Civilian vascular injuries in the Jeddah area

ABSTRACT

Over a 2-year period, 42 consecutive patients who suffered vascular injury and were referred to the vascular surgery service at King Fahd Hospital, Jeddah, Saudi Arabia, were studied to define patterns and problems in their management. The majority were males [n = 35], and the mean age of the whole group was 29 years [range 4-60 years]. Only ten patients [23.8%] were above 40 years of age. Penetrating injuries occurred in 20 patients [47.6%], while blunt trauma was responsible for 16 injuries [38.1%]. Six patients had iatrogenic injuries. Trauma due to road traffic accidents headed the list of underlying aetiological factors, and was encountered in 16 patients [38.1%]. Acute limb ischaemia occurred in 27 patients [64.3%], while bleeding occurred in 19 patients [45.2%]; these being considered the most common modes of presentation. Associated orthopaedic injuries were found in 15 patients [35.7%]. Most of the injuries in our patients involved the extremities [n = 39]. Lower limb injuries were more common [59%] than upper limb injuries [41%]. A delay of more than 8 h from the onset of injury to presentation at our casualty department occurred in 12 cases [28.6%]. Angiography was performed in selected cases [n = 12]. Direct repair was attempted in 15 patients [35.7%] and was the commonest surgical procedure performed in the whole group of patients. No death was encountered in the whole group. Five limbs were lost [12.0%]. In the follow-up period, 32 patients [76.2%] were asymptomatic and only five [12.0%] had residual neurovascular deficits. However, none of them required any further surgery. In conclusion, early diagnosis of vascular injuries, particularly in multiple trauma victims, is essential to save more limbs in the future. Whenever possible, this must be followed by immediate transfer to a centre where angiography and vascular surgery facilities are available. Education of medical colleagues and improvement in transport are recommended