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Geriatric Vascular Trauma and Vascular emergencies

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Abstract

We review the epidemiology, diagnosis, and management of vascular injuries to the extremities in this chapter. For the purpose of practical learning we define the extremities as upper anything distal to the intrathoracic subclavian artery, and lower as anything distal to the common iliac arteries. We present any injuries resulting from blunt and penetrating noniatrogenic trauma.

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References

  1. Konstantinidis A, Inaba K, Dubose J, Barmparas G, Lam L, Plurad D, Branco BC, Demetriades D. Vascular trauma in geriatric patients: a national trauma databank review. J Trauma. 2011;71(4):909–16.

    Article  PubMed  Google Scholar 

  2. Weaver FA, et al. Is arterial proximity a valid indication for arteriography in penetrating extremity trauma? A prospective analysis. Arch Surg. 1990;125:1256–60.

    Article  CAS  PubMed  Google Scholar 

  3. Stain SC, Yellin AE, Weaver FA, Pentecost MJ. Selective management of nonocclusive arterial injuries. Arch Surg. 1989;124(10):1136–41.

    Article  CAS  PubMed  Google Scholar 

  4. Worni M, et al. Use of endovascular therapy for peripheral arterial lesions: an analysis of the National Trauma Data Bank from 2007 to 2009. Ann Vasc Surg. 2013;27:299–305.

    Article  PubMed  Google Scholar 

  5. Feliciano DV, et al. Five-year experience with PTFE grafts in vascular wounds. J Trauma. 1985;25:71–82.

    Article  CAS  PubMed  Google Scholar 

  6. Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007;CD002945.

    Google Scholar 

  7. Lovegrove RE, Javid M, Magee TR, et al. A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg. 2008;95:677–84.

    Article  CAS  PubMed  Google Scholar 

  8. Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day opera- tive mortality results: randomised controlled trial. Lancet. 2004;364:843–8.

    Article  CAS  PubMed  Google Scholar 

  9. Greenhalgh RM. Commentary: impact of EVAR and DREAM trials on clinical practice. J Endovasc Ther. 2007;14:541–3.

    PubMed  Google Scholar 

  10. De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881–9.

    Article  PubMed  Google Scholar 

  11. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607–18.

    Article  CAS  PubMed  Google Scholar 

  12. Banerjee A. Atypical manifestations of ruptured abdominal aortic aneurysms. Postgrad Med J. 1993;69:6–11. https://doi.org/10.1136/pgmj.69.807.6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Smith TA, Ramirez DE. Awake, percutaneous repair of a ruptured abdominal aortic aneurysm. Ochsner J. 2013;13(2):248–51.

    PubMed  PubMed Central  Google Scholar 

  14. Mehta M, Taggert J, Clement Darling III R, Chang BB, Kreienberg PB, Paty PSK, Roddy SP, Sternbach Y, Ozsvath KJ, Shah DM. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 2006;44(1):1–8; discussion 8.

    Google Scholar 

  15. Starnes BW, Quiroga E, Hutter C, Tran NT, Hatsukami T, Meissner M, Tang G, Kohler T. Management of ruptured abdominal aortic aneurysm in the endovascular era. J Vasc Surg. 2010;51(1):9–17; discussion 17–8. doi:https://doi.org/10.1016/j.jvs.2009.08.038.

  16. Wallace GA, Starnes BW, Hatsukami TS, et al. Favorable discharge disposition and survival after successful endovascular repair of ruptured abdominal aortic aneurysm. J Vasc Surg. 2013;57:1495.

    Article  PubMed  Google Scholar 

  17. Bown MJ, Sutton AJ, Bell PRF, et al. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg. 2002;89:714.

    Article  CAS  PubMed  Google Scholar 

  18. Biancari F, Catania A, D'Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2011;42:571–6.

    Article  CAS  PubMed  Google Scholar 

  19. Raval MV, Eskandari MK. Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair. Surgery. 2012;151:245–60.

    Article  PubMed  Google Scholar 

  20. Schermerhorn ML, O'Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358:464–74.

    Article  CAS  PubMed  Google Scholar 

  21. Sicard GA, Rubin BG, Sanchez LA, et al. Endoluminal graft repair for abdominal aortic aneurysms in high-risk patients and octogenarians: is it better than open repair? Ann Surg. 2001;234:427–435; discussion 435–437.

    Google Scholar 

  22. Leon LR Jr, Labropoulos N, Laredo J, et al. To what extent has endovascular aneurysm repair influenced abdominal aortic aneurysm management in the state of Illinois? J Vasc Surg. 2005;41:568–74.

    Article  PubMed  Google Scholar 

  23. Paolini D, Chahwan S, Wojnarowski D, et al. Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians. J Vasc Surg. 2008;47:924–7.

    Article  PubMed  Google Scholar 

  24. de Donato G, Setacci C, Chisci E, et al. Abdominal aortic aneurysm repair in octogenarians: myth or reality? J Cardiovasc Surg. 2007;48:697–703.

    Google Scholar 

  25. IMPROVE Trial Investigators. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial. Eur Heart J. 2015;36:2061.

    Article  PubMed Central  Google Scholar 

  26. IMPROVE Trial Investigators, Powell JT, Hinchliffe RJ, et al. Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg. 2014;101:216.

    Article  PubMed Central  Google Scholar 

  27. Hinchliffe RJ, Bruijstens L, MacSweeney ST, Braithwaite BD. A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm - results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg. 2006;32:506.

    Article  CAS  PubMed  Google Scholar 

  28. Reimerink JJ, Hoornweg LL, Vahl AC, et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg. 2013;258:248.

    Article  PubMed  Google Scholar 

  29. Desgranges P, Kobeiter H, Katsahian S, et al. Editor’s choice - ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): a French randomized controlled trial of endovascular versus open surgical repair of ruptured Aorto-iliac aneurysms. Eur J Vasc Endovasc Surg. 2015;50:303.

    Article  CAS  PubMed  Google Scholar 

  30. Hoornweg LL, Wisselink W, Vahl A, et al. The Amsterdam acute aneurysm trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2007;33:679.

    Article  CAS  PubMed  Google Scholar 

  31. Sweeting MJ, Ulug P, Powell JT, et al. Ruptured aneurysm trials: the importance of longer-term outcomes and meta-analysis for 1-year mortality. Eur J Vasc Endovasc Surg. 2015;50:297.

    Article  CAS  PubMed  Google Scholar 

  32. Antoniou GA, Georgiadis GS, Antoniou SA, et al. Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair. J Vasc Surg. 2013;58:1091.

    Article  PubMed  Google Scholar 

  33. von Meijenfeldt GC, Ultee KH, Eefting D, et al. Differences in mortality, risk factors, and complications after open and endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2014;47:479.

    Article  Google Scholar 

  34. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607.

    Article  CAS  PubMed  Google Scholar 

  35. Kassahun WT, et al. Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbeck’s Arch Surg. 2008;393:163–71.

    Article  Google Scholar 

  36. Oldenburg WA, et al. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164:1054–62.

    Article  PubMed  Google Scholar 

  37. Taylor LM, Moneta GL, Porter JM. Treatment of acute intestinal ischemia caused by arterial occlusions. Rutherford Vascular surgery. 5th ed. Philadelphia: WB Saunders; 2000. p. 1512–8.

    Google Scholar 

  38. Park WM, Gloviczki P, Cherry KJ, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35:445–52.

    Article  PubMed  Google Scholar 

  39. Taylor LM, Moenta GL, Porter JM. Treatment of chronic visceral ischemia. Rutherford Vascular surgery. 5th ed. Philadelphia: WB Saunders; 2000. p. 1532–41.

    Google Scholar 

  40. Wilson DB, Mostafavi K, Craven TE, et al. Clinical course of mesenteric artery stenosis in elderly Americans. Arch Intern Med. 2006;166(19):2095–100.

    Article  PubMed  Google Scholar 

  41. Schermerhorn ML, et al. Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg. 2009;50:341–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kougias P, et al. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46:467–74.

    Article  PubMed  Google Scholar 

  43. Moneta GL. Diagnosis of intestinal ischemia. Rutherford Vascular surgery. 5th ed. Philadelphia: WB Saunders; 2000. p. 1501–10.

    Google Scholar 

  44. Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29(3):226–35.

    Article  CAS  PubMed  Google Scholar 

  45. Kolkman JJ, et al. Occlusive and non-occlusive gastrointestinal ischaemia: a clinical review with special emphasis on the diagnostic value of tonometry. Scand J Gastroenterol Suppl. 1998;225:3–12.

    Article  CAS  PubMed  Google Scholar 

  46. Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med. 2014;7:43.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Gallego AM, Ramirez P, Rodriquez JM, et al. Role of urokinase in the superior mesenteric artery embolism. Surgery. 1996;120:111–3.

    Article  CAS  PubMed  Google Scholar 

  48. Block TA, Acosta S, Björck M. Endovascular and open surgery for acute occlusion of the superior mesenteric artery. J Vasc Surg. 2010;52:959–66.

    Article  PubMed  Google Scholar 

  49. Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB. Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg. 2009;50:341–8. e1

    Article  PubMed  PubMed Central  Google Scholar 

  50. Arthurs ZM, Titus J, Bannazadeh M, Eagleton MJ, Srivastava S, Sarac TP, Clair DG. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg. 2011;53:698–704; discussion 704–705.

    Google Scholar 

  51. Ryer EJ, Kalra M, Oderich GS, Duncan AA, Gloviczki P, Cha S, Bower TC. Revascularization for acute mesenteric ischemia. J Vasc Surg. 2012;55:1682–9.

    Article  PubMed  Google Scholar 

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Correspondence to Justin Boccardo M.D., F.A.C.S. .

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Boccardo, J. (2018). Geriatric Vascular Trauma and Vascular emergencies. In: Rodriguez, A., Barraco, R., Ivatury, R. (eds) Geriatric Trauma and Acute Care Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-57403-5_24

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  • DOI: https://doi.org/10.1007/978-3-319-57403-5_24

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