Experience in treatment of post-traumatic arteriovenous discharges syndrome resulting from gunshot wounds of the main vessels

Abstract

The aim — to analyze the experience of surgical treatment of patients with posttraumatic arteriovenous discharges in the lower limbs. During the period of the Anti-Terrorist Operation in the east of Ukraine, 8 patients with AV-discharge aged 25 to 57 years old (middle age — 42 years) were hospitalized in the department of vascular surgery at the National Military Medical Clinical Center «Main Military Clinical Hospital». In all patients, AV-fistulas arose as a result of fragmentation wounds of the vessels of the extremities. All patients underwent primary surgical debridement of wounds and repositioning of bone fragments. By localization the distribution of damage was as follows: the predominant affection of vessels of middle caliber — 10 (56 %), arteries of lower extremities — 10 (56 %), including femoral arteries — 5 (50 %), popliteal arteries — 3 (30 %), the anterior tibia arteries — 1 (10 %), posterior tibia arteries — 1 (10 %). Open surgery was performed in 6 (75 %) cases, X-ray-endovascular — in 1 (12.5 %), combined stage-by-stage treatment — in 1 (12.5 %). Minimally invasive endovascular interventions are effective both in acute and chronic vascular trauma, but the possibility of their use is limited by anatomical features. Radical surgical elimination of the AV-discharge guarantees an improvement in the systemic hemodynamics indicators already in the early postoperative period. Methods of X-ray endovascular occlusion and endovascular prosthetics, as well as the combined use of surgical and X-ray endovascular methods, can be independent methods of treating traumatic injury.