Peripheral Vascular Trauma among Vascular Surgery Cases Operated in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Sushil Dahal,Prasesh Dhakal,Robin Man Karmacharya,Sohail Bade,Pratima Thapa,Niroj Bhandari,Amit Kumar Singh,Prabha Shrestha,Satish Vaidya,Sahil Bade

doi:10.31729/jnma.6764

Sushil Dahal, Prasesh Dhakal + Show 8 more

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https://doi.org/10.31729/jnma.6764

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Abstract

Peripheral vascular trauma can result in limb or life-threatening injuries. Early surgical intervention leads to a better outcome. Diagnosis is made clinically, by non-invasive and invasive imaging modalities. Our aim in this study is to find out the prevalence of peripheral vascular trauma among vascular surgery cases operated in a tertiary care centre of Nepal. This is a descriptive cross-sectional study of peripheral vascular injuries that underwent operative management in a tertiary care hospital of Nepal from January 2018 to May 2020. Ethical approval was taken from the Institutional Review Committee of Kathmandu University School of Medical Sciences (Registration Number 79/20). Convenience sampling technique was used. Data for the study was retrieved from operation records of the patients along with their treatment summaries and entered and analyzed in the Statistical Package for Social Sciences version 20.0. All cases with complete records were included. Conservatively managed cases and cases that underwent primary amputation were not included in the study. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 624 vascular surgery patients, 40 (6.41%) (4.48-8.33 at 95% Confidence Interval) patients had presented with peripheral vascular trauma during the study period. There were 26 (65%) cases where the upper limb was involved. The prevalence of vascular surgery for peripheral vascular trauma among vascular surgeries operated in our study was similar to other studies done in similar settings. Vascular injury needs urgent intervention and appropriate management will result in a high chance of limb salvage and survival.

Highlights

Peripheral vascular trauma can result in limb or life-threatening injuries
Among 624 vascular surgery patients, 40 (6.41%) (4.48-8.33 at 95% Confidence Interval) patients had presented with peripheral vascular trauma during the study period
The prevalence of vascular surgery for peripheral vascular trauma among vascular surgeries operated in our study was similar to other studies done in similar settings

Summary

Introduction

Peripheral vascular trauma can result in limb or life-threatening injuries. Surgical intervention leads to a better outcome. Peripheral vascular injuries accompany up to 5% of total injuries of the extremities.[1] Initial physiological response to vascular injury is vascular spasm.[2] It is essential that we revascularize the limb within the golden time period, that is two hours of ischemia before there is permanent nerve damage or at most 4-6 hours after which the muscle is not salvageable.[3] Lower limb proximal arteries are associated more with life and limb loss whereas amputation was more associated with distal arterial injuries.[4]. Mortality is associated more with penetrating injury and limb loss more with blunt injury.[4,5] Different surgical interventions according to the type of injuries are anastomosis, lateral repair, reverse saphenous vein graft, or ligation if repair is not possible.[6]

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