Vascular trauma in the Amazon - the challenge of great distances.

Adenauer Marinho De Oliveira Góes Junior,Simone De Campos Vieira Abib,Mariseth Carvalho De Andrade,Fábio Brito Braga,Allan Dias Vasconcelos Rodrigues

doi:10.1590/0100-69912015004009

Adenauer Marinho De Oliveira Góes Junior, Simone De Campos Vieira Abib + Show 3 more

Open Access

https://doi.org/10.1590/0100-69912015004009

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Abstract

to evaluate the incidence of unfavorable outcomes in vascular trauma patients and their possible correlation to the distance between the city where the injury was sustained and the hospital where the patient received definitive treatment. descriptive and retrospective study. Data were collected from medical records of patients submitted to surgical procedures for arterial or venous injuries from February 2011 to February 2013 at the only trauma center providing vascular surgery in a vast area of the Amazon region. Trauma date, patient gender and age, mechanism and anatomic topography of injury, surgical management, need for surgical re-intervention, hospitalization period, postoperative complications, mortality and limb amputation rates were analyzed. The incidence of unfavorable outcomes was assessed according to the distance between the city where the vascular injury was sustained and the trauma center. One hundred seventy-three patients with 255 vascular injuries were analyzed; 95.95% were male (p<0.05), mean age of 28.92 years; 47.4% were caused by firearm projectiles (p<0.05); topographic distribution: 45.66% lower limbs (p<0.05), 37.57% upper limbs, 6.94% abdominal, 5.2% thoracic and 4.62% were cervical vascular injuries; 51.42% of patients required hospitalization for seven days or less (p<0.05); limb amputation was necessary in 15.6% and the overall mortality was 6.36%. distances greater than 200 Km were associated to longer hospitalization period; distances greater than 300 Km were associated to increased limb amputation probability; severe vascular trauma have an increased death probability when patients need to travel more than 200 Km for surgical treatment.

Highlights

Trauma due to violence and traffic accidents represents the major cause of mortality and morbidity related to external causes worldwide[1,2]
This study aims to evaluate the outcomes of patients operated for vascular trauma at the only center providing specialized assistance in such a large area, which brings medical rescue and definitive care challenges
Most patients sustained penetrating traumas (88.44%), mainly firearm’s projectile wounds (FPW) (47.4%), a data supported by other studies[12,21]

Summary

Introduction

Trauma due to violence and traffic accidents represents the major cause of mortality and morbidity related to external causes worldwide[1,2]. Vascular injuries are among the most frequent death mechanisms on traumatized patients, representing considerable demand on civilian and military hospitals[3,4,5]. Many studies have shown that penetrating mechanisms prevail in vascular lesions and that lower limbs are the most frequent sites of injury[6,7,8]. Blunt trauma has worse prognosis than penetrating ones; as external bleeding is commonly absent, there can be no obvious sing of vascular trauma at the initial evaluation of the multi injured patient, delaying the suspicion of the vascular injury, in the patient with altered level of consciousness[9,10]. That explains why limb amputation rate differs from penetrating (10%) to blunt (30%) vascular traumas[13]

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