VASCULAR TRAUMA IN THE AMAZON REGION: A TWO YEARS CASES REVIEW FROM A SINGLE INSTITUTION

Abstract

Introduction: Vascular injuries are among the main mechanisms of death in trauma. In Brazil, the general surgeon is in charge of emergencies procedures in most hospitals, but many times these surgeons are not familiarized with more complex vascular surgical techniques that often require a vascular surgeon. Pará State is the most populated one in the Brazilian Amazon region and a single hospital with vascular surgeons permanently on call is available. Objectives: To evaluate demographic data on vascular trauma victims; to establish the mechanism, anatomic location, injury pattern and surgical techniques used to manage the vascular lesions treated at the Metropolitan Emergency Hospital; to ascertain associated non-vascular injuries and victim’s clinical outcome. Methods: Retrospective analysis of medical records of patients treated for vascular injuries from February 2011 to February 2013 at the institution in case. All arterial and venous injuries were analyzed. Patients who were not operated by the vascular surgery team, iatrogenic injuries and those who underwent primary or sustained traumatic amputation were excluded. Results: 173 cases; 95.95% were male; 54.90% were between 25 and 49 years; penetrating trauma mechanisms were found in 88.44%; lower limb was the most affected topography (41.50%); the most injured vessels were the superficial femoral and ulnar arteries (in 15.75% of cases each) and the superficial femoral vein (17.77 %); autologous vein graft was the most performed technique for arterial repair (36.57%) and ligature was performed in 85.00% of venous trauma; amputation rate was 15.60% and mortality rate was 6.35%. Conclusions: Vascular injuries occurred predominantly in men from 24 to 49 years old; penetrating mechanisms were most frequent; lower limb was the most affected topography; the most frequently injured vessels were the ulnar and superficial femoral arteries and the superficial femoral vein; complete vessel transection was the most common injury pattern; arterial trauma was most frequently treated by autologous venous graft interposition and ligature was performed for most of venous injuries; fractures were the most common associated lesions; the majority of patients recovered uneventfully, ischemic and infectious complications were the most frequent ones; deaths were caused by hypovolemic and septic shocks.