Surgical techniques for hemostasis in penetrating trauma to femoral artery

Abstract

Objectives: To analyse the efficacy of various operative procedures and factors affecting the outcome especially the effect of limb ischemia time in penetrating trauma to the femoral artery. Study Design: Prospective. Setting: Study was conducted at West Surgical Ward, Mayo Hospital Lahore. Duration: August 2001 to July 2004. Materials and Methods: All the patients >12 years of age referred from periphery as well as directly admitted with penetrating trauma to the femoral vessels alone or associated with other organ injuries having hard/soft physical signs of an arterial injury were included in the study. Results: 39(97.5%) patients were male, age ranged from 14-53 years with the mean limb ischemia time of 7.8 hours in the series. 35(87.5%) patients sustained firearm injuries. Superficial femoral artery was injured in 23(57.5%) followed by vein in 12(30%) and major vessels were found intact in 4(10%) patients. Lateral arteriorrhaphy was performed in 4(10%) & venorrhaphy in 3(7.5%) patients with 100 % succ ess rate, resection and primary anastomosis in 18(45%) patients with pseudo aneurysm formation in 1(2.5%) patient. Reverse great saphenous vein graft was interposed in 9(22.5%) patients with graft failure rate of 5% (2 patients). Femoral vein was ligated in 12(30%) patients with development of deep vein thrombosis in 2(5%) patients. There were 3(7.5%) deaths. No synthetic graft was used in the series. Conclusion: Exsanguination, prolonged injury duration, associated organ injuries and extensive soft tissue and skin damage of the extremities were the major factors responsible for increased morbidity particularly limb loss and mortality. Proximity of injury to the femoral vessels was a poor predictor of an arterial injury in the study. Arteriorrhaphy and primary end-to-end anastomosis are the main stays for an arterial injury repair, next comes the use of autogenous vein graft, in our setup. Moreover ligation of femoral vein is not associated with leg amputation.