Experience of vascular trauma in a tertiary care hospital

ABSTRACT

To highlight the presentation and management of various vascular injuries and their outcome. Descriptive study. Surgical unit III, Combined Military Hospital, Rawalpindi, from September 2005 to October 2006. Thirty nine cases of vascular trauma were referred to vascular surgeon CMH Rawalpindi, in the above mentioned period. These cases were evaluated for mechanism of injury, age, gender and time of presentation. Out of these, only thirty cases were found suitable for surgical intervention. These thirty cases were evaluated for site of vascular injury, associated injuries, type of surgery performed and the outcome. Blunt trauma was the predominant cause of vascular injuries in our study 16/39 [41%]. Fourteen cases [35.8%] had gun shot wounds. Only thirty patients [76.9%] underwent various surgical procedures. Primary end to end anastomosis was possible in only 5/30 cases [16.6%] while reversed venous graft was used in 13/30 cases [43.3%]. Wound infection occurred in 2/30[6.6%] cases out of which 1 case [3.3%] ultimately had an amputation. The time period between injury and surgical intervention ranged between 1 to 20 hours for most of the vascular injuries while delayed presentation in the form of traumatic arteriovenous fistula or pseudoaneurysm was between 48 hours to 3 months. There are reasonable numbers of vascular trauma cases being referred to a tertiary care hospital. Most of these cases reach us quite late due to unnecessary investigations, delayed referral and transportation. Early intervention and revascularization definitely reduces amputation and complication rate. All gunshot wounds not only require thorough surrounding soft tissue debridement but also liberal excision of traumatised vessel itself, resulting in interposition graft repair