Management Of Peripheral Vascular Trauma: Our Experience

Abstract

Introduction: The incidence of vascular trauma has increased considerably during the past 40 years. However, although they represent less than 3% of all injuries, they deserve special attention because of their severe complications. The study is to analyses the causes of injury, presentations, surgical approaches, outcome and complication of vascular trauma of the upper and lower limbs. Methods: A retrospective analyses of twelve years. From January 1992 to December 2004, 662 patients were operated for peripheral vascular injuries. Diagnosis was made by physical examination and hand Doppler alone or in combination with Doppler scan/angiography. Primer vascular repair was carried out where possible; if not possible the interposition vein graft was placed. Early liberal fasciotomy was considered as and when required. Patients with isolated venous trauma and patients with obviously unsalvageable lower extremity injury requiring primary amputation were excluded from the study. Result: Five hundred and eighty of the patients were males (88%) and eighty two of them were females (12%), and their ages ranged from 4-65 years (mean 24 years). Mean duration of presentation was ten hours after the injury. The most common etiological reason was road traffic accidents i.e. 70% in penetrating trauma group and 52% amongst all blunt traumas. Incidence of concomitant orthopedic injuries was very high in our study (70.2%). The most common injured artery was brachial artery (32.6%), followed by popliteal artery (29.7%).Surgical procedures performed were primary repair in 55.5%, whereas interposition vein grafts were placed in 35.2% cases. The limb salvage rate was 94.2%. Conclusion: Patients who suffer vascular injuries to the extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present. Early fasciotomy is warranted if there is any suspicion of occurrence of compartment syndrome.