PERIPHERAL VASCULAR INJURIES

EPIDEMIOLOGY AND MANAGEMENT

Abstract

Introduction: Peripheral vascular injuries constitute
4-6% major trauma. Although uncommon the complication of hemorrhage and Ischemia can be limb threatening and
life threatening. Rapid diagnosis and appropriate treatment is therefore essential. Delay allows irreversible Ischemic
injury to take place and encourages propagation of intravascular thrombosis, which results in eventual loss of function
or even limb itself. Objective: (I) To collect data about different aspect of epidemiology and management of Peripheral
vascular injuries. (II) To study the relationship between latent period for revascularization and outcome of surgery.
Design: Non interventional observational study. Setting: C M H Kohat. Period: From 01 Jan 2004 to 31 Dec 2006.
Material & Methods: Total of 46 cases of all age and sex groups was included in the study. Only those patients were
included who had vascular injury to extremities whether direct (penetrating, blunt) or indirect (associated with fracture
and dislocations) injuries. Relevant history was obtained from the patients themselves and from their relatives or
witnesses. Relevant physical examination was performed. Necessary investigations were done. Patients were treated
according to standard protocol. Results: The peripheral vascular injuries were more common in 21-40 years of age
group (69%) and among male(82%).Vascular trauma caused by the firearm injuries (60.86%) was the most common
cause, other being road traffic accidents (26.08%) and blunt trauma (13.04%). The most common clinical presentation
was shock and paresthesia (50%). Most off the patient reached hospital within 6-12 hours (47%), and belongs to rural
areas (69%). Frequency of involvement of vessels was femoral artery (41%) and brachial artery (23%). Types of
vascular injuries were , laceration to the vessel wall (56%) and loss of vessel wall segment (17%). End-to-end
anastomosis was most common (78%) .others being interposition reverse vein graft (13%) and direct suturing of vessel
wall (8.7%)Amputation rate was highest in cases where revascularization occurred after more than 12 hour (71%).
Common complications after repair were residual edema (17%) and infection (6%). Overall mortality rate was 4 % and
morbidity rate was 28%. Conclusion: All cases of peripheral vascular injuries should be surgically explored.
Revascularization should be achieved within 12 hours. Patients presenting late or with crush injuries may need
amputation.