The delayed management of main arterial injuries in extremity trauma: surgical challenges and outcomes

Abstract

Objective: To analyse the early outcome of main arterial injuries with delayed treatment in extremity trauma and help vascular surgeons in determining proper treatment strategy for such injuries. Methodology: Forty-three patients with delayed treatment of main arterial injuries during May 2003 and January 2008 were reviewed retrospectively. Results: In 43 patients, injuries were caused by blunt trauma in 26 cases and penetrating trauma in 17 cases. The maximum ischaemia time was 38 hours and the minimum was 13 hours. Eight patients underwent primary amputations and four patients underwent secondary amputation. There was no perioperative mortality, while wound infection occurred in five patients, followed by graft occlusion in four patients, arteriovenous fistulae in two patients and pseudoaneurysm in one patient. Conclusion: The delayed intervention in main arterial injuries is associated with higher risk of amputation, while the suitable surgical techniques may decrease the risk of limb loss. Viable limbs should be revascularized in otherwise stable patients even with long periods of ischaemia.

Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection—The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report

“…This is a typical and educational case that demonstrates the importance of the rapid diagnosis and multidisciplinary team approach to decrease the period of ischemia and the rate of amputation [1,4]. A limb ischemia greater than 6 h results in severe necrosis and amputation in up to 30% of patients [3,9]. Additionally, compartment syndrome is a major risk factor for amputation following artery injury; thus, fasciotomy done at the time of arterial repair lowers amputation rates [10,11].…”

Triple vessel injury with single penetrating trauma to the lower extremity requiring popliteal to posterior tibial artery bypass

“…This emphasizes the need for frequent neurovascular checks in such patients, especially when multiple procedures are necessary. Delay in deterioration of vascular exam can take place over a period of time of variable length, ranging from several hours up to three weeks [ [6] , [7] , [8] ]. This indicates the need for close follow up and even outpatient screening after discharge.…”

Successful Late Repair of Popliteal Artery Rupture with Compartment Syndrome

“…3 Many factors, such as the extent of soft tissue damage, the capacity of collaterals, pre-existing arterial disease, and the ischemia time may affect the clinical outcomes. 6 Mckenzie et al 7 found that the greatest impact on decision making between limb salvage and amputation depend on the severity of soft tissue injury. Prolonged ischemia is a well-recognized predictor of cell death, but the tolerance period varies between persons and depends on the severity of the ischemia and the presence of collateral flow.…”