3 results found in Vascular Trauma
Social Determinants of Health and Clinical Outcomes in Patients with Diabetic Foot Ulcers in Singapore
By: Dylan Marc Cheong
Diabetic foot ulcers (DFU) represent a major global health concern, contributing substantially to clinical morbidity, functional impairment and healthcare expenditure worldwide. While multidisciplinary care has improved outcomes, the influence of Social Determinants of Health (SDOH) on DFU disease and clinical trajectories remain underexplored in Asian populations. Understanding how social, behavioural, and contextual factors interact with clinical care is critical for crafting patient-centred models for more optimal DFU prevention and management. This study aims to identify and analyse key domains of SDOH—adapted from a framework proposed by Hill-Briggs et al. (2020)— and examine how micro-level social variables predict disease severity and clinically meaningful outcomes among patients with DFU. A retrospective cohort study was conducted among adults (n=168) with DFU who presented to Woodlands Health, Singapore, between May 2024 and December 2024. Patients who were deceased or recently admitted were excluded. Social variables, disease severity markers and outcomes were extracted from electronic health records. Dependent variables included glycaemic control, WIfI classification scores, clinical staging, and outcomes such as readmission, re-ulceration, healing status, incision and drainage (I&D), revascularisation and lower-extremity amputations (LEA). Categorical data were binary-coded, and univariate analysis performed using two-tailed Fisher’s exact test. Mean patient age was 63 ± 13 years with 65.5% male, 38.1% Malay, and 56.0% non-English-speaking. Most had lower educational attatinment (78.0%) and were unemployed (62.1%). Sedentary lifestyle (58.4%), smoking (52.7%) and poor dietary control (56.4%) were common, alongside limited social support (45.5%) and poor healthcare engagement, with 43.5% defaulting follow-ups. Non-English language preference and unemployment were associated with poorer glycaemic control (p = 0.001, p = 0.02) and higher ischemia and infection WIfI scores (p = 0.01, p = 0.02), while malnutrition was a strong predictor of 1-year risk of LEA (p = 0.003). Defaulting appointments predicted re-ulceration (p = 0.02) and readmission (p = 0.04) incidences, while higher education predicted complete wound healing (p = 0.007). Unemployment was associated with greater need for I&D (p = 0.009) and revascularisation (p = 0.001), whereas caregiver dependence predicted major LEA (p = 0.01) and revascularisation (p = 0.001). Social disadvantage, poor health behaviours and low healthcare engagement were prevalent among DFU patients. Language barriers, unemployment and malnutrition predicted greater disease severity, while education and healthcare engagement improved healing. These findings highlight the influence of social determinants on DFU outcomes and the need for integrated, socially-responsive care models that address both clinical and social risk factors to improve healing and limb preservation.
Vascular TraumaPost-traumatic Axillofemoral Bypass Graft Rupture: A Rare Vascular Emergency
By: Raoua Harrath
Background: Axillofemoral bypass graft (AFBG) is an extra-anatomic revascularization technique used in selected patients with lower extremity occlusive disease. The most frequently reported complications of AFBG are graft thrombosis and infection, while mechanical disruption or pseudoaneurysm formation is uncommon and potentially life-threatening. Traumatic non-anastomotic pseudoaneurysm or rupture of an AFBG is exceptionally rare, with fewer than 20 cases reported in the literature. We report a unique case of blunt trauma inducing a rupture of an axillofemoral bypass graft. Case Report: A 48-year-old male, chronic smoker with no other significant medical history, initially underwent an aortobifemoral bypass and a left femoro–posterior tibial bypass in March 2024 for critical limb-threatening ischemia. Unfortunately, both grafts thrombosed within seven months, necessitating an AFBG and left transtibial amputation, after which he was started on long-term oral anticoagulation. Eight months later, the patient sustained a blunt abdominal trauma following a fall from standing height. Two weeks post-injury, he presented to the emergency department with a large, tense swelling over the left lateral abdominal wall. He was hemodynamically stable and laboratory tests revealed a hemoglobin level of 13.3 g/dL, hematocrit 40.7%, platelets 206,000/μL; prothrombin time (PT) 16.9 sec, INR 4.6; troponin 4 ng/L; creatinine clearance 97 mL/min. Computed tomography angiography (CTA) demonstrated an 8 cm pseudoaneurysm along the axillofemoral graft with contrast extravasation, confirming graft rupture. The patient was admitted to the cardiovascular surgery unit and underwent urgent operative repair. Upon surgical exploration and evacuation of the contained hematoma, the rupture site was identified along the mid-lateral abdominal segment of the graft. No active bleeding was present at that time. The disrupted graft ends were separated by approximately 6 cm and were both securely ligated. Graft reconstruction was deferred due to complete thrombosis of the distal graft leg and adequate perfusion of the residual limb via profunda femoris collaterals and remnants of the common and external iliac arteries. The postoperative course was uneventful, and the patient was discharged in good condition. At three-month follow-up, he remained well, with stable hemodynamics and no recurrence of swelling or infection. Conclusion: This case underscores the potential severity and diagnostic challenges of mid-graft AFBG disruption. Awareness of this rare but life-threatening complication can facilitate early recognition and timely surgical intervention, which are essential for limb preservation and minimizing morbidity.
Vascular TraumaA Rare Case Of An Isolated Traumatic Ruptured Left Iliac Artery and Endovascular Repair
By: Daniel Hern
Background Iliac vascular injuries are uncommon (Around 2% of all vascular injuries presenting to trauma centres) and when they do occur, they are more likely as a result of penetrating trauma. When injury to iliac arteries occurs due to blunt trauma it is more commonly affecting the internal iliac arteries. The usual mechanism of secondary to blunt trauma is often through laceration from pelvic fracture. Therefore, a common iliac artery injury secondary to blunt trauma in isolation is particularly peculiar. Iliac artery injury can present with persistent hypotension and abdominal distension however this can be more occult due to the typical retroperitoneal bleeding. In all cases due to blunt trauma, repair with end-to-end anastomosis or graft is usually required. Iliac artery injuries are shown to be lethal with analysis reporting a 51% overall survival rate of isolated iliac vessel injury. Case A 68-year-old woman was pre-alerted to A&E with abdominal pain following a fall one week prior and feeling a pop in her left lower abdomen. She was hypotensive, tachycardic and reported to be in maximal pain whilst appearing haemodynamically unstable. Initial FAST scan was inconclusive. CT revealed a significant injury to the left common iliac artery. Other than a small left sided haemothorax there were no other acute injuries identified. Overall, this demonstrated an isolated left common iliac artery injury/dissection with associated large volume retroperitoneal haematoma. She underwent resuscitation with blood to maintain normotension before being emergency transferred to the nearest vascular centre. The rupture was controlled with embolisation of the left internal iliac artery and insertion of iliac covered stent graft. This was done endovascularly with retrograde access via the right common femoral artery. After navigating past the bifurcation, the left internal iliac artery was cannulated and embolised. The iliac artery was stented from distal to the artery origin to past the area of ruptured pseudoaneurysm. Angiogram confirmed success with no endoleak demonstrated. She recovered remarkably well and was discharged with no post op complications during her admission. Discussion This case highlights the importance of considering potential intra/retro peritoneal bleeding when treating a patient presenting with haemodynamic instability and abdominal pain (especially post trauma). This is commonly remembered in trauma management with the mnemonic of “blood on the floor and four more”. This case presented with abdominal bleeding and although US FAST scan is an effective immediate investigation it is very operator dependant and therefore gold standard diagnostic in this case is through Pan CT. Conclusion Despite data showing that iliac artery rupture is an uncommon vascular emergency, even less so in isolation, this case shows that it is possible. This injury should be considered in patients presenting with haemodynamic instability, abdominal pain and with a history of trauma even in the absence of other traumatic injuries such as bony injuries, particularly due to the severity and associated mortality rate (up to 50% in iliac arterial injuries). This can be managed effectively through emergency endovascular surgery and is demonstrated to have a considerably successful outcome in this case.
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