PERIPHERAL VASCULAR INJURIES

Abstract

Introduction: Peripheral vascular injuries constitute4-6% major trauma. Although uncommon the complication of hemorrhage and Ischemia can be limb threatening andlife threatening. Rapid diagnosis and appropriate treatment is therefore essential. Delay allows irreversible Ischemicinjury to take place and encourages propagation of intravascular thrombosis, which results in eventual loss of functionor even limb itself. Objective: (I) To collect data about different aspect of epidemiology and management of Peripheralvascular injuries. (II) To study the relationship between latent period for revascularization and outcome of surgery.Design: Non interventional observational study. Setting: C M H Kohat. Period: From 01 Jan 2004 to 31 Dec 2006.Material & Methods: Total of 46 cases of all age and sex groups was included in the study. Only those patients wereincluded who had vascular injury to extremities whether direct (penetrating, blunt) or indirect (associated with fractureand dislocations) injuries. Relevant history was obtained from the patients themselves and from their relatives orwitnesses. Relevant physical examination was performed. Necessary investigations were done. Patients were treatedaccording to standard protocol. Results: The peripheral vascular injuries were more common in 21-40 years of agegroup (69%) and among male(82%).Vascular trauma caused by the firearm injuries (60.86%) was the most commoncause, other being road traffic accidents (26.08%) and blunt trauma (13.04%). The most common clinical presentationwas shock and paresthesia (50%). Most off the patient reached hospital within 6-12 hours (47%), and belongs to ruralareas (69%). Frequency of involvement of vessels was femoral artery (41%) and brachial artery (23%). Types ofvascular injuries were , laceration to the vessel wall (56%) and loss of vessel wall segment (17%). End-to-endanastomosis was most common (78%) .others being interposition reverse vein graft (13%) and direct suturing of vesselwall (8.7%)Amputation rate was highest in cases where revascularization occurred after more than 12 hour (71%).Common complications after repair were residual edema (17%) and infection (6%). Overall mortality rate was 4 % andmorbidity rate was 28%. Conclusion: All cases of peripheral vascular injuries should be surgically explored.Revascularization should be achieved within 12 hours. Patients presenting late or with crush injuries may needamputation.