Peripheral vascular injuries; epidemiology and management

ABSTRACT

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. [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. Non interventional observational study. CMH Kohat. From 01 Jan 2004 to 31 Dec 2006. 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. 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 of 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%. 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