Review article: History of venous trauma

Abstract

This is a literature review on the history of venous trauma since the 1800s, especially that to the common femoral, femoral and popliteal veins, with focus on the early 1900s, World War I, World War II, Korean War, Vietnam War, and then civilian and military reviews . In the latter two groups, tables were used to summarize the following: incidence of venous repair versus ligation, management of popliteal venous injuries, patency of venous repairs when assessed <30 days from operation, patency of venous repairs when assessed >30 days from operation, clinical assessment (edema or not) after ligation versus repair, incidence of deep venous thrombosis after ligation versus repair, and incidence of pulmonary embolism after ligation versus repair. There is a lack of the following in the literature on the management of venous injuries over the past 80 years: standard definition of magnitude of venous injury in operative reports, accepted indications for venous repair, standard postoperative management, and timing and mode of early and later postoperative assessment. Multiple factors have entered into the decision on venous ligation versus repair after trauma for the past 60 years, but a surgeon's training and local management protocols have the most influence in both civilian and military centers. Ligation of venous injuries, particularly those in the lower extremities, is well tolerated in civilian trauma, although there is the usual lack of short-and long-term follow-up as noted in many of the articles reviewed.

Impact of Ischemia Duration on Lower Limb Salvage in Combat Casualties

“…There is also an ongoing debate on the influence of concomitant venous injury ligation or repair on limb outcomes. 16 While both methods were used to treat venous injuries in this study population, the presence of an associated venous injury was not associated with any increase in amputation risk.…”

“…Prophylactic fasciotomy was liberally employed in the treatment of patients included in this study, with only 7% developing compartment syndrome, and no measurable impact on limb salvage detected in those who did. There is also an ongoing debate on the influence of concomitant venous injury ligation or repair on limb outcomes 16. While both methods were used to treat venous injuries in this study population, the presence of an associated venous injury was not associated with any increase in amputation risk.…”

“…The study population therefore comprised data from 122 military personnel who had sustained a traumatic arterial injury to the iliac-femoral-popliteal axis in 129 limbs and underwent a surgical attempt to restore limb perfusion following a known duration of ischemia (Table 1). The median age was 24 years (range: 18-52 years) and the median ISS was 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The most common mechanism of injury was an explosion (n = 86, 66.7%), followed by gunshot wound (n = 41, 31.8%) and blunt (n = 2, 1.6%) trauma.…”

Manejo de trauma en miembro pélvico con compromiso arterial y venoso

“…Las maniobras de evacuación rápidas y control de daños, así como la derivación temporal y fasciotomía temprana, ayudan a la reparación definitiva oportuna y parecen efectivas para disminuir la necesidad de amputación 13 .…”

Wrong incisions

“…One of the major differences between open repairs of vascular trauma and newer endovascular approaches is that there have always been reports on long-term results with the former,15–19 but uncommonly with the latter 6 7. It can be argued that the length of time since the original reports on endovascular repairs in vascular trauma is too short to allow for meaningful follow-up.…”