Missed arterial injuries modes of presentation and complications

Missed injuries are more frequently encountered due to the increased use of invasive procedures that involve arteries, i.e. in cardiac catheterization and hemodialysis. Occult and minor injuries are frequently missed and present later with delayed complications. The natural history of these injuries is poorly understood. This work is a prospective evaluation of 88 patients [with 89 arterial injury] who presented with complications of missed arterial injuries. The majority of patients 80% were symptomatizing on admission. They were more commonly presented with non-ischemic complications [53.4%] than with acute [18.2%] or chronic ischemia [28.4%]. The causative mechanisms of the missed injuries were: external trauma [31 patients] and iatrogenic injuries [57 patients]. External trauma was penetrating in 19 patients and blunt in 12 patients]. latrogenic injuries included those associated with cardiac catheterization [28 patients,], haemodialysis [26 patients] or open surgery [3 patients]. Duplex scanning was used to diagnose the problem accurately in 54 patients [61.4%], while in only 9 patients [10.2%] angiography was mandatory to properly diagnose the problem. In addition angiography was primarily ordered in 25 patients [28.4%]. Early detection and prompt repair of all identified injuries is mandatory to avoid the potentialities for developing serious complications [up to several years] following the undetected injury or its initial conservative management. Objective and thoughtful discussion of the complications of missed arterial injuries on a routine basis also will keep this problem minimal

Ischemia-reperfusion injury of the extremities and its reversal by PGE1 and experimental study

Ischemia-reperfusion injury [IRI] occurs after restoration of blood supply following a period of ischemia. It presents as a "no-reflow" or a "slow re-flow" state. In this work, this disorder was experimentally studied in the muscles and skin of the extremities. The study was carried on dogs and was conducted by histological and ultrastrucrural assessment of the studied tissues after ischemia and reperfusion. Vascular endothelial damage [swelling and breaks] proved to be the most striking change in this disorder. Reperfusion injury was more evident in muscle tissue than in skin. A study of possible reversal of the damage was attempted The infusion of PGE1, Pentoxifylline or saline solution during reperfusion of ischemic tissues, was tested as an anti-IRI therapy. Results were satisfactory with PGE1 which reduced reperfusion endothelial damages and induced reparative tissue changes as well [as proved Histopathologically and by E/M examination]. These changes were more observed in skeletal muscles than in skin

Three years experience in management of non traumatic acute arterial thrombosis

Acute nontraumatic arterial thrombosis continues to be complicated by significant mortality and limb loss. A 3-years experience in the management of 35 patients [43 limbs] with 40 episodes of arterial nontraumatic thrombosis, is reviewed to assess the factors contributing in the final outcome. Almost all the patients presented in this study suffered the manifestations of acute arterial occlusion with subsequent distal ischaemia. The time lapse between the onset and the presentation of the patient was nearly 12 days ranging between 4 hours and 60 days. In 7 patients [20%] the diagnosis was missed for arterial embolism and was corrected by arteriograph [5 patients] and operative findings [2 patients]. The treatment adopted was selective being based on the severity of limb ischaemia, findings in arteriographic examination as will as the patients operative risk. Surgical treatment was adopted in 18 patients [20 limbs] and nonsurgical treatment in 17 patients [23 limbs] with an overall mortality of 10 patients out of 35 [28.6%] and morbidity [including survival amputee] in 10 patients of survivals [40%]. Our limited experience with the use of thrombolytic therapy demonstrated a promising role in limb salvage. It was found that the old age and the site of occlusion were significant predictors for patient's mortality [p<0.05]. The degree of attendant limb ischaemia at presentation was found to be the most significant predictor for limb loss [P < 0.01]. The modality of treatment was found to be a significant factor only when the underlying cause of arterial thrombosis is considered, [P < 0.05] and to a lesser extent the time delay before treatment that was also a predictor for the limb outcome [P = 0.07]