Management of serious arterial injuries of the limbs

Abstract

Introduction: The majority of arterial traumas concern the arteries of the limbs and today most often occur in a multiple lesion context. In addition, the iatrogenic pathology due to catheterizations, and the specific accidents of drug addiction have been added to classic vascular trauma and pose a specific management problem. Objective: The objective of this study is to compare the results of our series with other data from the literature. This, in order to elucidate the intersections as well as the differences, the purpose of which is to codify the principles of management of serious vascular trauma to the limbs. Patients and methods: A retrospective review was conducted in the Cardiovascular Surgery Department of Gafsa Hospital, of 23 patients with severe vascular limb trauma between 2012 and 2020. Patient data included socioeconomic data, mechanism lesion, the clinical admission profile, the vascular axis affected, whether or not an additional examination is carried out, the associated lesions as well as the therapeutic management and evolution. Our series excluded patients lost to follow-up as well as those admitted for minor arterial trauma. Results: The average age of our patients was 38.3 years (extremes: 3 and 81), with a clear male predominance of 86.7%. The mechanism was primarily weapon assault white (39%) followed by iatrogenic accidents (35%) and public road accidents (13%). The upper limb was the most traumatized (52%). In the most affected territories, there was the wound of the brachial artery in the first place (34.8%), followed by the territory of the common femoral artery (21.7%). The most frequent clinical picture was the association of hemorrhage with ischemia (34.8%), followed by hemorrhage (30.8%) then false aneurysms (21.7%). During our series, CT angiography was requested in 30.7% of patients, and arterial echo-Doppler for 26% of patients. The surgical intervention was an end-to-end suture (34.7%), the interposition of a venous graft was performed in 4.3% of cases, and 5 patients benefited from a bypass (21.7%). Limb salvage was 100%. Conclusion: The management of serious vascular trauma has experienced great development in terms of diagnostic and therapeutic means which aim to revascularize the affected limb and stop the bleeding, on which the functional and vital prognosis depend respectively.