Vascular Trauma in Civilian Practice- Experience at Lady Reading Hospital Peshawar Pakistan

Abstract

Introduction - To evaluate vascular trauma management mainly on clinical assessment, at a less equipped set-up and compare the outcome in early and late presented patients. Methods - A prospective study of vascular trauma patients at Lady Reading, Peshawar. The nature, site, early and late presentation and outcome of surgery in vascular injuries presenting to our department between Jan 2007 to Dec. 2017 were assessed. Out of these cases, only few stable neck injuries had pre-operative angiographies. There were 2041 vascular injuries in 1952 patients (mean age 29, range 3—71 years). Mechanism and nature of injuries were assessed. Early presentations (group A: 667 cases < 8 hours) were compared with late presentations (group B: 1285 cases > 8 hours). The hospital mortality, complication, associated injuries and outcome were assessed. Results - Male accounted for 90% of patients. The majority of injuries (79.85%) were caused by bullets; followed by stab injuries (7.35%), blunt trauma (8.75%) and Iatrogenic (3.38%). 62.74% were arterial, 11.35% were venous, 24.10% were mixed, 2.11% had intact vessels. Upper limb injuries were 31.63%, lower limb (60.16%), remaining were neck or abdominal injuries. Associated injuries included fractures (16.38%), nerve injuries (25.42%), chest injuries (5.93%), abdominal (9.03%) and cervical spine or head injuries (1.41%). About 70% presented with hemorrhage and 80% with pulse deficit. Injuries treated with end-to-end anastomosis (44%), vein graft (21.46%), prosthetic graft (6.98%), lateral suture (16.66%), Ligation (5.36%), thrombectomy (4.51%) and primary amputation (2.25%), Group "A" had higher mortality than group "B" (16% vs. 5%) with amputation rate of (7.86% vs. 10.48%) and infection rate of (32% vs. 14.65%). Conclusion - The higher mortality in those arriving within 8 hours of injury reflects, their more severe injuries. Early recognition and prompt referral to vascular surgery center may save life and limbs in vascular trauma patients.