Peripheral Arterial Injuries: an Indian Experience.

Abstract

Arterial injuries present the most challenging conditions in surgical practice. Many fail to reach the specialist in time and end up losing limbs or lives. Though well addressed elsewhere, it has received less attention in developing countries like India. There is a need to study these injuries from the perspective of countries like India. The aims of the study are to (1) analyze the epidemiology, presentation, and outcomes of arterial injuries operated by the author in Indian settings; (2) identify factors associated with adverse outcomes; and (3) discuss the critical issues with relevance to our country. Retrospective analysis of arterial injuries operated by the author between July 2010 and February 2014 at our institution was performed. Patients with feasibility of revascularization were included and nonviable limbs requiring primary amputations were excluded. Sixty-one patients fulfilled the criteria of which 55 (90.1%) were males and 6 (9.8%) females aged between 5 and 70years. The mean duration of presentation was 21h. Majority were resultant of road traffic accidents (62.7%). Among 49 (80.3%) noniatrogenic injuries, the mechanism was blunt in 46 (93.8%, n = 49) and penetrating in 3 (6.1%) cases. Iatrogenic injuries were seen in 12 (19.6%) cases. Lower limbs accounted for 37 (60.6%) cases, popliteal segment being common, 22 (36%) cases. Bony injuries were associated in 39 (63.9%) cases. The most common procedure was interposition graft (49.1%). Six (9.8%) patients required an amputation resulting in 55 (90.1%) salvaged limbs. Reaching a specialist center in appropriate time can result in good limb salvage rates and functional outcomes. Creating awareness and training the personnel are the critical issues in the management of arterial injuries in India.