Surgical management of traumatic arteriovenous aneurysms

Abstract

For many years quadruple ligation and excision was the method of choice in the management of arteriovenous aneurysms. Such a procedure usually required a period of delay for the development of collateral circulation and frequently was followed by arterial insufficiency of the involved extremity. During the Korean conflict, primary repair of acute arterial injuries was shown to be feasible and the method of choice; this experience has been borne out in several large civilian series. To evaluate the changing concepts in the management of arteriovenous aneurysms in civilian practice, fifty consecutive cases, treated in the Baylor University College of Medicine Affiliated Hospitals, were reviewed. Although quadruple ligation and excision following a period of delay was employed in the early years of this series, in recent years our policy has been to repair the injury immediately if recognized, particularly in the presence of significant hemorrhage or arterial insufficiency of the distal part. Otherwise, repair was done as soon as the inflammatory reaction associated with wounding subsided, usually within one to two weeks. Quadruple ligation and excision was reserved for minor vessels. If a major vessel was involved, excision followed by some type of reconstructive arterial procedure was utilized. Careful attention was paid to concomitant venous repair whenever possible. By this policy normal circulation was restored in almost every instance. There were no deaths, and amputation was not required in a single patient.