion injury are being investigated with a focus on functional limb salvage as opposed to the more historic statistical salvage, since a dysfunctional limb may be a worse outcome than amputation. Translatable animal research, supported by reports from forward deployed surgeons in the field, is needed to improve care. Current studies have determined the threshold for meaningful recovery is less than 6 hours. Attempts at modeling vascular injury and ischemia reperfusion can be divided into 2 categories: chronic ischemia that mimics human age related disease and acute vascular injury that represents traumatic injury. A swine model to evaluate battlefield injuries and scenarios encountered in traumatic extremity vascular injury with a focus on functional limb salvage has been developed. Future endeavors should focus on understanding the factors that affect ischemic threshold as well as testing therapeutic and physical maneuvers to prolong this threshold.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"81-7"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511410356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30051138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compartment syndrome in the setting of vascular injury.","authors":"Thomas J Percival,&nbsp;Joseph M White,&nbsp;Michael A Ricci","doi":"10.1177/1531003511401422","DOIUrl":"https://doi.org/10.1177/1531003511401422","url":null,"abstract":"<p><p>Compartment syndrome after extremity vascular injury has gained attention with the current conflicts in Iraq and Afghanistan. Compartment syndrome after extremity vascular injury is due to the initial ischemic insult and reperfusion injury. Complications from compartment syndrome can be lessened by fasciotomy, which is reviewed in this article.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"119-24"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511401422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29822824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}