TY - JOUR
T1 - Coping with catastrophe
T2 - The value of endoscopic vascular injury training
AU - Padhye, Vikram
AU - Valentine, Rowan
AU - Sacks, Raymond
AU - Ooi, Eng H.
AU - Teo, Charlie
AU - Tewfik, Marc
AU - Wang, Dehui
AU - Wormald, Peter John
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background: Inadvertent injury to the internal carotid artery (ICA), if poorly managed, not only presents a risk of exsanguination but can also result in significant long-term morbidity. Through the implementation of a novel animal model of endoscopic carotid artery injury (CAI), effective techniques to manage this scenario have been developed. The Vascular Injuries Workshop has trained over 110 surgeons in these techniques. This study reviews events of major arterial hemorrhage managed by surgeons who completed this vascular injury workshop training. Methods: We report a retrospective multicenter case series of patients who required endoscopic management of intranasal major arterial hemorrhage. Delegates who had attended the course were contacted by e-mail and surveyed with regard to instances of major arterial bleeding and the management undertaken. Patient demographics, tumor type, factors influencing injury, management technique, and outcomes were reviewed. Results: The cases reported herein are characterized as follows: 9 cases are reported in total, 3 male, 6 female; age range 37 to 82 years; 1 basilar artery, and 8 ICA injuries. Each case was successfully managed endoscopically with intraoperative muscle patch application. There were no deaths, 1 case of pseudoaneurysm with successful endovascular treatment, 2 cases of impaired carotid flow, and 1 carotid dissection was conservatively managed. There were no permanent neurological sequelae or other permanent morbidity. Conclusion: The Vascular Injuries Workshop arms surgeons with a structured approach to managing the surgical field and provides effective hemostatic techniques in the face of impending catastrophe. In comparison to the existing literature on ICA rupture, our results show trained surgeons are well equipped to achieve safe outcomes for their patients.
AB - Background: Inadvertent injury to the internal carotid artery (ICA), if poorly managed, not only presents a risk of exsanguination but can also result in significant long-term morbidity. Through the implementation of a novel animal model of endoscopic carotid artery injury (CAI), effective techniques to manage this scenario have been developed. The Vascular Injuries Workshop has trained over 110 surgeons in these techniques. This study reviews events of major arterial hemorrhage managed by surgeons who completed this vascular injury workshop training. Methods: We report a retrospective multicenter case series of patients who required endoscopic management of intranasal major arterial hemorrhage. Delegates who had attended the course were contacted by e-mail and surveyed with regard to instances of major arterial bleeding and the management undertaken. Patient demographics, tumor type, factors influencing injury, management technique, and outcomes were reviewed. Results: The cases reported herein are characterized as follows: 9 cases are reported in total, 3 male, 6 female; age range 37 to 82 years; 1 basilar artery, and 8 ICA injuries. Each case was successfully managed endoscopically with intraoperative muscle patch application. There were no deaths, 1 case of pseudoaneurysm with successful endovascular treatment, 2 cases of impaired carotid flow, and 1 carotid dissection was conservatively managed. There were no permanent neurological sequelae or other permanent morbidity. Conclusion: The Vascular Injuries Workshop arms surgeons with a structured approach to managing the surgical field and provides effective hemostatic techniques in the face of impending catastrophe. In comparison to the existing literature on ICA rupture, our results show trained surgeons are well equipped to achieve safe outcomes for their patients.
UR - http://www.scopus.com/inward/record.url?scp=84923925742&partnerID=8YFLogxK
U2 - 10.1002/alr.21471
DO - 10.1002/alr.21471
M3 - Article
C2 - 25556647
AN - SCOPUS:84923925742
SN - 2042-6976
VL - 5
SP - 247
EP - 252
JO - International Forum of Allergy and Rhinology
JF - International Forum of Allergy and Rhinology
IS - 3
ER -