Jackson Rounds Notes (8/27/18)

Case: 56yo female with back pain radiating to the groin. Hypotensive w/pressers.
CT scan: Injury to right external iliac artery.
Notes: I believe it was an external iliac hemorrhage due to an aneurysm

How to access site: Oblique incision, below inguinal ligament

Important Imaging Modality: Ultrasound….Although, I don’t remember why this

was emphasized. Written next to my complications/management notes and
separate from it’s use in guiding thrombin injections.

Complications (at access site):

1) RP hemorrhage
2) Pseudoaneurysm – “pulsatile mass”
3) AV Fistula – artery-vein connection -> steal syndrome (meets OR criteria)
4) Dissection – Tear in intima -> obstruction & atherosclerosis
5) Infection – fever, pain, HTN, +cultures -> septic shock -> death
6) Thrombosis
a. 5’Ps: pain, paresthesia, pallor, pulseless, poikilothermic

Management (non-operative):
1) Holding Pressure (Manually)
2) Stop anticoagulants
3) GM fluid/blood products
4) Thrombin injections w/ultrasound guidance in shaft, NOT neck

Operative Management:
1) Selective balloon angioplasty
2) Stent Graft
3) Work proximal and distal to bleeding

Still High Pressure:

1) Fasciotomy
2) Angiogram
3) Failed endovascular therapy -> amputation (FINAL OPTION)

Risk Factors for external iliac hemorrhage:

1) Female – likely from density of vessel wall, smaller than males
2) Obese
3) Uses GP-IIb/IIIa