Clinical characteristics of latent artery injury in orthopaedics and the efficiency of intra-arterial therapy

Abstract

Objective To observe clinical characteristics of orthopaedic patients with latent artery injury and evaluate the efficiency of intra-arterial therapy. Methods Data of 13 orthopaedic patients with latent vascular injury who were enrolled in our hospital from June 2010 to October 2014 were retrospectively analyzed. There were 9 males and 12 females with an average age of 45.6 years(19-75 years). The affected arteries included superior gluteal artery (4 cases), obturator artery (2 cases), subclavian artery (2 cases), femoral profound artery (2 cases), femoral artery (1 case), popliteal artery (1 case) and brachial artery (1 case). According to the classification of systematic arterial injuries by Zhang Yingze, there were 6 cases of Type B and 7 cases of Type C. All patients were comfirmed by angiography with an average time of 16 hours (2-70 h) from primary injuries, and had undergone intra-arterial therapy with covered stent, spring coil and gelfoam. The functioning of arteries evaluated by ultrasound, CTA or DSA and the complication were recorded. Results Bleeding was successful controlled in 5 cases with covered stent, 5 cases with spring coil and 3 cases with spring coil and gelfoam. 7 cases with shock were improved immediately. 5 cases suffering lacunar infection were cured after repeated debridement. 1 case with popliteal artery rupture had amputation due to the long warm ischemia time. 1 case had gluteus muscular necrosis and secondary MODS, but recovered after treatment. All patients were followed up for 3-24 months with an average period of 7.3 months. No displacement of the stent, vascular occlusion and leakage were found. Conclusions Because latent artery injuries at an early stage are characterized by closure, delay and untypicality, they are often missed. Angiography is the gold standard for diagnosis. Intra-arterial therapy is an effective intervention for patients with latent non-major arterial injuries of Type B and C, and there are less recurrences and complications. Key words: Vascular system injuries; Endovascular procedures; Angiography