Literature Reviews
doi: 10.25005/2074-0581-2019-21-2-305-313
TO THE ISSUES OF DIAGNOSIS AND TREATMENT OF UPPER LIMB VASCULAR TRAUMA

G.D. Karim-Zade1, M.Kh. Malikov1, O. Nematzoda2, A.A. Davlatov2, Khayrulloi Narzillo2, N.A . Makhmadkulova3

1Department of Surgical Diseases № 2, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
3Department of Operative Surgery and Topographic Anatomy, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

The review reflects the most pressing issues of etiology, diagnosis, and treatment of upper limb vascular trauma. It was revealed that from year to year there is an increase in both the frequency and nature of vascular trauma to the upper limbs. Often, due to the combined lesion of the neurovascular structures, the victims develop partial or complete loss of limb function. Literature data show that factors of unsatisfactory results of treatment of vascular trauma to the upper limbs are the combined nature of the injury, inadequate medical aid in the stages of medical evacuation, transportation of the victims in a shock condition, as well as unreasonably carried out the reconstruction of the vessel. Due to the advent and introduction of modern diagnostic methods and new surgical techniques for vascular injuries of the upper limb, the frequency of amputation of limbs is essential. Despite this, a number of organizational and tactical issues in helping this category of patients need further solutions.

Keywords: vascular trauma, ischemia, autovenous grafts, bypass surgery , stenting.

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References
  1. Karita Y, Kimura Y, Sasaki S, Nitobe T, Tsuda E, Ishibashi Y. Axillary artery and brachial plexus injury secondary to proximal humeral fractures: A report of 2 cases. Int J Surg Case Rep. 2018;50:106-10. Available from: http://dx.doi. org/10.1016/j.ijscr.2018.04.044.
  2. Sadriev ON, Ahmadzhonov ZS. Sochetannye kostno-sosudistye povrezhdeniya nizhnikh konechnostey [Combined bone and vascular injuries of the lower extremities]. Nauka molodykh. 2015;1:67-73.
  3. Gubochkin NG. Rekonstruktivno-vosstanovitel’noe lechenie ranenykh i postradavshikh s sochetannymi povrezhdeniyami sukhozhiliy i nervov verkhney konechnosti [The reparative treatment of the wounded and injured with multisystem injuries to the tendons and nerves of the upper extremity]. Vestnik Baltiyskogo federal’nogo universiteta im. I. Kanta. 2011;7:45-50.
  4. Khmara AD, Norkin IA, Khmara TG. Tekhnika lecheniya pri sochetannoy travme grudi i segmentov konechnostey [Techniques of treatment for chest and extremity polytraumas]. Saratovskiy nauchno-meditsinskiy zhurnal. 2012;8(4):982-8.
  5. Makarova NP, Ermolaev VL, Kozlova MA, Khmelniker SM, Lobut OA, Shusharina VV. Povrezhdeniya magistral’nykh krovenosnykh sosudov. Evolyutsiya neotlozhnoy angiotravmatologicheskoy pomoshchi na srednem Urale [Damage of main blood vessels. Evolution of the angiotraumatological emergency assistance in the middle Urals]. Vestnik Ural’skoy meditsinskoy akademicheskoy nauki. 2010;3:73-8.
  6. Gaibov AD, Belov YuV, Sultanov DD, Kalmykov EL. Ognestrel’nye raneniya sosudov [Gunshot injuries of vessels]. Dushanbe, RT: Mega-Print; 2015. 130 p.
  7. Gubochkin NG, Gaydukov VM, Mikityuk SI. Lechenie postradavshikh s ognestrelnymi raneniyami i povrezhdeniyami sosudov konechnostey [Treating patients with gunshot wounds and injuries of limb vessels]. Mediko-biologicheskie i sotsial’no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh. 2015;4:38-41.
  8. Kiselyov VA, Mokhov EM, Vardak AM. Analiz oshibok diagnostiki i taktiki khirurgicheskogo lecheniya povrezhdeniy magistral’nykh arteriy konechnostey [Diagnosis and Surgical Treatment of Extremity Vascular Injuries: Error Analysis]. Vestnik eksperimental’noy i klinicheskoy khirurgii. 2015;8(4):325-34.
  9. Moskvichyova MG, Shishkin EV. Organizatsiya pomoshchi postradavshim v dorozhno-transportnykh proisshestviyakh za rubezhom [Organization of emergency relief to victims of road accidents abroad. Vestnik Avitsenny [Avicenna Bulletin]. 2014;2:126-30.
  10. Musoev DS. Osteosintez pri lechenii diafizarnykh perelomov dlinnykh trubchatykh kostey u detey [Osteosynthesis in treatment of diaphyseal fractures of long bones in children]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;3:37-41
  11. Pigolkin YuI, Dubrovin IA, Zotkin DA, Mosoyan AS, Dubrovin AI. Diagnostika mekhanizma perelomov kostey po rezul’tatam rentgenologicheskikh issledovaniy pri transportnoy travme [Diagnostics of bone fractures mechanism by radiological researches at traffic injuries]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;4:115-8.
  12. Muminov ShM, Nizov ON, Minaev TR, Khakimov AB, Kubeev BN, Khalikov AE, i dr. Sluchay uspeshno vypolnennoy rekonstruktivnoy operatsii pri sochetannoy travme verkhney konechnosti s narusheniem krovoobrashcheniya i nalichiem obshirnogo defekta kozhi i myagkikh tkaney [Case of successful reconstructive surgery in combined trauma of upper extremity with blood circulation disorder and extensive defects of covering tissue]. Vestnik ekstrennoy meditsiny. 2018;11(3):64-70.
  13. Shteynle AV. Compartment syndrome i kollateral’noe krovoobrashchenie pri sochetannykh ognestrel’nykh kostno-arterial’nykh povrezhdeniyakh konechnostey v eksperimente [Compartment syndrome and collateral circulation under associated gunshot bone-arterial injuries of extremities in experiment]. Sibirskiy meditsinskiy zhurnal. 2010;25(3-1):60-3
  14. Voynovskiy EA, Koltovich AP. Khirurgicheskaya taktika “damage control” pri povrezhdenii sosudov [Surgery tactics «damage control» in vascular injury]. Meditsina katastrof. 2011;1:54-8.
  15. Feliciano DV, Moore EE, West MA, Moore FA, Davis JW, Cocanour CS, et al. Western Trauma Association critical decisions in trauma: evaluation and management of peripheral vascular injury, part II. J Trauma Acute Care Surg. 2013;75(3):391-7. Available from: http://dx.doi.org/10.1097/ TA.0b013e3182994b48.
  16. Feliciano DV. Pitfalls in the management of peripheral vascular injuries. Trauma Surg Acute Care Open. 2017;2:e000110. Available from: http:// dx.doi.org/10.1136/tsaco-2017-000110.
  17. Perekhodov SN, Kokhan EP, Glyantsev SP, Galik NI. Okazanie khirurgicheskoy pomoshchi ranenym s povrezhdeniyami magistral’nykh sosudov [Surgical aid to the casualties with injuries of great vessels]. Voenno-meditsinskiy zhurnal. 2010;331(6):78-81.
  18. Mishwani AH, Ghaffar A, Janjua S. Combat related vascular trauma. J Coll Physicians Surg Pak. 2012;22(4):213-7. Available from: http://dx.doi. org/04.2012/JCPSP.213217.
  19. Ekim H, Tuncer M. Management of traumatic brachial artery injuries: A report on 49 patients. Ann Saudi Med. 2009;299(2):105-9. Available from: http://dx.doi.org/10.4103/0256-4947.51797.
  20. Nazarov KhN, Gaibov AD, Sadriev ON. Khirurgicheskaya taktika pri sochetannykh kostno-sosudistykh povrezhdeniyakh nizhnikh konechnostey [Surgical tactics in combined bone and vascular lesions of lower limb]. Vestnik Avitsenny [Avicenna Bulletin]. 2014;4:45-9.
  21. Ibodov ST, Abduazizov AA, Ali-Zade SG. Optimizatsiya vosstanovitel’nogo lecheniya pri travmakh oporno-dvigatel’nogo apparata v usloviyakh polikliniki [Optimizing medical rehabilitation in traumas of locomotorium in conditions of polyclinic]. Vestnik Avicenny [Avicenna Bulletin]. 2017;19(1):85- 9. Available from: http://dx.doi.org/10.25005/2074-0581-2017-19-1-85-89.
  22. Faisal MS, Muhammad SD, Ahmed A. An immediate exploration of penetrating upper extremity injury for unexpected vascular trauma: a case of limb salvage. Puk J Surg. 2015;30(1):80-2.
  23. Maslyukov VV, Barsukov VG, Uskov AV. Neposredstvennye i otdalyonnye rezul’taty lecheniya ognestrel’nykh raneniy magistral’nykh sosudov konechnostey grazhdanskogo naseleniya v usliviyakh lokal’nykh voennykh konfliktov [Immediate and long-term results of treatment of gunshot wounds of major vessels of extremities in civilians in local military conflicts]. Vestnik Smolenskoy gosudarstvennoy meditsinskoy akademii. 2016;15(1):35-40.
  24. Gerasimov VG, Shulga NV, Gerasimov VV, Gerasimov EV, Rybachuk EP, Baranenko AV, i dr. Organizatsionno-takticheskie aspekty okazaniya spetsializirovannoy angiokhirurgicheskoy pomoshchi bol’nym s povrezhdeniyami sosudov [Organizational and tactical aspects of specialized angiographic aid for patients with vascular injuries]. Vestnik neotlozhnoy i vosstanovitel’noy meditsiny. 2010;11(3):360-1.
  25. Sah B, Shrestha KG, Tiwari KK, Reddy J. Analysis of consecutive cases of vascular injury in tertiary level Hospital in Central Nepal. Journal of College of Medical Sciences – Nepal. 2017;13(3):357-62. Available from: http://dx.doi. org/10.3126/jcmsn.v13i3.17857.
  26. Nwafor A, Eze JC, Ezemba N, Onyekwulu FA, Ngene CI, Chinawa JM. The pattern and outcome of civilian vascular in a teaching hospital over a 7-year period. World Journal of Cardiovascular Diseases. 2016;6(2):44-53. Available from: http://dx.doi.org/10.4236/wjcd.2016.62006.
  27. Gubka VA, Konovalenko IA, Suzdalenko OV. Rezul’taty lecheniya bol’nykh s ostroy arterial’noy ishemiey konechnostey [Treatment results in patients with acute limb ischemia]. Patologiya. 2015;2:55-8.
  28. Zorin VI, Zhila NG. Neyrososudistye povrezhdeniya pri travme verkhnikh konechnostey u detey [Upper limb trauma with nerve and vessel injury in children]. Dal’nevostochnyy meditsinskiy zhurnal. 2013;1:61-4.
  29. Korolyov MP, Urakcheev ShK, Pastukhova NK. Khirurgicheskoe lechenie povrezhdeniy krupnykh sosudov [Surgical treatment of injuries of the large vessels]. Vestnik khirurgii im. I.I. Grekova. 2011;170(6):56-8.
  30. Zhakiev BS, Kasymov BZh, Karsakbaev UG. Lechenie travmaticheskikh povrezhdeniy magistral’nykh sosudov konechnostey v usloviyakh statsionara obshchekhirurgicheskogo profilya [Treatment of traumatic injuries of magistral vessels of extremities in condition of general surgery department]. Meditsinskiy zhurnal Zapadnogo Kazakhstana. 2011;3:82-3.
  31. Zolotov AS, Dubovyy SA. Lechenie chrezmyshchelkovykh razgibatel’nykh perelomov plechevoy kosti u detey: k voprosu ob istorii metoda “Collar and cuff” [Treatment of transcondylar extensor fractures of the humerus in children: on the issue of history of the method “Collar and cuff”]. Travmatologiya i ortopediya Rossii. 2013;1:146-8.
  32. Vickash K, Amer A, Naeem A, Falak S. Brachial artery injury in a child following closed elbow dislocation: case report of a rare injury. Malays Orthop J. 2016;10(3):36-8. Available from: http://dx.doi.org/10.5704/ MOJ.1611.001.
  33. Bravman JT, Ipaktchi K, Biffl WL, Stahel PF. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential “near miss” injuries. Scand J Trauma Resusc Emerg Med. 2008;16:16. Available from: http://dx.doi.org/10.1186/1757-7241-16-16
  34. Singh H, Yang JS, Voss A, Tinsely B, Shea KP. Brachial artery injury during surgical repair of distal biceps rupture: a report of two cases. Cresco J Clin Case Reps. 2016;2(1):1-6.
  35. Proshchenko YaN. Khirurgicheskiy dostup pri lechenii detey s chrezmyshchelkovymi perelomami plechevoy kosti [Surgical approach in treatment children with transcondylar fractures of the humerus]. Travmatologiya i ortopediya Rossii. 2012;2:86-90.
  36. Kaledin AL, Kochanov IN, Podmetin PS, Seletskiy SS, Ardeev VN, Garin YuYu, i dr. Distal’nyy otdel luchevoy arterii pri endovaskulyarnykh vmeshatel’stvakh [Distal radial artery in endovascular interventions]. Endovaskulyarnaya khirurgiya. 2017;4(2):125-33. Available from: http:// dx.doi.org/10.24183/2409-4080-2017-4-2-125-33.
  37. Corneille MG, Gallup TM, Villa C, Richa JM, Wolf SE, Myers JG, et al. Pediatric vascular injuries: acute management and early outcomes. J Trauma. 2011;70(4):823-8. Available from: http://dx.doi.org/10.1097/ TA.0b013e31820d0db6.
  38. Beşir Y, Gökalp O, Eygi B, Bahriye Lafcı B, Gökalp G, Yılık L, et al. A surgical approach to iatrogenic vascular injuries in pediatric cases. Ulus Travma Acil Cerrahi Derg. 2017;23(3):217-22. Available from: http://dx.doi.org/10.5505/ tjtes.2016.61282.
  39. Harnarayan P, Islam S, Ramsingh C, Naraynsingh V. Pit Bull attack causing limb threatening vascular trauma – A case series. Int J Surg Case Rep. 2018;42:133- 7. Available from: http://dx.doi.org/10.1016/j.ijscr.2017.11.061
  40. Kostyrnoy A, Potapenkov M, Argunova A, Chornobryvyy V. Vybor taktiki khirurgicheskogo vmeshatel’stva pri travmaticheskom povrezhdenii sosudov [Choice of surgical interventions for traumatic vascular injury]. Vestnik nauki i obrazovaniya. 2017;1:95-7.
  41. Sharma D, Goyal G, Singh A, Sisodia A, Devgarha S, Mathur RM. Management of vascular trauma: a single center 10 years’ experience. Cardiovascular Surgery. 2014;2(3):33-8. Available from: http://dx.doi.org/10.5455/ jcvs.2014231.
  42. Fodor L, Sobec R, Sita-Alb L, Fodor M, Ciuce C. Mangled lover extremity: can we trust the amputation scores? Int J Burns Trauma. 2012;2(1):51-8.
  43. Frech A, Pellegrini L, Fraedrich G, Goebel G, Klocker J. Long-term clinical outcome and functional status after arterial reconstruction in upper extremity injury. Eur J Vasc Endovasc Surg. 2016;52(1):119-23. Available from: http://dx.doi.org/10.1016/j.ejvs.2016.03.028.
  44. Ivanenko AA, Pshenichnyy VN, Duba DSh. Vozmozhnosti i problemy sosudistoy khirurgii v Donetskoy narodnoy respublike [Opportunities and challenges of vascular surgery in the Donetsk people republic]. Vestnik neotlozhnoy i vosstanovitel’noy khirurgii. 2016;1(1):132-5.
  45. Rozin AYu, Antipov NV, Berdnikov MA. Okazanie meditsinskoy pomoshchi pri ognestrel’nom povrezhdenii magistral’nykh sosudov [Medical aid in cases of the gunshot injuries to the main vessels]. Ukrainskiy morfologicheskiy al’manakh imeni professora V.G. Koveshnikova. 2017;15(4):59-62
  46. Prozorov SA, Belozyorov GE, Ivanov PA, Bocharov SM. Endovaskulyarnoe lechenie sosudistykh oslozhneniy posle travmatologicheskikh operatsiy [Endovascular treatment of vascular complications after traumatology operations]. Endovaskulyarnaya khirurgiya. 2017;4(3):213-8. Available from: http://dx.doi.org/10.24183/2409-4080-2017-4-3-213-218.
  47. Zhigunov AK, Aslanov AD, Abazova IS, Logvina OE. Khirurgicheskoe lechenie povrezhdeniy sosudov konechnostey [Surgical treatment of injuries of extremity vessels]. Vestnik khirurgii imeni I.I. Grekova. 2006;165(2):45-7.
  48. Rozin YuA, Ivanenko AA. Spetsializirovannaya khirurgicheskaya pomoshch’ v lechenii boevoy travmy sosudov [Specialized surgical care in the treatment of combat injury of blood vessels]. Vestnik neotlozhnoy i vosstanovitel’noy khirurgii. 2016;1(1):32-6.
  49. Wahlgren CM, Riddez L. Penetrating vascular trauma of the upper and lower limbs. Curr Trauma Rep. 2016;2:11-20. Available from: http://dx.doi. org/10.1007/s40719-016-0035-1
  50. Gakhal MS, Sartip KA. CT angiography signs of lower extremity vascular trauma. Am J Roentgenol. 2009;193(1):W49-57. Available from: http:// dx.doi.org/10.2214/AJR.08.2011.
  51. Sultanov DD, Usmanov NU, Kurbanov UA, Baratov AK, Kurbanov NR. Khirurgicheskaya taktika pri travmaticheskikh povrezhdeniyakh arteriy goleni [Surgical approach for crural arteries injuries]. Angiologiya i sosudistaya khirurgiya. 2003;9(2):111-7.
  52. Sultanov DD, Usmanov NU, Baratov AK, Gaibov AD, Kurbanov UA, Kurbanov NR. Travmaticheskie povrezhdeniya podkolennoy i bertsovykh arteriy: osobennosti ishemii i voprosy khirurgicheskoy taktiki [Traumatic injuries of popliteal and tibial arteries: features of limb ischemia and issues of surgery approach]. Angiologiya i sosudistaya khirurgiya. 2004;10(3):104-13.
  53. Usmanov NU, Sultanov DD, Baratov AK, Kurbanov NR. Khirurgicheskaya taktika pri povrezhdeniyakh podkolennoy arterii [Surgical approach for popliteal artery injuries]. Vestnik khirurgii im. I.I. Grekova. 2003;162(3):64-8.
  54. Lerner AA, Fomenko MV. Ispol’zovanie printsipov “damage control” pri lechenii tyazhyolykh povrezhdeniy konechnostey [Following “damage control” principles at severe limb injuries treatment]. Novosti khirurgii. 2012;20(3):128-32.
  55. Ponomarenko EV. Osobennosti khirurgicheskoy taktiki pri travmaticheskikh amputatsiyakh konechnostey [Features of surgical tactics in traumatic amputations of limbs]. Patologiya. 2016;3:48-51. Available from: http:// dx.doi.org/10.14739/2310-1237.2016.3.87492.
  56. Mukhammadieva KhS, Gaibov AD, Baratov AK, Kalmykov EL, Nematzoda O, Rahmonov DA. Mesto i znachenie endovaskulyarnykh tekhnologiy i “gibridnykh operatsiy” v lechenii okklyuzionno-stenoticheskikh porazheniy arteriy nizhnikh konechnostey [Place and value of endovascular and hybrid technologies in treatment of lower extremity peripheral artery disease]. Vestnik Avitsenny [Avicenna Bulletin]. 2018;20(1):103-12. Available from: http://dx.doi.org/10.25005/2074-0581-2018-20-1-103-112.
  57. Gaibov AD, Sultanov DD, Kalmykov EL, Sadriev ON, Baratov AK, Mukhammadieva KhS. Pervyy opyt “gibridnykh” operatsiy pri obliteriruyushchikh zabolevaniyakh arteriy nizhnikh konechnostey v Respublike Tadzhikistan [First experience of hybrid surgery for peripheral artery disease in Tajikistan]. Zdravookhranenie Tadzhikistana. 2017;3:27-35.
  58. Smeets RR, Ryskx A, Krasznai AG, Sikkink CJJM, Bouwman LH. Endovascular treatment of blunt traumatic injury to the brachial artery: Case report and revive of the literature. Clin Med Rev Case Rep. 2017;4:179. Available from: http://dx.doi.org/10.23937/2378-3656/1410179
  59. Reva VA, Samokhvalov IM, Sokhranov MV, Telitskiy SYu, Yudin AB, Seleznyov AB, i dr. Laparoskopicheskaya model’ povrezhdeniya magistral’noy arterii dlya sravnitel’nogo izucheniya effektivnosti otkrytykh i endovasculyarnykh vmeshatel’stv pri travmakh sosudov [A laparoscopic model of major artery injury for comparative evaluation of effectiveness of the open and endovascular operations for vascular trauma]. Politravma. 2017;4:67-75.

Authors' information:

Karim-Zade Gulandom Dzhangovarovna
, Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2, Avicenna Tajik State Medical University ORCID ID: 0000-0003-0845-3197

Malikov Mirzobadal Khalifaevich
,Doctor of Medical Sciences, Head of the Department of Surgical Diseases № 2, Avicenna Tajik State Medical University ORCID ID: 0000-0002-7816-5521

Nematzoda Okildzhon
,Candidate of Medical Sciences, Leading Researcher of the Republican Scientific Center for Cardiovascular Surgery ORCID ID: 0000-0001-6857-6653

Davlatov Abdumalik Abdulkhakovich
,Candidate of Medical Sciences, Leading Researcher of the Republican Scientific Center for Cardiovascular Surgery ORCID ID 0000-0003-2776-074X

Khayrulloi Narzillo
,Postgraduate Student of Republican Scientific Center for Cardiovascular Surgery ORCID ID: 0000-0001-6030-858Х

Makhmadkulova Nigora Akhtamovna
,Assistant of the Department of Operative Surgery and Topographic Anatomy, Avicenna Tajik State Medical University ORCID ID: 0000-0002-4269-6611

Conflicts of interest: No conflict

Address for correspondence:

Karim-Zade Gulandom Dzhangovarovna
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 808766

E-mail: gulandom71@mail.ru

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