Civil and War Peripheral Arterial Trauma: Review of Risk Factors Associated with Limb Loss

Abstract

We sought to analyze the early results of civil and war peripheral arterial injury treatment and to identify risk factors associated with limb loss. Between 1992 and 2001, data collected retrospectively and prospectively on 413 patients with 448 peripheral arterial injuries were analyzed. Of these, there were 140 patients with war injuries and 273 patients with civil injuries. The mechanism of injury was gunshot in 40%, blunt injury in 24%, explosive trauma in 20.3%, and stabbing in 15.7% of the cases. The most frequently injured vessels were the femoral arteries (37.3%), followed by the popliteal (27.8%), axillary and brachial (23.5%), and crural arteries (6.5%). Associated injuries, which included bone, nerve, and remote injuries affecting the head, chest, or abdomen, were present in 60.8% of the cases. Surgery was carried out on all patients, with a limb salvage rate of 89.1% and a survival rate of 97.3%. In spite of a rising trend in peripheral arterial injuries, our total and delayed amputation rates remained stable. On statistical analysis, significant risk factors for amputation were found to be failed revascularization, associated injuries, secondary operation, explosive injury, war injury (p < .01) and arterial contusion with consecutive thrombosis, popliteal artery injury, and late surgery (p < .05). Peripheral arterial injuries, if inadequately treated, carry a high amputation rate. Explosive injuries are the most likely to lead to amputations, whereas stab injuries are the least likely to do so. The most significant independent risk factor for limb loss was failed revascularization.

Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management

“…Blunt traumas and gunshot wounds are more likely to affect the arterial supply at more than 1 level. More extensive injury to the vessel and surrounding structures leads to severe interruption of the main as well as collateral blood supply, complicating the management of these injuries and likely explaining the higher amputation rates compared with stab wounds 4,5,9. Consistent with previous reports, we found that stab trauma in particular is associated with a 10-fold decreased risk of multilevel arterial injury, bone fractures, and tissue destruction compared with other injury patterns.…”

Effect of temporary vascular shunting as a previous intervention on lower extremity arterial injury: single centre experiences in syrian civil war

“…War-related arterial injuries are a challenge to manage and may result in different ways, from simple injuries caused by low energy basic devices to complex injuries caused by high energy explosive and destructive devices. [1][2][3]9,10] We are now regularly encountering these kinds of injuries due to the Syrian Civil War in parallel to the literature. The hospital where the injured people are treated is located in Hatay, near the border with Syria in southernmost Turkey.…”

Vascular Trauma

“…An effective modification of that technique is to apply two tourniquets, one high on the limb and the second 8 cm above the wound. Then the first one is released, while the second stays closed [3,7].…”