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Rivista di Chirurgia
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2016 Agosto;29(4):107-13
Endovascular approaches in the management of extremity vascular trauma
Ahmed ELBADAWY 1, Ayman HASSABALLA 1, Mostafa OSMAN 2, Haitham ALI 1, Mahmoud SALEH 1
1 Department of Vascular and Endovascular Surgery, Assiut University Hospital, Assiut, Egypt; 2 Department of Interventional Radiology, Assiut University Hospital, Assiut, Egypt
BACKGROUND: The aim of this study was to understand the role and best indications of endovascular interventions and techniques in management of extremity vascular trauma.
METHODS: A retrospective study. We included patients presented with extremity vascular injuries and managed with either transcatheter embolization of bleeding arteries, balloon vascular control or covered stents. Data recorded for each patient were demographics, mechanism of injury, clinical presentation, location of injured vessel, type of endovascular approach in management, complications, need for reinterventions and the outcome. Primary outcomes were freedom from rebleeding, freedom from reinterventions, complete exclusion of pseudoaneurysm or arteriovenous fistula (AVF) and limb salvage. Descriptive statistics were used for analysis of retrieved data.
RESULTS: Sixteen cases (9.5%) were included in current series. The mean age was 35.2 years (range 20: 65 years). The clinical presentations were: acute bleeding in 4 cases (25%), pseudoaneurysm (N.=7, 43.7%) and AVF (N.=5, 31.3%). Transcatheter embolization of bleeding vessel using NBCA glue was performed in 10 patients (62.5%). Covered stent grafts were deployed in 2 cases (12.5%). Balloon vascular control was deemed necessary in 4 trauma patients (25%). Primary technical success was 93.7% (15 cases). Reintervention was needed in a single case. Immediate and 6 month follow up survival rate and limb salvage rate in the current series were 100%.
CONCLUSIONS: Endovascular approaches could provide definite management of extremity vascular trauma or pave the way for definite surgical treatment in situations needed to avoid aggressive surgical exposures associated with higher morbidity in such young trauma population.