Management of venous injuries.
About: This article is published in Annals of Surgery.The article was published on 1970-05-01 and is currently open access. It has received 119 citations till now.
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TL;DR: The most frequent causes of CVI are primary abnormalities of the venous wall and the valves and secondary changes due to previous venous thrombosis that can lead to reflux, obstruction, or both as discussed by the authors.
Abstract: This consensus document provides an up-to-date account of the various methods available for the investigation of chronic venous insufficiency of the lower limbs (CVI), with an outline of their history, usefulness, and limitations. CVI is characterized by symptoms or signs produced by venous hypertension as a result of structural or functional abnormalities of veins. The most frequent causes of CVI are primary abnormalities of the venous wall and the valves and secondary changes due to previous venous thrombosis that can lead to reflux, obstruction, or both. Because the history and clinical examination will not always indicate the nature and extent of the underlying abnormality (anatomic extent, pathology, and cause), a number of diagnostic investigations have been developed that can elucidate whether there is calf muscle pump dysfunction and determine the anatomic extent and severity of obstruction or reflux. The difficulty in deciding which investigations to use and how to interpret the results has stimulated the development of this consensus document. The aim of this document was to provide an account of these tests, with an outline of their usefulness and limitations and indications of which patients should be subjected to the tests and when and of what clinical decisions can be made. This document was written primarily for the clinician who would like to learn the latest approaches to the investigation of patients with CVI and the new applications that have emerged from recent research, as well as for the novice who is embarking on venous research. Care has been taken to indicate which methods have entered the clinical arena and which are mainly used for research. The foundation for this consensus document was laid by the faculty at a meeting held under the auspices of the American Venous Forum, the Cardiovascular Disease Educational and Research Trust, the European Society of Vascular Surgery, the International Angiology Scientific Activity Congress Organization, the International Union of Angiology, and the Union Internationale de Phlebologie at the Abbaye des Vaux de Cernay, France, on March 5 to 9, 1997. Subsequent input by co-opted faculty members and revisions in 1998 and 1999 have ensured a document that provides an up-to-date account of the various methods available for the investigation of CVI.
934Â citations
TL;DR: This evaluation represents the first in-theater report of wartime vascular injury since Vietnam and shows the principles of rapid evacuation, temporary shunting, and early reconstruction are effective, with satisfactory early in theater limb salvage.
Abstract: Background Wartime vascular injury management has traditionally advanced vascular surgery. Despite past military experience, and recent civilian publications, there are no reports detailing current in-theater treatment. The objective of this analysis is to describe the management of vascular injury at the central echelon III surgical facility in Iraq, and to place this experience in perspective with past conflicts. Study Design Vascular injuries evaluated at our facility between September 1, 2004 and August 31, 2006 were prospectively entered into a registry and reviewed. Results During this 24-month period, 6,801 battle-related casualties were assessed. Three hundred twenty-four (4.8%) were diagnosed with 347 vascular injuries. Extremity injuries accounted for 260 (74.9%). Vascular injuries in the neck (n = 56; 16.1%) and thoracoabdominal domain (n = 31; 8.9%) were less common. US forces accounted for 149 casualties (46%), 97 (30%) were local civilian, and 78 (24%) were Iraqi forces. One hundred seven (33%) patients with vascular injury were evacuated from forward locations after treatment initiation. Fifty-four (50%) of these had temporary shunts placed. Of 43 proximal shunts placed in-field, 37 (86%) were patent at the time of our assessment. Early amputation rate was 6.6% for those extremity injuries treated for limb salvage. Perioperative mortality was 4.3%. Conclusions This evaluation represents the first in-theater report of wartime vascular injury since Vietnam. Extremity injuries continue to predominate, although the incidence of vascular injury appears to be somewhat increased. Local forces and civilians now represent a substantial proportion of those injured. The principles of rapid evacuation, temporary shunting, and early reconstruction are effective, with satisfactory early in-theater limb salvage.
167Â citations
TL;DR: From perspective on TVS's impact on limb salvage, and estimate longer-term freedom from amputation, temporary vascular shunting used as a damage control adjunct in management of wartime extremity vascular injury does not lead to worse outcomes.
144Â citations
Cites background from "Management of venous injuries."
...Rich and colleagues have championed venous repair with extremity vascular injury since Vietnam; however, this practice continues to meet criticism.(26-29) Current reports allude to chronic symptoms associated with venous hypertension, although no others have corroborated increased amputation risk with venous ligation....
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TL;DR: Arteriography is sufficiency sensitive to exclude the presence of arterial injury in patients with equivocal clinical signs of injury and any arteriographic abnormality are indications for operative exploration.
Abstract: The detection of underlying arterial injury is a major problem in the management of penetrating trauma. Arteriovenous fistula and false aneurysm are late sequelae of unrepaired injuries. The diagnostic accuracy of arteriography in clinically occult injury has not been defined. One hundred and seventy-seven patients with 183 penetrating extremity wounds underwent arteriography followed by operative vessel exploration. Arteriogram/operation correlation demonstrated 36 true-positive, 132 true-negative, 14 false-positive, and one false-negative arteriogram. Arteriography is sufficiency sensitive to exclude the presence of arterial injury in patients with equivocal clinical signs of injury. The radiographic changes are often sublte and diagnostic accuracy demands attention to the details of technique and interpretation. Unequivocal clinical signs of arterial injury and any arteriographic abnormality are indications for operative exploration.
122Â citations
TL;DR: Although randomized trials are currently lacking, at least some data suggests that catheter-directed thrombolysis or combined pharmaco-mechanical thrombectomy can reduce post-thrombotic symptoms and improve quality of life after acute ileofemoral DVT.
118Â citations
Cites background from "Management of venous injuries."
...Three hundred seventy seven (38%) of these arterial injuries were associated with concomitant venous injuries.(165,166) Several reports have documented the incidence of venous injuries in civilian trauma centers....
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