Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side ...Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects,while helping to prepare for an alternate procedure and improving patient's overall satisfaction.Methods:A retrospective analysis between January 2006 and December 2018 was performed,and the indications for RAE were classified into post-traumatic,iatrogenic,renal tumors,and spontaneous.Patients who underwent RAE prior to nephrectomy were eliminated.Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy,otherwise magnetic resonance angiography was performed.For the purpose of statistical analysis,we stratified patients into two main categories based on the final outcome—successful or failed.Results:Of 180 patients,32 with negative angiography were eliminated,leaving 148 patients;136(91%)had successful outcomes after one or more trials and 12 had unsuccessful outcomes.The mean age was 45±15 years,and 105(71%)were male.Neither gender,side of the lesion,presence of hematuria,indication for RAE,nor the type of lesion affected the outcome.On the other hand,renal anatomy with presence of accessory artery was the only predictor to failed RAE(p=0.001).Failed RAE trial was a predictor for nephrectomy as a secondary procedure(p=0.03).Conclusion:No pre-procedural predictors could anticipate the RAE outcome,and different indications can be scheduled to RAE,which is equally effective.The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.展开更多
Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and ...Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.展开更多
Background:The aim is to study the safety of Angioembolization on long-term sexual function and quality of life.Methods:IRB approval was gained to review the prospectively collected trauma database as well as prospect...Background:The aim is to study the safety of Angioembolization on long-term sexual function and quality of life.Methods:IRB approval was gained to review the prospectively collected trauma database as well as prospective questionnaires of patients at least 1 year out from pelvic fractures that occurred between 1996 and 2009.Surveys included the SF36v2,Female Sexual Function Index and the International Index of Erectile Function.Values for each domain were compared between patients treated with AE and 2:1 case-matched control patients as well as between the national norms.Values are presented as percentages or means with 95%CI.P<0.05 was considered statistically significant.Results:Thirty Seven cases and 74 matched controls were identified.42 patients completed the survey.There were 13 cases(12 males),and 29 controls(22 males).There was a higher ISS(Injury Severity Score)(32 vs 27;p=0.048)in the cases,but no difference in pelvic AIS(Abbreviated Injury Severity Score)(3 vs 3).Both groups scored similarly in the SF36 in all domains,but the entire cohort scored lower than the national norms in the physical functioning(41.9(37.8–46.0)vs50),role physical(40.9(36.2–45.7)vs50),body pain 43.8(40.7–46.9)vs50),role emotional 46.3(42.8–49.8)vs50),and physical composite score(42.1(38.0–46.3)vs50).All domains of the sexual function in both questionnaires showed significant impairment in our cohort compared with norms.Male cases had similar scores to the controls.Conclusion:Pelvic fractures portend a worse long-term QOL and sexual function than the general population.AE,however,does not have an additive affect to these indices.展开更多
BACKGROUND Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma,iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and ch...BACKGROUND Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma,iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and cholecystectomy.Hepatic artery pseudoaneurysms after endoscopic retrograde cholangiopancreatography(ERCP)are uncommon and potentially life threatening and should be identified and treated rapidly.CASE SUMMARY We report a case of intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm resulting from guide wire injury at ERCP.The patient primary diagnosis was acute biliary pancreatitis with cholangitis,he underwent ERCP on the third day of admission.During ERCP,the left intrahepatic bile duct was cannulated three times.Over the sixth day,Contrast enhanced computed tomography scan demonstrated left hepatic lobe contusion and a pseudoaneurysm formation.The patient was successfully treated with the embolization of a small branch of left hepatic artery angiographically.CONCLUSION The common complications of ERCP are pancreatitis,bleeding and perforation.False aneurysms occur as a result of damage to the wall of an artery.As far as we know,it is rare complication has been reported following ERCP.We advise urgent referral for angiographic embolization in this situation to avoid aneurysm rupture.展开更多
BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard t...BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.展开更多
BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Ab...BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.展开更多
Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of an...Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. Methods: A systematic literature review searched "liver trauma" , "hepatic trauma" , "conservative management" , "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs;studies reported NOM complications together with those post-intervention;case reports;studies including less than 5 cases;studies not written in English;and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. Results: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%. Conclusion: NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.展开更多
Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We repor...Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.展开更多
Background:The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization(RAE)compelled us to report our overall experience on a series of patients...Background:The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization(RAE)compelled us to report our overall experience on a series of patients.Materials and methods:A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019.History,physical examination,and laboratory data were reviewed for all patients.Abdominal ultrasound was the initial imaging study,and all patients underwent subsequent computed tomography or magnetic resonance imaging.The outcome of RAE was determined based on radiographic and clinical findings.Results:Data from 202 patients were analyzed,with a mean age of 45±15 years,and 71.3%of patients were male.Iatrogenic injury was the most common indication for RAE(54%),followed by renal tumors,trauma,and spontaneous,in 27.7%,10.4%,and 8.4%of patients,respectively.Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding(40.6%),whereas no lesions were identified on angiography in 32 patients(15.8%),after which RAE was subsequently aborted.Renal arterial embolization was successful in 158 of 170 patients(92.9%)after 1 or more trials(maximum of 4).Microcoil alone or with other embolic materials was the most commonly used material for embolization(85%).Conclusions:latrogenic injury was the most common indication for RAE.Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography;however,angiography showed a negative result in 16%of patients,even those with symptoms.When lesions are present on angiography,the overall success of repeated trials of RAE reached 92.9%.展开更多
文摘Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects,while helping to prepare for an alternate procedure and improving patient's overall satisfaction.Methods:A retrospective analysis between January 2006 and December 2018 was performed,and the indications for RAE were classified into post-traumatic,iatrogenic,renal tumors,and spontaneous.Patients who underwent RAE prior to nephrectomy were eliminated.Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy,otherwise magnetic resonance angiography was performed.For the purpose of statistical analysis,we stratified patients into two main categories based on the final outcome—successful or failed.Results:Of 180 patients,32 with negative angiography were eliminated,leaving 148 patients;136(91%)had successful outcomes after one or more trials and 12 had unsuccessful outcomes.The mean age was 45±15 years,and 105(71%)were male.Neither gender,side of the lesion,presence of hematuria,indication for RAE,nor the type of lesion affected the outcome.On the other hand,renal anatomy with presence of accessory artery was the only predictor to failed RAE(p=0.001).Failed RAE trial was a predictor for nephrectomy as a secondary procedure(p=0.03).Conclusion:No pre-procedural predictors could anticipate the RAE outcome,and different indications can be scheduled to RAE,which is equally effective.The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.
文摘Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.
基金The publication was made possible by funds from the Department of Surgery and Mayo Clinic Surgery Research Committee
文摘Background:The aim is to study the safety of Angioembolization on long-term sexual function and quality of life.Methods:IRB approval was gained to review the prospectively collected trauma database as well as prospective questionnaires of patients at least 1 year out from pelvic fractures that occurred between 1996 and 2009.Surveys included the SF36v2,Female Sexual Function Index and the International Index of Erectile Function.Values for each domain were compared between patients treated with AE and 2:1 case-matched control patients as well as between the national norms.Values are presented as percentages or means with 95%CI.P<0.05 was considered statistically significant.Results:Thirty Seven cases and 74 matched controls were identified.42 patients completed the survey.There were 13 cases(12 males),and 29 controls(22 males).There was a higher ISS(Injury Severity Score)(32 vs 27;p=0.048)in the cases,but no difference in pelvic AIS(Abbreviated Injury Severity Score)(3 vs 3).Both groups scored similarly in the SF36 in all domains,but the entire cohort scored lower than the national norms in the physical functioning(41.9(37.8–46.0)vs50),role physical(40.9(36.2–45.7)vs50),body pain 43.8(40.7–46.9)vs50),role emotional 46.3(42.8–49.8)vs50),and physical composite score(42.1(38.0–46.3)vs50).All domains of the sexual function in both questionnaires showed significant impairment in our cohort compared with norms.Male cases had similar scores to the controls.Conclusion:Pelvic fractures portend a worse long-term QOL and sexual function than the general population.AE,however,does not have an additive affect to these indices.
基金Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2020KY1082and No.2021KY1238。
文摘BACKGROUND Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma,iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and cholecystectomy.Hepatic artery pseudoaneurysms after endoscopic retrograde cholangiopancreatography(ERCP)are uncommon and potentially life threatening and should be identified and treated rapidly.CASE SUMMARY We report a case of intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm resulting from guide wire injury at ERCP.The patient primary diagnosis was acute biliary pancreatitis with cholangitis,he underwent ERCP on the third day of admission.During ERCP,the left intrahepatic bile duct was cannulated three times.Over the sixth day,Contrast enhanced computed tomography scan demonstrated left hepatic lobe contusion and a pseudoaneurysm formation.The patient was successfully treated with the embolization of a small branch of left hepatic artery angiographically.CONCLUSION The common complications of ERCP are pancreatitis,bleeding and perforation.False aneurysms occur as a result of damage to the wall of an artery.As far as we know,it is rare complication has been reported following ERCP.We advise urgent referral for angiographic embolization in this situation to avoid aneurysm rupture.
文摘BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.
文摘BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.
文摘Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. Methods: A systematic literature review searched "liver trauma" , "hepatic trauma" , "conservative management" , "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs;studies reported NOM complications together with those post-intervention;case reports;studies including less than 5 cases;studies not written in English;and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. Results: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%. Conclusion: NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.
文摘Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.
文摘Background:The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization(RAE)compelled us to report our overall experience on a series of patients.Materials and methods:A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019.History,physical examination,and laboratory data were reviewed for all patients.Abdominal ultrasound was the initial imaging study,and all patients underwent subsequent computed tomography or magnetic resonance imaging.The outcome of RAE was determined based on radiographic and clinical findings.Results:Data from 202 patients were analyzed,with a mean age of 45±15 years,and 71.3%of patients were male.Iatrogenic injury was the most common indication for RAE(54%),followed by renal tumors,trauma,and spontaneous,in 27.7%,10.4%,and 8.4%of patients,respectively.Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding(40.6%),whereas no lesions were identified on angiography in 32 patients(15.8%),after which RAE was subsequently aborted.Renal arterial embolization was successful in 158 of 170 patients(92.9%)after 1 or more trials(maximum of 4).Microcoil alone or with other embolic materials was the most commonly used material for embolization(85%).Conclusions:latrogenic injury was the most common indication for RAE.Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography;however,angiography showed a negative result in 16%of patients,even those with symptoms.When lesions are present on angiography,the overall success of repeated trials of RAE reached 92.9%.
