Background Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. Methods and results We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. Conclusions Stent placement for iliofemoral venous outflow obstruction results in high technical success and acceptable complication rates regardless of cause of obstruction.

Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction: Systematic Review and Meta-Analysis

Background: Radically different conclusions exist in the pediatric orthopaedic and vascular literature regarding the management of patients with a pink hand but no palpable radial pulse in association with a supracondylar humeral fracture.

Methods: One thousand two hundred and ninety-seven consecutive, operatively treated supracondylar humeral fractures in patients presenting to a level-I pediatric trauma center from January 2003 through December 2007 were studied retrospectively. Clinical records were reviewed to determine vascular and neurological examination findings, Gartland classification, timing of surgery, and postoperative complications.

Results: One thousand two hundred and sixty-six patients had a documented radial pulse examination at the time of arrival in the emergency room; fifty-four (4%) of those patients lacked a palpable radial pulse. All fifty-four patients had type-3 fractures. Five (9%) of the fifty-four patients underwent open exploration of vascular structures on the basis of clinical findings of a pale hand, sluggish capillary refill, and/or weak or no pulse detected with use of Doppler ultrasound after closed reduction and percutaneous pinning. All five underwent vascular surgery to restore blood flow (two primary repairs, three saphenous vein grafts). Twenty (37%) of the fifty-four patients had a pulse documented with use of Doppler ultrasound and a pink hand after closed reduction and percutaneous pinning, but the radial pulse remained nonpalpable. These patients were observed in the hospital for signs of ischemia; one of the twenty patients required vascular repair after developing a pale hand nine hours after closed reduction and percutaneous pinning, and the other nineteen patients were also observed while they were in the hospital, and they all regained a palpable pulse either prior to discharge or by the time of the first postoperative visit. When compared with the group of patients with type-3 fractures for whom data regarding nerve examination were available, patients with type-3 fractures who lacked a palpable radial pulse had a higher rate of nerve palsy postoperatively (31% versus 9%, p < 0.0001).

Conclusions: In this cohort, nearly 10% of patients who presented with a type-3 supracondylar humeral fracture and no palpable radial pulse underwent immediate vascular repair to restore blood flow following closed reduction and percutaneous pinning. However, in our series, the lack of a palpable radial pulse after closed reduction and percutaneous pinning was not an absolute indication to proceed with vascular exploration if clinical findings (i.e., Doppler signal and capillary refill) suggested that the limb was perfused. Careful inpatient monitoring of these patients postoperatively is mandatory to identify late-developing vascular compromise.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Management of the pediatric pulseless supracondylar humeral fracture: Is vascular exploration necessary?

ObjectivesThe aim is to evaluate venous stent patency, the development of post-thrombotic syndrome, recurrence, quality of life and the optimal post-procedural anticoagulation regimen in the treatm...

A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb.

Purpose. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children. Material and Methods. 220 children hospitalized in the Pediatric Trauma-Orthopedic Department in the years 2004-2014. The group consisted of 143 males and 77 females. Results. Acute neurovascular complications occurred in 16.81% of patients with displaced supracondylar fracture (37 children). Nerve damage was found in 10% of patients with displaced fracture (22 children). The most injured nerve was median nerve; this complication occurred in 15 patients (68.18%). The total nerve function returned after average of 122 days (0-220 days after surgery). Symptoms of vascular injury occurred in 7.7% children with displaced fracture (17 children). Conclusions. (1) In children with supracondylar fracture the most often injured nerve is median nerve. (2) The incidence of vascular and nerve complications positively correlates with the progression of fracture according to Gartland classification.

/pdf/analysis-of-early-neurovascular-complications-of-pediatric-pbido5qc4b.pdf

Analysis of Early Neurovascular Complications of Pediatric Supracondylar Humerus Fractures: A Long-Term Observation

The cases of forty patients who were operated on consecutively for palsy of the posterior interosseous nerve were analyzed. The injury was iatrogenic in sixteen patients, traumatic in fifteen, and nontraumatic in nine. Persistent paralysis (partial or cornplete) was the only indication for operation. Operative neurolysis was done in twenty-three patients; interfascicular nerve-grafting, in twelve; internal neurolysis, in one; and tendon transfer, in four. An excellent or good functional result was documented for all but three patients, of whom two had had neurolysis and one, nerve-

http://synapse.koreamed.org/Synapse/Data/PDFData/1104JKSF/jksf-4-369.pdf

Neural injuries associated with supracondylar fractures of the humerus in children

https://www.jvascsurg.org/article/S0741-5214(11)00438-1/pdf

Hand ischemia associated with elbow trauma in children

Background Treatment of deep venous thrombosis (DVT) with therapeutic anticoagulation has been increasingly challenged by aggressive percutaneous treatment using ultrasound-accelerated catheter-directed thrombolysis (US-CDT) or percutaneous pharmacomechanical thrombectomy (PMT). These techniques have been promoted to improve thrombus removal, prolong venous patency, prevent venous insufficiency, and reduce postthrombotic syndrome. This study reviews midterm results using these endovascular techniques for both acute and chronic DVT. Methods A retrospective chart review was performed on patients treated for acute or chronic DVT with US-CDT and/or PMT. Charts were reviewed for patient demographics, medical history and treatment, operative details, and postoperative outcomes. Intraoperative venography and intravascular ultrasound quantified clot response to therapy. Duplex ultrasound defined the pre- and postoperative extent of venous thrombosis, venous patency, and valvular function. Results Between October 1, 2002 and September 30, 2010, 80 patients were treated for iliofemoral (n = 48), iliofemoropopliteal (n = 15), or femoropopliteal (n = 17) venous thrombosis. Mean age was 45.8 years (range, 15-78 years), and 24 patients (30%) had a documented history of hypercoagulable state. Intravascular ultrasound confirmed May-Thurner syndrome in 34 patients (42.5%). Fifty-two patients (65%) were treated for acute DVT; the mean time to intervention from symptom onset was 8.7 ± 4.5 days (range, 1-14 days). The remaining 28 patients (35%) had chronic symptoms and were treated at a mean of 8.6 ± 10.9 months (range, 1.5-36 months) after DVT diagnosis was made. Patients were treated with PMT (n = 43, 53.8%), US-CDT (n = 14, 17.5%), or both (n = 32, 28.7%). Clot lysis (>90%) was achieved in 72 of 80 patients (90%). Tenecteplase was used for all cases, and the mean dose was 8.6 ± 4.3 mg. Adjunctive procedures, including angioplasty with or without stent placement, were required in 90% (n = 47) of acute patients and in 96% (n = 27) of chronic patients ( P  = .33). Three patients (3.8%) had postoperative bleeding events requiring blood transfusion; there were no occurrences of intracranial hemorrhage or clinically significant pulmonary embolism. At a mean follow-up of 3.8 years (range, 1-8.9 years), venous patency was present in 49 of 52 acute patients (94%) and in 23 of 28 chronic patients (82%) ( P  = .12). Valve function was preserved in 41 of 52 (79%) acute patients vs 11 of 28 (39%) chronic patients ( P Conclusions US-CDT and PMT can effectively remove acute and chronic thrombus in the lower extremity deep venous system. Vein patency and valvular function is better preserved at midterm follow-up after treatment for acute DVT, however intervention should be considered in patients with chronic DVT as well.

Midterm results of percutaneous endovascular treatment for acute and chronic deep venous thrombosis

Midterm Results of Percutaneous Treatment for Acute and Chronic Deep Venous Thrombosis

Chapter 59 – Vascular Infection

Longitudinal changes in kidney parenchymal volume associated with renal artery stenting.

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