Peripheral vascular injuries: diagnosis, management, out come, and review of risk Factors

The aim of this study is to retrospectively analyse our data regarding patients with vascular injuries admitted to Al-Noor hospital, reviewing the diagnosis, management, outcomes and identifying the risk factors associated with limb loss. Between November 2003 and January 2006, prospectively collected data for 152 patients with vascular injuries were reviewed and analysed retrospectively. The data were obtained from data base of all the hospital admissions. 88 [57.9%] patients were due to blunt trauma. In 52 [34.2%] patients the injury was due to penetrating wounds and 12 [7.3%] patients sustained firearm injuries. The upper limb was affected in 68 [44.7%] patients, lower limb in 65 [42.8%] patients, neck in 12 [7.9%] patients and pelvis in 7 [4.6%] patients. 151 arterial injuries and 28 venous injuries. Brachial artery was the most common type of injury, 36 [20.1%] of the injuries, 29 [16.2%] popliteal artery injuries, superficial femoral artery injuries were 14 [7.8%'], and 14 [7.8%] were ulnar artery injuries. 80 patients had associated fractures and dislocations. Supracondylar fracture of the numerous was the commonest [28]. Extensive soft tissue injury and open fracture were present in 30 patients, 65 of the arterial injuries were managed by vein graft repair. 62 fasciotomies were done, 50 for lower limb and 12 for upper limb injuries. 5 of our patients with combined musculoskeletal and vascular injuries of the lower limb underwent primary vascular shunt insertion, 5 arteries and 2 veins. We had 12 patients underwent amputation and 3 patients died during their hospitalisation. Blunt trauma is more serious than penetrating injuries. The most significant risk factor for limb loss was failure of revascularization

Upper limb arterial injury: Management and Outcome

In this study we are aiming to document and analyse the roles of arterial damage and associated injuries on long-term functional outcomes after upper extremity arterial trauma. In this retrospective study we reviewed patients who presented with an arterial injury to the upper limb during the period between [2003 to 2006]. The location and management of the arterial injuries, the nature and severity of concomitant nerve injuries and the overall degree of disability in the survivors were determined. 68 patients were included in this study. 34 patients [50%] sustained blunt injuries, 33 [48.5%] were presented with penetrating injuries, and one patient sustained firearm injury. The most common site of arterial injury was the brachial artery 36 patients [52.9%]. The most common method of surgical management was an autogenous vein interposition graft, placed in 24 patients [35.3%]. 28 patients were suffered serious upper limb fractures such as supracondylar fracture humerous. There were 19 nerve injuries. Residual disability was present in 13 patients [19%]. Only 2 patients had complete recovery of the injured nerves. Associated injuries, rather than the vascular injury, are the cause of long-term disability in the multisystem trauma victim who has upper extremity arterial injury

Recurrent varicose veins: investigation of reflux patterns and causes of recurrence

This study was conducted to investigate the patterns of venous reflux and causes of recurrent varicose veins disease with venography, color flow duplex imaging and operative exploration. Eighty-five limbs of sixty-three unselected patients with residual or recurrent varicose veins after undergoing an operation were included in this study. 57.3% of the limbs with a recurrence in the long saphenous vein [LSV] system had incompetent perforating veins. Incompetent perforators in the thigh were more common after ligation than stripping, but this finding was not true in the calf. After saphenopopliteal junction ligation was performed, the more common pattern was the reflux in the short saphenous vein [SSV]. A precise mapping of the reflux and an identification of the possible causes were required to instigate the appropriate treatment. Color flow duplex imaging was an efficient noninvasive diagnostic technique. Routine LSV stripping reduced the rate of recurrence

Reconstruction for multisegmental lower limb occlusive arterial disease

This study was conducted on 40 limbs in 32 patients classified into two groups. They were evaluated clinically, hemodynamically and by imaging techniques. Multiple criteria were used to identify patients with multilevel disease likely to benefit from multilevel correction. The mortality and morbidity rates were not significantly different between group A and B. The pregnancy rate for inflow procedures was 90.9% in group A and 94.1% in group B. Limb salvage rate was 42.8% in group A and 84.6% in group B. 59.1% in group A were relieved of their symptoms, while 83.3% in group B were cured. 27.2% of patients in group A required subsequent distal bypass. The study concluded that complete correction of multilevel disease can be accomplished with the operative time, morbidity, mortality and patency rates equal to that of single level repair. Multilevel procedures provide a complete relief of symptoms in a higher percentage of patients than has been reported after single level repair. This approach is indicated in limbs with critical ischemia and diabetics with severe distal lesions