Assessment of Vascular Injuries and Reconstruction

Abstract

Background:Trauma is the third leading cause of death. In this regard, vascular injury plays a leading role in of morbidity and mortality rates.Objectives:The present study aimed to assess the prevalence of vascular injuries and results of vascular reconstruction at a referral hospital in northern Iran.Patients and Methods:A retrospective observational study assessed 88 consecutive patients with vascular injury admitted to Poursina Hospital, Rasht in northern Iran, from October 2007 to October 2009. All study information was collected retrospectively from hospital charts.Results:Most of the affected patients (87/88) were male with a mean age of 29.12 ± 11.20 years. The mechanism of injury in 39.8% was blunt trauma and penetrating trauma in the rest. Of the 53 injured by penetrating trauma (60.2%), the most common cause was stabbing (94.3%). The most common cause of blunt trauma was road traffic accidents (93.1%). The most common mechanism for vascular injuries in upper extremities was penetrating trauma (86.0%) and in lower extremities was blunt trauma (60.0%). Fasciotomy was performed in 16 patients (18.2%) mostly in the lower extremities. Major amputation was required in 10% of the patients. In upper extremities, the most common type of revascularization was end to end anastomosis, followed by inter-position graft. The most common type of reconstruction in the lower extremity was bypass graft. All patients who underwent major amputation were admitted to the center with a delay of more than 6 hours after injury.Conclusions:Major vascular injuries in our center occurred in young men, frequently because of stab wounds. Popliteal injuries mostly caused by motor vehicle accidents was the second most common arterial injury, followed by combined ulnar and radial injuries. Vascular reconstruction in the first hours after trauma may prevent many unnecessary and preventable amputation procedures.

Limb-Salvage Outcomes of Arterial Repair Beyond Time Limit at Different Lower-Extremity Injury Sites

“…Unlike amputated limbs, which may resist up to a typical 6 h of ischemia because of complete disruption of blood supply, limbs with arterial injuries could survive longer due to collateral circulation. However, prolonged ischemia of an injured limb (longer than 6 h) is associated with a 4-fold increased risk of secondary amputation [ 10 ]. Therefore, whether revascularization is worth more than 6 h after arterial injury has been a controversial issue.…”

“…Prior studies have documented factors that affect limb salvage after arterial injury [ 7 ], of which the duration of ischemia is the most influential [ 8 , 9 ]. The golden time for arterial repair, widely accepted by scholars and researchers, is less than 6 h [ 10 ]. Hence, essential management for substantial improvement in limb salvage rates includes attention to minimizing delayed repair of vascular injury [ 11 ].…”

Traumatic Peripheral Arterial Injury with Open Repair: A 10-Year Single-Institutional Analysis

“…Peripheral arterial injuries constitute approximately 4%-6% of all major traumas [1,2]. However, they comprise 80% of vascular injuries that manifest as fatal hemorrhage or limb-threatening ischemia [3]. Peripheral arterial injury in trauma patients can potentially progress to ischemia and amputation unless it is immediately diagnosed and revascularized.…”

Evaluation of Subclavian, Thoracic Aorta, and Innominate Artery Injuries in Blunt Trauma Mechanisms: A Systematic Review of Case Reports and Case Series

“…Furthermore, motor vehicle accidents are the principal cause of blunt trauma, accounting for 1.3 million deaths, 20s-50 million non-fatal injuries, and 29% of all trauma cases annually [4,5] . The overall incidence of vascular trauma is 5%, with a larger fraction contributed by penetrating trauma mechanisms [6,7] . In fact, trauma centers report that only 5% of vascular trauma cases are caused by…”