J A Asensio

Creighton University, Omaha, Nebraska, United States

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Publications (191)442.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Las lesiones duodenales, debido a su localización retroperitoneal, constituyen un reto diagnóstico para el cirujano, de forma que son identificadas tardíamente y, en consecuencia, se asocian a un aumento de la morbimortalidad. En las mejores estimaciones las lesiones duodenales ocurren en un 4,3% de todos los pacientes con lesiones abdominales, en un rango de 3,7% a 5% y, además, debido a su proximidad anatómica con otros órganos sus lesiones raramente se presentan de forma aislada. El objetivo de este trabajo es presentar una descripción concisa de la anatomía, diagnóstico, manejo quirúrgico y tratamiento de las complicaciones del traumatismo duodenal, y realizar un análisis de las complicaciones y de la mortalidad de las lesiones del duodeno en función de una revisión de la literatura de los últimos 46 años.
    Cirugía Española 10/2014; 93(2). · 0.87 Impact Factor
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    ABSTRACT: Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitoneal location. When identified, they present associated with other abdominal injuries. Consequently, they have an increased morbidity and mortality. At best estimates, duodenal lesions occur in 4.3% of all patients with abdominal injuries, ranging from 3.7% to 5%, and because of their anatomical proximity to other organs, they are rarely an isolated injury. The aim of this paper is to present a concise description of the anatomy, diagnosis, surgical management and treatment of complications of duodenal trauma, and an analysis of complications and mortality rates of duodenal injuries based on a 46-year review of the literature. Copyright © 2014 AEC. Published by Elsevier Espana. All rights reserved.
    Cirugía Española 10/2014; 93(2). · 0.87 Impact Factor
  • Article: In brief.
    Current problems in surgery. 10/2014; 51(10):414-5.
  • Current Problems in Surgery 10/2014; · 1.42 Impact Factor
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    ABSTRACT: Background Multimodality monitoring and goal directed therapy (MM&GDTP) may not prevent blood flow and brain oxygen (Flow/BrOx) crisis. We sought to determine the impact of these events on outcome in patients with severe TBI (sTBI). Methods 24 patients with sTBI were treated to maintain ICP≤ 20 mmHg, CPP ≥ 60 mmHg, brain oxygen (PbtO2) ≥ 20 mm Hg, and Near Infrared Spectroscopy (NIRS) ≥ 60%. Flow/BrOx crisis events were recorded. The 14-day predicted mortality (PM) was compared to actual mortality (AM). Results Non-survivors (NS) had a significantly higher number of crisis events non-responsive to treatment, p < 0.05. Mortality was 87.5% versus 6.3% in patients with ≥ 20 and < 20 events, respectively. The PM was 58% whereas AM was 33.3% (8/24), yielding a 42% reduction in mortality. Conclusions A MM&GDTP may decrease mortality in sTBI. However, Flow/BrOx crisis events still occur and predict a poor outcome.
    The American Journal of Surgery 09/2014; · 2.41 Impact Factor
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    ABSTRACT: Introduction Man’s inhumanity for man still knows no boundaries, as we continue as a species as a whole to engage in war. According to Kohn’s Dictionary of Wars [1], of over 3,700 years of recorded history, there have been a total of 3,010 wars. One is hard pressed to actually find a period of time in which here has not been an active conflict in the globe. The world has experienced two world wars: WWI (1914–1918) and WWII (1939–1945). The total number of military casualties in WWI was over 37 million, while WWII so far, has been the deadliest military conflict in history with over 60 million people killed accounting for slightly over 2.5 % of the world’s population. Material and methods The purpose of this study is to review contemporary wars and their contributions to vascular injury management. It is precisely wartime contributions that have led to the more precise identification and management of these injuries resulting in countless lives and extremities saved. However, surgeons dealing with vascular injuries have faced a tough and arduous road. Their journey was initiated by surgical mavericks which undaunted, pressed on against all odds guided by William Stewart Halsted’s classic statement in 1912: “One of the chief fascinations in surgery is the management of wounded vessels.” Conclusion Contemporary wars of the XX–XXI centuries gave birth, defined and advanced the field of vascular injury management.
    European Journal of Trauma and Emergency Surgery 01/2014; · 0.26 Impact Factor
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    ABSTRACT: The evaluation and management of patients with vascular trauma or injury often involve rapid decision making in less than ideal circumstances. Immediate consequences such as hemorrhage, ischemia, compartment syndrome, thrombosis, and embolization may be life threatening and require immediate intervention. In addition, a number of regional and systemic complications of the initial vascular pathology are possible, such as shock, acute renal failure, myocardial infarction, or stroke. Understanding the disease process, as well as the optimal diagnostic and therapeutic interventions, is critically important to minimize the risk of these highly morbid or potentially mortal complications. The managing physician must be adept and well versed at both the initial management of the specific vascular injury and the many potential complications that may subsequently arise. This article will review a number of vascular-specific complications and provide details of strategies for their prevention or optimal management. These problems include traumatic injuries to the arterial or venous system, failure of vascular repairs or reconstructions, surgical site and graft infections, anastomotic complications, and compartment syndromes. In addition, arterial and venous complications secondary to the use of illicit intravenous drug use and cocaine-related vascular injury will be discussed. Finally, the increasingly important topic of iatrogenic or procedure-related vascular injuries and complications will be reviewed.
    European Journal of Trauma and Emergency Surgery 12/2013; · 0.38 Impact Factor
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    ABSTRACT: Explosives create and energize particles that act as projectiles prone to further fragmentation or create other secondary missiles in the body. These fragments may result in secondary injuries. This has been repeatedly described in the orthopedic and neurosurgical literature. We report the same process for abdominal injuries after fascial penetration in the military setting. This is an observational case series study. Local wound exploration as a standard approach was performed in conscious patients who sustained abdominal wall injuries. Patients with negative physical examination were excluded from the study. An intraperitoneal injury was assumed in those with a full-thickness fascial defect, and laparotomy was performed. Twenty patients met the study eligibility criteria. Of those 20 patients, 12 had negative wound exploration and were excluded from the study, while abdominal organ injuries were found in eight (40%) patients. During laparotomy, projectile-induced injuries in a sprayed distribution were found in three (38%) of these patients. These injuries were far from the predictable trajectory and in the absence of bone fragmentation. The overall mean number of peritoneal defects was 1.7, and a mean 6.8 intra-abdominal injuries for each peritoneal defect were found when through-and-through injuries were excluded.Despite a single peritoneal defect, there may be multiple intraperitoneal injuries due to further fragmentation of the projectile. Under mass casualties, wound exploration with a full-thickness fascial defect could serve as an indicator of possible intra-abdominal injuries, and consequently indicate exploratory laparotomy.
    Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 11/2012; 18(6):531-4. · 0.38 Impact Factor
  • Source
    T Vu, F N Mazzini, J A Asensio
    Annals of The Royal College of Surgeons of England 10/2012; 94(7):530. · 1.22 Impact Factor
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    ABSTRACT: Introduction Injury to the iliac vessels poses a serious and frustrating treatment dilemma for all trauma surgeons. Generally, patients present in profound shock secondary to severe hemorrhage from either iliac arterial, venous, or combined injuries. Despite improvements in our emergency medical services (EMS), rapid transport, standard training of trauma surgeons, and improved technology, the morbidity and mortality from iliac vessel injuries remain high, ranging from 25 to 40 %. Materials and methods A systematic review of the literature, with emphasis placed on the diagnosis, treatment, and outcomes of these injuries, incorporating the author’s experience. Conclusions Injuries to the iliac vessel remain a daunting task, even after great advances in anatomic injury grading and damage control as well as advances in surgical techniques and critical care. Despite all the advances in treatment and appropriate management strategies, the morbidity and mortality from iliac vessel injuries remain high, demonstrating the complex challenge their treatment presents to even the modern-day trauma surgeon.
    European Journal of Trauma and Emergency Surgery 08/2012; 38(4). · 0.38 Impact Factor
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    ABSTRACT: Introduction Vascular injuries in branch vessels of the popliteal artery, such as the tibioperoneal trunk, and shank vessels, such as anterior, posterior tibial, and peroneal vessels, occur in both blunt and penetrating trauma. Their management has evolved significantly in the past few decades. While their incidence is variable, limb loss and morbidity remain significant. Material and methods Physical examination, along with measuring an Ankle–Brachial Index (ABI), is still sometimes all that is required for diagnosis and can expeditiously triage those that require urgent operation. Despite our technological advancements and newer algorithms for lower extremity vascular trauma, operative intervention and exposure still remain difficult and pose a great challenge for surgeons that normally do not operate on this area. Conclusions Shank vessel injuries still comprise a significant proportion of combat and civilian vascular injuries, and modern advances have led to a dramatic decrease in amputation rates.
    European Journal of Trauma and Emergency Surgery 08/2012; 38(4). · 0.38 Impact Factor
  • Juan Manuel SÁNCHEZ, Pablo MENÉNDEZ, Juan Antonio Asensio
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    ABSTRACT: Abdominal vascular lesions are amongst the most lethal lesions suffered by patients with multiple injuries, as well as being among the most difficult and challenging for the surgeon. They are rarely isolated, they are usually found with associated multiple injuries, which increases its seriousness and the time required to repair them and may lead to a significant morbidity and mortality. The correct management involves an early diagnosis and surgical approach.
    Cirugía Española 04/2012; · 0.89 Impact Factor
  • Juan Manuel Sánchez, Pablo Menéndez, Juan Antonio Asensio
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    ABSTRACT: Abdominal vascular lesions are amongst the most lethal lesions suffered by patients with multiple injuries, as well as being among the most difficult and challenging for the surgeon. They are rarely isolated, they are usually found with associated multiple injuries, which increases its seriousness and the time required to repair them and may lead to a significant morbidity and mortality. The correct management involves an early diagnosis and surgical approach.
    Cirugía Española 02/2012; 90(4):215-21. · 0.87 Impact Factor
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    ABSTRACT: Introduction Thoracic and thoracic related vascular injuries represent complex challenges to the trauma surgeon. Subclavian vessel injuries, in particular, are uncommon and highly lethal. Regardless of the mechanism, such injuries can result in significant morbidity and mortality. Materials and methods Systematic review of the literature, with emphasis on the diagnosis, treatment and outcomes of these injuries, incorporating the authors’ experience. Conclusions These injuries are associated with significant morbidity and mortality. Patients who survive transport are subject to potentially debilitating injury and possibly death. Management of these injuries varies, depending on hemodynamic stability, mechanism of injury, and associated injuries. Despite significant advancements, mortality due to subclavian vessel injury remains high.
    European Journal of Trauma and Emergency Surgery 10/2011; 37(5). · 0.38 Impact Factor
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    ABSTRACT: Introduction Axillary vessel injuries are uncommon and challenging injuries encountered by trauma surgeons. Proximity of this vessel to other adjacent veins including the axillary vein, brachial plexus and the osseous structures of the shoulder and upper arm account for a large number of associated injuries. Materials and methods Systematic review of the literature, with emphasis on the diagnosis, treatment and outcomes of these injuries, incorporating the authors’ experience. Conclusions Although uncommon, axillary arterial injuries can result in significant morbidity, limb loss and mortality. Early diagnosis and timely repair of the artery leads to good outcomes.
    European Journal of Trauma and Emergency Surgery 10/2011; 37(5). · 0.38 Impact Factor
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    ABSTRACT: Carotid arterial injuries are the most difficult and certainly the most immediately life-threatening injuries found in penetrating neck trauma. Their propensity to bleed actively and potentially occludes the airway and makes surgical intervention very challenging. Their potential for causing fatal neurological outcomes demands that trauma surgeons exercise excellent judgment in the approach to their definitive management. The purpose of this article is to review the diagnosis and management of these injuries.
    European Journal of Trauma and Emergency Surgery 10/2011; · 0.38 Impact Factor
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    ABSTRACT: Introduction Reports of arterial injuries from both the civilian and military arenas report the brachial artery as the most frequently injured vessel, accounting for approximately 25–33% of all peripheral arterial injuries. The brachial artery is surrounded by important peripheral nerves —the median, ulnar and radial, and also parallels the humerus and associated veins. Due to its close proximity to these structures, associated nerve and osseous injuries are frequent with residual neuropathy from such nerve injuries, often the main sources of permanent disability. Materials and methods Systematic review of the literature, with emphasis in the diagnosis, treatment and outcomes of these injuries, incorporating the authors experience. Conclusions The morbidity and mortality rates associated with brachial artery injuries depend on the cause of the injury itself, which vein or tendon is injured, and whether musculoskeletal and nerve injuries are also present. During the last 20 years, amputation associated with upper extremity arterial injuries has decreased to a rate of 3% because of advances in the treatment of shock, the use of antibiotic therapy, and increased surgical experience.
    European Journal of Trauma and Emergency Surgery 10/2011; · 0.38 Impact Factor
  • Source
    J. A. Asensio
    European Journal of Trauma and Emergency Surgery 10/2011; 37(5). · 0.38 Impact Factor
  • T Vu, K D Stahl, J A Asensio
    Annals of The Royal College of Surgeons of England 09/2011; 93(6):490-1. · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Upper extremity injuries are increasingly common among peripheral vascular injuries, as a result of penetrating trauma (Figure 18.1). Blunt trauma may also result in significant vascular injury primarily due to associated injuries such as fractures and dislocations. Injuries to the brachial artery are most commonly reported.
    01/2011: pages 403-411;

Publication Stats

4k Citations
442.38 Total Impact Points

Institutions

  • 2014
    • Creighton University
      • Department of Surgery
      Omaha, Nebraska, United States
  • 2013
    • Westchester Medical Center
      Valhalla, New York, United States
  • 2012
    • Hospital Universitario Nuestra Señora de Candelaria
      Cancelaria, Canary Islands, Spain
  • 2009–2012
    • University of Miami Miller School of Medicine
      • • Department of Surgery
      • • Division of Trauma and Surgical Critical Care
      Miami, Florida, United States
  • 2006–2012
    • University of Miami
      • Department of Surgery
      كورال غيبلز، فلوريدا, Florida, United States
  • 1997–2009
    • University of Southern California
      • • Department of Surgery
      • • Keck School of Medicine
      Los Angeles, CA, United States
  • 2007
    • Stavanger University Hospital
      • Division of Surgery
      Stavanger, Rogaland Fylke, Norway
  • 1996–2007
    • University of California, Los Angeles
      • Department of Surgery
      Los Angeles, CA, United States
  • 2000–2003
    • Keck School of Medicine USC
      Los Ángeles, California, United States
    • California State University, Los Angeles
      Los Ángeles, California, United States