Management of Vascular Injury during Current Peaceful Yemeni Revolution

Abstract

To provide a complete review of our experience on the observed vascular injuries patterns during contemporary Yemeni revolution, management strategies used in the care of injuries and to highlight lessons learned from that period. From February 2011 to January 2012, all casualties evaluated at Yemen International Hospital, were prospectively entered into a database and retrospectively reviewed. Data collected included site, type, and mechanism of vascular injury, associated trauma, type of vascular repair; initial outcome, amputation rate, and complication. Of 2,200 injured patients evacuated from field hospital, vascular injuries occurred in 63 patients, and these patients comprised the study group. Fifty-one (80.9%) patients were wounded by gunshots high velocity, 6 (9.5%) were wounded by gunshots low velocity, and 6 (9.5%) experienced explosive devices injury. Most of injuries 55 (87%) occurred in the extremities 45 (71%) in the lower extremities and 10 (16%) in the upper extremities, 3 (5%) in carotid arteries, 3 (5%) in internal iliac arteries, and 2 (3%) in internal jugular vein. Nearly half 31 (49%) of the patients sustained complex vascular injuries (arterial and venous injuries), isolated arterial injuries 28 (45%), and isolated venous injuries 4 (6%). Twenty (32%) of the patients underwent complete revascularization and 11 (15%) just arterial repair with venous ligation. According arterial management 32 (51%) of patients underwent revascularization with venous graft, 18 (29%) repaired by end-to-end anastomosis, 1 (2%) polytetrafluorethylene, 7 (11%) thrombectomy, and 5 (8%) arterial ligation. Vascular injuries were associated with bony fracture in 33 (52%) of patients. Postoperative wound infection occurred in 9 (14%) patients. Of those, 7 had venous ligation. Secondary amputation and mortality rates during the study period were 3 (5%) and 4 (6%), respectively. This report represents the first analysis of vascular injuries during contemporary Yemeni revolution in Taiz city. Vascular injuries occurred in 3% of revolution-related injured patients. Our secondary amputation rate of extremities was 5%. Management of arterial repair with autologous vein graft remains the treatment of choice. Ligation of venous injured in a watershed area, such an iliofemoral and popliteal vein should be avoided to prevent leg phlegmasia.