ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 3-7

Management of Vascular Trauma: A Single Center Experience


Department of Cardiothoracic and Vascular Surgery, S.M.S. Medical College, Jaipur, Rajasthan, India

Correspondence Address:
Dheeraj Sharma
Department of Cardiothoracic and Vascular Surgery, S.M.S. Medical College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.142354

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Introduction: This was a retrospective study of the experience with extremity vascular trauma at a tertiary level referral center in North India. The objective of this study was to analyze the cause of injury, surgical approach, outcome, and complications in patients with vascular trauma operated from 2003 to 2013. Materials and Methods: A retrospective analysis of records of patients who were operated for peripheral vascular injuries in the last 10 years (November 2003 to November 2013) was done. Diagnosis was made by physical examination and hand Doppler alone or in combination with computed tomography angiography. There were 3948 patients; primary vascular repair was carried out where possible; if not possible an interposition vein graft was placed. Patients with isolated venous trauma or unsalvageable lower extremity injury requiring primary amputation were excluded from the study. Results: Of 3948 patients, 3347 were male (84.78%), and 601 were females (15.22%); their ages range was 5-80 years. Mean duration of the presentation was 11 h after the injury. Road traffic accidents were the most common cause of injury: 67% in those with penetrating trauma and 58% in those with blunt trauma. The incidence of concomitant orthopedic injuries was very high in our patients (73.6%). The most common injured artery was the brachial artery (36.4%), followed by the popliteal (30.4%) and femoral artery (21.7%). Primary repair was performed in 58.3%, interposition vein grafts in 41.4%. Majority of patients had a good outcome-78% had functional, viable limbs. About 13% had a nonfunctional, but viable limb; the secondary amputation rate was 9%. Conclusion: Early diagnosis and treatment of vascular injuries is crucial for saving the patient's limb and life. Our study is the largest study from a single center in India/South West Asia: Increased awareness is required to ensure that patients identified to have a vascular injury are transferred to a specialist vascular surgery center at the earliest. Vascular injuries require immediate localization and surgical intervention. Prompt and decisive management maximizes patient survival and limb salvage- and as we demonstrate, this is possible even in patients with delayed presentation or when early ischemic changes are present. Protocols must be established in the management of associated injuries to avoid delay.


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