EVALUATION OF EMERGENCY REVASCULARISATION IN VASCULAR TRAUMA

Authors

  • Mohammad Iqbal Khan
  • Najam Khan
  • Shafquat Ali Abbasi
  • Mohammad Tariq Baqai
  • Bashir ur Rehman
  • Abdul Wayne

Abstract

Background: Vascular trauma is a common life threatening injury leading to serious consequences if not timely and efficiently managed.  We evaluated early surgical interventions aimed at revascularization and thus salvaging limb/ organ in life threatening vascular injuries.  Aims of our study were to evaluate the outcome of available diagnostic modalities, earliest possible surgical intervention and rate of related complications with particular reference to our existing situation. Methods: Emergency diagnostic workup based mainly on clinical evaluations and required laboratory and imaging parameters leading to revascularisation was performed in 48 patients in Combined Military Hospital (CMH) Muzaffarabad and Islamic Medical College Hospitals between June 1997 and December 2001. Data was collected on pre-designed computerized proforma’s which were completed by the treating surgeon and data was entered and analyzed accordingly.  Results: Out of the total 48 patients who sustained major vascular injuries during this period, 14 (29.2%) were having injury to upper limb vessels, 26 (54.2%) patients had injury to the lower limb vessels, 6 (12.5%) patients reported with injury to abdominal vessels.  One (2%) patient had injury to common carotid artery, while an other patient to thoracic aorta respectively (2%).  Penetrating trauma caused 38 (79%) and blunt trauma caused 10 (21%) major vascular injuries.  Out of 48 patients, 41 (85.4%) patients were successful managed by vascular reconstruction without any residual disability.  Conclusion:  Speedy diagnostic work up and early revascularization yields favourable outcome in vast majority of patients requiring vascular repair.  Selections of surgical technique including use of autologous vein graft or artificial vascular graft can save many limbs. In order to achieve good results the time lapse between injury and revascularisation should be less than 6 hours.Key words: vascular injury, emergency revascularisations, limb umasalvage.

References

Frykberg E R. Advances in the diagnosis and treatment of extremity vascular trauma. Surg Clin North Am 1995;75:207-23.

Rich NM, Baugh JH, Hugh as CW: Acute arterial injuries in Vietnam. 1000 cases. J Trauma 1970;10:359-69.

Frykberg ER, Dennis JW, Bishop K: The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year. J Trauma 1991;31(4): 502-11

Guraya SY, Gardezi JR, Sai GA, Malik U, Nasim A, Imran A. “Peripheral vascular injuries – Jinnah hospital Lahore experience. Pakistan Post Graduate Med J 2000;11(3)99-102

Nassoura ZE, Ivatury RR, Somon RJ: A reassessment of Doppler pressure indices in the detection of arterial lesions in proximity penetrating injuries of extremities: a prospective study. Am J Emerg Med 1996;14(2):151-5

Sheriff AA. Vascular injuries, Experience during the Afghanistan War. Int Surg 1992;77:133-4

Hafez HM, Woolgar J, Robbs JV: Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 2001;33(6): 1212-9

Siegmeth A, Mullner T, kukla C, Vecsei V.” Associated injuries in severe pelvic trauma. Unfallchirurg 2000;103(7):572-81 [German]

Jahnke EJ. Late structural and functional results of arterial injuries primarily repaired. Surgery 1998;43:175-83.

Miller PR, Kortesis BG, McLauhilin CA, Chen My, Chang MC. Complex blunt aortic injury or repair; beneficial effects of cardiopulmonary bypass use. Ann Surg 2003;237(6) 877-83.

Espinosa Ga, Chiu JC, Samett EJ: Clinical assessment and arteriography for patients with penetrating extremity injuries: a review of 500 cases with the Veterans West Side Medical Center. Military Medicine 1997;162:19-23

Gahtan V, Bramson RT, Norman J. The role of emergent arteriography in penetrating limb trauma. Am Surg 1994; 60(2):123-7.

Jan WA, Samad A, Anwar R. Mortality and morbidity of abdominal inferior vena cava injuries. J Coll Physician Surg Pak 2004;14910) 622-5

Starnes BW, Bruce JM. Popliteal artery trauma in a forward deployed Mobil Army surgical hospital. Lessons learned from the war in Kosovo. J Trauma 2000;48:1144-9

Davidovic L, Lotina S, Kostic D. Popliteal artery war injuries. Cardiovasc Surg 1997;5:133-7

Bynoe RP, Miles Ws, Bell RM. Noninvasive diagnosis of vascular trauma by duplex ultrasonography. J Vasc Surg 1991;14(3):346-52

Bouchart F, Bessou J, Tabley A, Litzler PY, Haas-Hubscher C. Acute traumatic rupture of the thoracic aorta and its branches. Result of surgical management. Ann 2001; 126(3) 201-11 [French[.

Meimner M, Paun M, Johansen K: Duplex scanning for arterial trauma. Am J Surg 1991;161:552-5.

Cuschieri A, Steele RJC, Moossa AR. Essential surgical practice by Butterworth. 4th ed Rome, Heinemann, Italy, fourth edition 2000.

Hood DB, Weaver FA, Yellin AE: Changing perspectives in the diagnosis of peripheral vascular trauma. Semin Vasc Surg 1998;11(4):255-60

Knudson MM, Lewis FR, Atkinson K. The role of duplex ultrasound arterial imaging in patients with penetrating extremity trauma. Arch Surg 1993;128(9): 1033-7.

Nassoura ZE, Ivatury RR, Somon RJ. A reassessment of Doppler pressure indices in the detection of arterial lesions in proximity penetrating injuries of extremities: a prospective study. Am J Emerg Med 1996;14(2):151-5

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