Evaluation, Surgical Management and Outcome of Traumatic Extremity Vascular Injuries: A 5-year Level-1 Trauma Centres Experience (original) (raw)
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EXTREMITY VASCULAR INJURIES ? A PROSPECTIVE STUDY.
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Journal of Islamabad Medical & Dental College
Background: Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan. Material and Methods: This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size < 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Co...
Vascular injuries of the extremities are a major challenge in a third world country
Journal of Trauma Management & Outcomes, 2015
Background: Traumatic vascular injuries of the extremities are a major challenge especially in the third world countries. These injuries are mostly due to poor traffic laws, street crimes, firearms and blast associated injuries. We therefore would like to share our 10 years of experience in dealing with vascular injuries in Pakistan. Methods: This was a retrospective observational study conducted in the department of vascular surgery of Liaquat National Hospital, Karachi, Pakistan. Patients' records were retrieved from the department and were reviewed. Cases with vascular injuries of upper and lower limb that presented with signs of salvageable limb and presented within 12 hours of injury were included in the study. Patients with more than 12 hours of presentation and in whom primary amputation was done, were excluded from the study. Results: There were 328 patients who presented with vascular injuries of the extremities that fell in the inclusion criteria. Limb salvage rate was 41 %, whereas 30-days perioperative mortality was 5.48 %. The major cause of limb loss was delay in presentation of more than 8 h of injury. Major vessels involved were popliteal artery (41.76 %), followed by femoral artery (27.43 %). Conclusion: Vascular injuries are becoming a major contributor of limb loss in third world countries due to violence, terrorism and unavailability of vascular facilities. This morbidity can be reduced by improving law and order situation, evolving an effective emergency ambulatory system and with better training and provision of vascular services in remote areas so that the delay factor can be reduced.
A two-year experience of treating vascular trauma in the extremities in a military hospital
JPMA. The Journal of the Pakistan Medical Association, 2013
To assess the presentation, diagnostic evaluation, various techniques of vascular repair and their outcomes. The prospective descriptive study was conducted at the Combined Military Hospital, Rawalpindi, from October 2008 to December 2010. It involved 54 patients with vascular injuries in the extremities who underwent various vascular surgical interventions.Those who presented with irreversible ischaemia or had primary amputation and presented late with missed vascular injuries were excluded. The cases were evaluated for mechanism of injury, site and type of injury, associated injuries, type of repair performed and its outcome. Mean with standard deviation and frequency and percentage was calculated wherever relevant. The mean age of 54 patients was 26.8 +/- 9.2 years (range: 9-67 years), and the male-to-female ratio was 17:1. Penetrating trauma was the most common cause (n=34; 62.9%). Lower extremities were affected more commonly (n=33; 61.1%) and superficial femoral artery was the...
Amputation-free treatment of vascular trauma patients
2010
Amaç: Bu çalışmada vasküler yaralanma nedeniyle cerrahi onarım işlemi uygulanan olgular ve tedavi sonuçları geriye dönük olarak değerlendirildi. Ça lış ma pla nı: Haziran 2005 -Eylül 2008 tarihleri arasında vasküler yaralanma nedeniyle kliniğimizde cerrahi onarım işlemi uygulanan 165 hasta (140 erkek 25 kadın; ort. yaş 30.1±11.5 yıl; dağılım 12 -73 yıl) çalışmaya dahil edildi. Vasküler travmaya yol açan yaralanmaların 96'sı alt ekstremitede, 61'i üst ekstremite ve sekizi ise batında idi. Bul gu lar: Yaralanmaların en sık nedeni penetran yaralanmalardı (n=110) ve hastaların 55'i ateşli silahla yaralanmıştı. Hastaların 145'inde arteriyel hasar saptandı. Yüz sekizinde izole arter ve 20'sinde izole ven hasarı tespit edildi. En sık yaralanan arterler femoral (n=47) ve popliteal (n=35) arterler idi. En sık hasar gören ven femoral ven (n=26) idi. En sık tercih edilen cerrahi tedavi primer onarım (n=105) idi. Ameliyat sonrası mortalite oranı iki hastanın kaybıyla %1.2 oldu. Ameliyat sonrası dönemde yedi hastaya (%4.2) fasyotomi açılması gerekti. Ortalama hastane kalış süresi 5.2±5.0 (dağılım 0-30) gün oldu. So nuç: Erken cerrahi girişim, yaralanma şekli, yara yeri ve ek lezyon varlığı vasküler yaralanmalarda morbidite ve mortaliteyi etkileyen en önemli parametrelerdir.
OUTCOME ANALYSIS OF UPPER LIMB VASCULAR TRAUMA ? OUR INSTITUTIONAL EXPERIENCE.
Introduction: Vascular injuries involving major vessels can be limb threatening and at times life threatening. Ours being a a tertiary care center, we encounter lot of vascular injuries due to industrial accidents and road traffic accidents. Loss of upperlimb means loss of job. This study is to analyze the outcomes of upper limb vascular injuries. Methods: This is a prospective study from august 2015 and is an ongoing study.we are submitting the interim report of the study till March 2018. All patients admitted with upper limb vascular trauma proximal to wrist irrespective of age and mode of injury were included in our study. Results: Blunt injury was seen in 22 cases (68.75%).Most common complication was wound infection 6/32 (18.75%).Graft thrombosis seen in two patients (6.25%).Pseudoaneurysm with blow out occurred in 1 patient (3.125%) In spite of delayed presentation (>6 hours) and wound infections and ligation of artery due to pseudoaneurysm,all the limbs were saved (limb salvage rate is 100%). Conclusion: Timely intervention in upper limb vascular injuries can save the limb and at times the life. This means they can be economically productive and lead a independent life.
Vascular trauma and its management: one and a half years after the 25th January revolution
Background/Aim Vascular trauma is a common life-threatening injury leading to serious consequences if not timely and efficiently managed. Although they represent less than 3% of all injuries, they deserve special attention because of their severe complications. The aim of this study was to analyze the causes of injury, presentations, surgical (recent) approaches, outcomes, and complications of vascular trauma. Patients and methods This was a retrospective analysis performed over 1.5 years. From January 2011 to June 2012, 48 patients were included in the study and were operated upon for peripheral vascular injuries. Diagnosis was made by physical examination as well as with hand Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was carried out whenever possible; however, if it was not possible, an interposition vein graft was placed. In some patients, endovascular approaches were applied, whereas in other patients a combination of open surgical and endovascular approaches was used (hybrid technique). Results Of the total 48 patients who sustained major vascular injuries during this period, 17 sustained injuries to the upper limb vessels, 26 had injuries of the lower limb vessels, two patients had injuries of the abdominal vessels, and three patients had injuries of the neck. A penetrating trauma was the cause in 45 cases and a blunt trauma was the cause in three cases. Of the 48 patients, 46 patients were successfully managed by vascular reconstruction without any residual disability. There were 46 male patients (95.83%) and two female patients (4.16%), and their ages ranged from 17–40 years (mean 28.5 years). Conclusion Patients who suffer vascular injuries should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.
The journal of trauma and acute care surgery, 2012
Extremity arterial injury after penetrating trauma is common in military conflict or urban trauma centers. Most peripheral arterial injuries occur in the femoral and popliteal vessels of the lower extremity. The Eastern Association for the Surgery of Trauma first published practice management guidelines for the evaluation and treatment of penetrating lower extremity arterial trauma in 2002. Since that time, there have been advancements in the management of penetrating lower extremity arterial trauma. As a result, the Practice Management Guidelines Committee set out to develop updated guidelines. A MEDLINE computer search was performed using PubMed (www.pubmed.gov). The search retrieved English language articles regarding penetrating lower extremity trauma from 1998 to 2011. References of these articles were also used to locate articles not identified through the MEDLINE search. Letters to the editor, case reports, book chapters, and review articles were excluded. The topics investig...