Management of combined femoral artery and vein injuries

ABSTRACT

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