warfarin and Wounds--Gunshot

A 35-year-old man developed priapism with the use of low-molecular-weight heparin and warfarin following repair of left brachial artery sustained after gunshot injury. Priapism progressed to penile gangrene despite decompression and distal shunt procedure leading to total penectomy and perineal urethrostomy. We describe the mechanism of anticoagulant (heparin and warfarin)-induced penile gangrene and the possible methods to avert such a devastating complication.

Topics: Adult; Anticoagulants; Brachial Artery; Dalteparin; Drug Therapy, Combination; Gangrene; Hemopneumothorax; Humans; International Normalized Ratio; Male; Penis; Perineum; Postoperative Care; Postoperative Complications; Priapism; Saphenous Vein; Thrombosis; Ultrasonography, Doppler, Color; Urethra; Warfarin; Wounds, Gunshot

Iliac vein aneurysm is a rare vascular abnormality. It has been reported as a primary aneurysm of unknown cause, or, when a cause could be identified, as a secondary iliac vein aneurysm. Occasionally, iliac vein aneurysm develops in association with distal arteriovenous fistula. Although venous aneurysms occur most commonly in the neck and central thoracic veins, they also have been reported in the visceral veins and the extremities.Herein, we present the case of a 34-year-old man in whom a giant external-iliac-vein aneurysm was incidentally found during the investigation of a post-traumatic femoral arteriovenous fistula. The aneurysm was surgically resected, the iliac vein was reconstructed by means of lateral venorrhaphy, and the patient had an uneventful, complete recovery. We discuss the origin of the aneurysm and our choice of surgical techniques.

Topics: Adult; Aneurysm; Anticoagulants; Arteriovenous Fistula; Femoral Artery; Femoral Vein; Humans; Iliac Vein; Incidental Findings; Male; Stockings, Compression; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Vascular Surgical Procedures; Vascular System Injuries; Warfarin; Wounds, Gunshot

A prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p less than 0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p less than 0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p less than 0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

Topics: Aspartate Aminotransferases; Blood Proteins; Extracorporeal Circulation; Heart Valve Prosthesis; Humans; Hypoxia; L-Lactate Dehydrogenase; Liver; Prothrombin Time; Warfarin; Wounds, Gunshot