INTERVENTIONS TO VASCULAR INJURIES

Purpose: The incidence of vascular injuries has increased worldwide during the last few years and very often these injuries are associated with complex trauma to extremities. The risk of fatalities is very high unless prompt diagnosis is made and appropriate surgical management is applied. The patients who underwent surgical operation for vascular trauma over the period between 1999 and 2003, were analysed retrospectively for etiology, localization, modality of the injury, existence of associated trauma , procedure of the operation and hospital mortality and morbidity.

Methods: Among the 64 cases, in 59 patients (%92.1) the injuries were penetrating, in 3 patients (%4.7) had gunshot wounds, in 1 patient (%1.6) had falling down and in 1 patient (%1.6) had traffic accident. 36 injuries (%56.3) occurred in the lower extremity, 24 (%37.5) occurred in the upper extremity and 4 (%6.2) occurred in the neck. In 58 cases (%90.6) patients suffered isolated vascular damage, and in 6 patients (%9.4) concomitant bone fractures, nerve injuries and/or massive soft tissue damage were observed. The most commonly injured vessels were superficial femoral (%20.3) and brachial (%17.1) arteries.

Results: 80 primary operations were performed in the 64 patients. End-to-end anastomosis was applied in 27 patients (%33.7). 18 patients (%22.5) were treated by saphenous vein interposition grafting and 2 patients (%2.5) were managed by polytetrafluoroethylene (PTFE) interposition graft. Arterial and venous repairs were performed in 24 (%30) and 3 (%3.75) patients respectively. The venous vessels were ligated in 4 patients (%5) and arteriel ligations were applied in 2 patients (%2.5). Three hospital mortality were observed. Amputation was carried out in one patient. In one patient, PTFE greft infection was developed 25 days after the operation.

Conclusion: In vascular injuries; a careful physical examination and early intervention with a suitable reconstructive technique should be used in order to achieve a successful result. (Turkish J Vasc Surg 2004;13(1): 17-22)