Lower and Upper Extremity Vascular Injuries: Our 12-Year Experience

Year 2020, Volume: 46 Issue: 3, 337 - 341, 01.12.2020

Atif Yolgösteren , Mustafa Yalçın İris Kan , Mustafa Tok , Işık Şenkaya , Murat Biçer

https://doi.org/10.32708/uutfd.815357

Abstract

We aimed to retrospectively evaluate our evaluation protocols, treatment methods and results of patients admitted to our center with limb vascular injury in the light of the literature. Age and gender information of patients who were operated for peripheral vascular injury between January 2007 and December 2019 in Uludağ University Faculty of Medicine Cardiovascular Surgery Clinic, time between injury and operation, preoperative evaluation information, injured vessel segments, injury mechanisms, vessel repair techniques, early postoperative period, and control data on the 30th day were retrospectively analyzed. 102 patients were included in the study (9.8% female, 90.2% male; mean age 28.9). Twenty-eight of the patients were gunshot wounds injury (27.4%), 37 were sharp object injurie (36.3%), 37 were blunt injuries (36.3%). The ischemia times of the patients were 1-8 hours. Eighty-four patients underwent bypass with autogenous graft (vena saphena magna) (82.4%), 7 patients with PTFE synthetic ringed vein graft (6.8%), 10 patients underwent end-to-end anastomosis, 1 patient was performed patch-plasty with saphenous vein graft (%). one). Fasciotomy was performed in 22 patients (21.5%). Amputation was performed in five patients (4.9%). Two patients died (1.9%). Our evaluation and treatment protocols for patients with extremity vascular injury and our surgical results are similar to those in the literature. We think that multidisciplinary approach, rapid diagnosis and treatment are the most important factors in reducing mortality and morbidity rates in peripheral vascular injuries. In addition, we think that CT angiography should be the first choice in patients who require preoperative imaging, that the use of autogenous grafts is the most appropriate approach in all possible patients in vascular repair, and fasciotomy should be performed to reduce amputation rates in long-term ischemia.

Keywords

vascular injury, amputation, fasciotomy

Alt ve Üst Ekstremite Damar Yaralanmaları: On İki Yıllık Deneyimimiz

Abstract

Ekstremite damar yaralanması nedeniyle merkezimize başvuran hastaları değerlendirme protokollerimizi, tedavi yöntemlerimizi ve sonuçlarımızı literatür eşliğinde retrospektif olarak değerlendirmeyi amaçladık. Ocak 2007-Aralık 2019 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniğinde periferik damar yaralanması nedeniyle ameliyat edilen hastaların yaş ve cinsiyet bilgileri, yaralanma ile ameliyata alınma arasında geçen süre, preoperatif değerlendirme bilgileri, yaralanan damar segmentleri, yaralanma mekanizmaları, damar onarım teknikleri, postoperatif erken dönem ve 30. günde ki kontrol bilgileri retrospektif olarak incelendi. Çalışmaya 102 hasta dahil edildi (%9.8’i kadın, %90.2’si erkek; yaş ortalaması 28.9). Hastaların 28’si ateşli silah yaralanması (%27.4), 37’si delici-kesici alet yaralanması (%36.3), 37’si künt yaralanmaydı (%36.3). Hastaların iskemi süreleri 1-8 saati. Seksen dört hastaya otojen greft ile (vena safena magna) baypas (%82.4), 7 hastaya PTFE sentetik ringli damar grefti ile baypas (%6.8), 10 hastaya uç-uca anastomoz, 1 hastaya da safen ven greftiyle patch-plast yapıldı (%1). Yirmi iki hastaya fasyatomi açıldı (%21.5). Beş hastaya amputasyon uygulandı (%4.9). İki hasta ex oldu (%1.9). Ekstremite damar yaralanmalı hastaları değerlendirme ve tedavi protokollerimiz ile cerrahi sonuçlarımız literatürdekilerle benzerlik göstermektedir Periferik damar yaralanmalarında mortalite ve morbidite oranlarını azaltmak için multidisipliner yaklaşımın, hızlı tanı ve tedavinin en önemli faktörler olduğunu düşünüyoruz. Ayrıca preoperatif görüntüleme gereken hastalarda ilk tercihin BT anjiografi olması gerektiğini, damar onarımında mümkün olan tüm hastalarda otojen greft kullanılmasının en doğru yaklaşım olduğunu ve uzun süreli iskemilerde ampütasyon oranlarını düşürmek için fasyatomi yapılması gerektiğini düşünüyoruz.

Keywords

damar yaralanmaları, amputasyon, fasyatomi

References

• Feliciano DV, Moore FA, Moore EE, et al. Evaluation and management of peripheral vascular injury. Part 1. Western trauma association/critical decisions in trauma. J Trauma - Inj Infect Crit Care. 2011;70(6):1551–6.
• Frykberg ER, Schinco MA. Peripheral vascular injury. In: Feliciano DV, Mattox KL, Moore EE, eds. Trauma. 6th ed. New York, NY: McGraw- Hill; 2008:941–971.
• Baker AC, Clouse WD. Upper extremity and junc- tional zone injuries. Rich’s Vascular Trauma. 2016. p. 149–167
• Mullenix PS, Steele SR, Andersen CA, et al. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg 2006;44(1):94–100.
• Dorlac WC, DeBakey ME, Holcomb JB, et al. Mortality from isolated civilian penetrating extremity injury. J Trauma 2005;59(1):217–22.
• Tan TW, Joglar FL, Hamburg NM, et al. Limb outcome and mortality in lower and upper extremity arterial injury: a comparison using the National Trauma Data Bank. Vasc Endovascular Surg 2011;45(7):592–7.
• DuBose JJ, Savage SA, Fabian TC, et al. AAST PROOVIT Study Group. The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg. 2015 Feb;78(2):215-22
• Inaba K, Siboni S, Resnick S, et al. Tourniquet use for civilian extremity trauma. J Trauma Acute Care Surg. 2015;79(2):232–7.
• Kauvar DS, Miller D, Walters TJ. Tourniquet use is not associated with limb loss following military lower extremity arterial trauma. J Trauma Acute Care Surg. 2018;85(3):495–9.
• Callcut RA, Mell MW. Modern advances in vascular trauma. Surg Clin North Am. 2013;93(4):941–61.
• Asensio JA, Kuncir EJ, Garcia-Nunez LM, et al. Femoral vessel injuries: analysis of factors predictive of outcomes. J Am Coll Surg 2006;203(4):512–20.
• Sekharan J, Dennis JW, Veldenz HC, et al. Continued experience with physical examination alone for evaluation and management of penetrating zone 2 neck injuries: Results of 145 cases. J Vasc Surg. 2000;32(3):483–9.
• Slama R, Villaume F. Penetrating Vascular Injury: Diagnosis and Management Updates. Emerg Med Clin North Am. 2017 Nov;35(4):789-801
• Baker WE, Wassermann J. Unsuspected vascular trauma: blunt arterial injuries. Emerg Med Clin North Am. 2004 Nov;22(4):1081-98.
• Sadjadi J, Cureton EL, Dozier KC, Kwan RO, Victorino GP. Expedited treatment of lower extremity gunshot wounds. J Am Coll Surg. 2009; 209:740–745
• Harkin DW, Dunlop DM. Vascular trauma. Surg (United Kingdom) [Internet]. 2018;36(6):306–13
• Colip CG, Gorantla V, LeBedis CA, et al. Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner. Emerg Radiol 2017; 223: 24
• Patterson BO, Holt PJ, Cleanthis M, et al. London Vascular Injuries Working Group. Imaging vascular trauma. Br J Surg. 2012 Apr;99(4):494-505
• Ivatury RR, Anand R, Ordonez C. Penetrating extremity trauma. World J Surg 2015;39(6):1389–96.
• Feliciano DV, Moore EE, West MA, et al. Western Trauma Association critical decisions in trauma: evaluation and management of peripheral vascular injury, part II. J Trauma Acute Care Surg. 2013 Sep;75(3):391-7.
• Teixeira PGR, DuBose J. Surgical Management of Vascular Trauma. Surg Clin North Am. 2017 Oct;97(5):1133-1155.
• Back MR. Local complications: graft infections. In: Cronenwett J, Johnston KW, editors. Rutherford’s vascular surgery. 8th edition. Atlanta (GA): Elsevier Press; 2014. p. 654–72.
• Callcut RA, Acher CW, Hoch J, et al. Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury. J Trauma 2009;67(2):252–7
• Scalea TM, DuBose J, Moore EE et al (2012) Western Trauma Association critical decisions in trauma: management of the mangled extremity. J Trauma Acute Care Surg 72(1):86–93
• Sciarretta JD, Macedo FIB, Otero CA, et al. Management of traumatic popliteal vascular injuries in a level I trauma center: A 6-year experience. Int J Surg. 2015;18:136–41