Treatment of Major Vascular Injuries

ABSTRACT

PURPOSE: Major vascular injuries are frequently a challenging problem, jeopardizing patient or limb survival. We performed this retrospective study to establish an optimal management plan for major vascular injuries. METHOD: Our subjects consisted of 38 cases treated for major vascular injury between January 1999 and December 2002 at Gil Medical Center. The cause of injury, location, clinical presentations, treatment modalities and prognosis were reviewed. RESULT: The mean age was 48.6 years (range 18~76) and the male-to-female ratio was 1.51. There were 34 arterial injuries and 11 venous injuries, including 7 cases with both injuries. The causes of injury were iatrogenic in 22 cases, traffic accident in 7, stab injury in 5, industrial injury in 3, and fall injury in 1. In the iatrogenic injuries, 15 cases were due to angiography or vascular interventional procedures, 6 to other operations, and 1 to arterial catheter for pressure monitoring. The types of arterial injuries were pseudoaneurysm in 16 cases, laceration in 7, thrombosis in 6, transection in 2 and arteriovenous fistula (AVF) in 3. The venous injury types were laceration in 6 cases, AVF in 3, and thrombosis and transection in 1 each. We performed various types of revascularization operation in 26 cases and radiologic intervention in 12. There was no hospital mortality or unexpected major amputation. CONCLUSION: Recently, as a consequence of the widespread application of vascular interventional procedures, the incidence of iatrogenic vascular injuries has increased. The factors for successful management of major vascular injuries are early diagnosis, earlier involvement of a vascular surgeon in the patient care, and prompt revascularization either by surgery or interventional procedure.