Management of combined femoral artery and vein injuries

The aim of this study was to review our experience with combined injuries to the femoral artery and vein, and to analyze the role of venous repair. Thirty two patients with penetrating injuries of the both femoral artery and vein underwent surgical management at our hospital from May 1999 to August 2009. Primary vascular repair was carried out whenever possible; if not possible the interposition graft was used. This study group consisted of 27 males and 5 females, ranging in age from 15 to 72 years with a mean age of 28.3 years. The mechanism of injury included gunshot wounds in 18 patients and stab wounds in 14 patients. Primary arterial repair was performed in 17 patients. Autogenous saphenous vein graft was used in nine patients and vein patch in two patients. Polytetraflouroethylene [PTFE] graft was used in four patients. All patients had associated venous injuries of which 24 patients had primary venous repair, five had vein graft interposition, and two had PTFE graft interposition. Seven patients had fasciotomies. Graft thrombosis occurred in three arterial repairs. Above-knee amputation was required in two patients with femur fracture. Patients with combined femoral artery and vein injuries can be managed successfully with clinical assessment alone. In these dual vascular injuries, both the femoral artery and vein injuries should be repaired to avoid complications. If venous ligation becomes compulsory, adjuvant therapies and techniques should be recommended such as the use of fasciotomy, anticoagulation treatment, elevation of the lower limb and compression stockings

Surgical Techniques for haemostasis in penetrating trauma to femoral artery

To analyse the efficacy of various operative procedures and factors affecting the outcome especially the effect of limb ischemia time in penetrating trauma to the femoral artery. Prospective. Study was conducted at West Surgical Ward, Mayo Hospital Lahore. August 2001 to July 2004. All the patients >12 years of age referred from periphery as well as directly admitted with penetrating trauma to the femoral vessels alone or associated with other organ injuries having hard/soft physical signs of an arterial injury were included in the study. 39[97.5%] patients were male, age ranged from 14-53 years with the mean limb ischemia time of 7.8 hours in the series. 35[87.5%] patients sustained firearm injuries. Superficial femoral artery was injured in 23[57.5%] followed by vein in 12[30%] and major vessels were found intact in 4[10%] patients. Lateral arteriorrhaphy was performed in 4[10%] and venorrhaphy in 3[7.5%] patients with 100% succ ess rate, resection and primary anastomosis in 18[45%] patients with pseudo aneurysm formation in 1[2.5%] patient. Reverse great saphenous vein graft was interposed in 9[22.5%] patients with graft failure rate of 5% [2 patients]. Femoral vein was ligated in 12[30%] patients with development of deep vein thrombosis in 2[5%] patients. There were 3[7.5%] deaths. No synthetic graft was used in the series. Exsanguination, prolonged injury duration, associated organ injuries and extensive soft tissue and skin damage of the extremities were the major factors responsible for increased morbidity particularly limb loss and mortality. Proximity of injury to the femoral vessels was a poor predictor of an arterial injury in the study. Arteriorrhaphy and primary end-to-end anastomosis are the main stays for an arterial injury repair, next comes the use of autogenous vein graft, in our setup. Moreover ligation of femoral vein is not associated with leg amputation

Estratégias atuais para o tratamento da infecção em revascularização infra-inguinais / Current strategies for the management of infection in lower extremity revascularization

A infecção pós-operatória representa uma complicação grave em revasculatizaçóes de membros inferiores e sua prevenção, controle e tratamento são um desafio ao cirurgião vascular. Os pacientes que desenvolvem essa infecção apresentam não só morbidade aumentada, como também mortalidade significativa. A infecção pós-operatória é difícil de ser erradicada e, se não for adequadamente tratada, pode causar falência do enxerto vascular, hemorragia e sepsis, sendo de extrema importância o uso de medidas para a prevenção da infecção pós-operatória. A utilização de técnicas menos invasivas para a retirada.da veia safena magna em cirurgias de revascularização de membros inferiores e o uso de próteses impregnadas com sais de prata e antibióticos são exemplos de medidas profiláticas utilizadas. O sucesso do tratamento requer uma ampla compreensão da fisiopatogenia do processo, assim como o uso criterioso das várias modalidades terapêuticas, entre elas: a ntibioticoterapia apropriada, o desbridamento cirúrgico e a revascularização quando necessário. Atualmente, o uso de próteses impregnadas com rifampicina tem se mostrado eficaz no tratamento de infecção causada pelo Staphylococcus epidermidis. Os resultados iniciais com o uso de enxertos autólogos criopreservados e a utilização da veia femoral superficial como substituto arterial são promissores. O objetivo deste artigo é fazer uma revisão atualizada sobre a avaliação e o tratamento da infecção em revascularizaçóes infrainguinais.

Remissäo de insuficiência cardíaca através de correçäo endoluminal de fístula arteriovenosa femoral com o uso de stent recoberto / Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent

We report the case of a 21-year-old male with high-output heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas

Lesiones arteriales / Arterial injuries

Objetivo: Evaluación diagnóstica y terapéutica, de resultados y complicaciones de esta patología. Materila y métodos: Entre mayo de 1990 y mayo de 1995 se operaron en el Hospital Durand, 65 pacientes con lesiones vasculares periféricas. Fueron analizadas las historias clínicas y fichas de seguimiento de consultorios externos, evaluando la incidencia, con cálculo porcentual de los ítem analizados. Resultados: El 83 por ciento fueron del sexo masculino. El grupo etario prevalente entre 20 y 29 años, siendo el 91 por ciento abiertos. El miembro más afectado fue el superior. Las arterias más lesionadas fueron la humeral, femoral, radial y poplítea, y las venas femoral común y poplítea. Ingresaron con síndrome hemorrágico el 66 por ciento de los pacientes y el 34 por ciento isquémico. El tratamiento más frecuente fue la interposición venosa, siguiéndole la anastomosis termino-terminal arterial. Hubo un 12 por ciento de complicaciones (trombosis) y la mortalidad fue del 1,5 por ciento. Conclusiones: Tratamos de usar vena autóloga para restablecer la continuidad del flujo arterial. En isquemias prolongadas realizamos fasciotomías. Resecamos ampliamente músculos isquémicos. En algunos pacientes con pulsos distales presentes se constató arteriográficamente lesiones vasculares y viceversa. Si hay fracturas asociadas, primero realizamos la inmovilización y luego el reparo vascular

Lesiones venosas mayores en las extremidades inferiores: presentación de dos casos / Transoperative severe venous injuries of the lower extremities

Comunicación del caso de pacientes con lesión iatrogénica de las venas iliofemorales. En el primer caso la lesión ocurrió durante una hernioplastia inguinal y en el segundo en una safenectomía. Ambas lesiones se repararon con injerto venoso autólogo en espiral. El primer paciente fue intervenido quirúrgicamente 48 horas después de la lesión, la reparación mejoró el retorno venoso sustancialmente. La otra lesión fue reparada durante la operación original y el resultado fue completamente satisfactorio. Las lesiones venosas iliofemorales son raras y deben ser reparadas en cuanto se advierten para disminuri la morbilidad. La técnica con injerto venoso autólogo en espiral demostró ser útil en estos dos pacientes.

Traumatismo de los vasos femorales / Traumatisms of the femoral vessels

Se analizan 32 traumatismos de los vasos femorales haciendo consideraciones etiopatogénicas, clínicas, de diagnóstico y terapéuticas. Se enumeran las técnicas empleadas para la reconstrucción arterial: sutura simple 3 casos (12%), interposición con safena 10 (40%), anastomosis terminoterminal 9 (36%), parche con vena 2 (8%) y "bypass" femoropoplíteo en 1 caso (4%). En las reparaciones venosas se utilizó en 4 casos (44,4%) la anastomosis terminoterminal en 3 casos (33,3%) la interposición con safena y en 2 (22,2%) la sutura simple. Del total de miembros operados, 31 (96,8%) fueron viables y la mortalidad incluyó 1 enfermo por lesiones asociadas. Se discute la utilidad de la arteriografía, destacando las ventajas de la utilización venosa cuando es necesario interponer un injerto