ORIGINAL ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 3  |  Page : 88-95

Good Vascular and Neuromuscular Outcome Even in Delayed Repaired Extremities Vascular Trauma-100 Cases Experience


Department of CTVS, SMS Medical College, Jaipur, Rajasthan, India

Correspondence Address:
Ram Chandra Sherawat
Department of CTVS, SMS Medical College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.166939

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Objectives: To determine whether delayed vascular repair is feasible or has good results in delayed presented cases of vascular trauma, even after >48 h with ischemic changes in some cases. General literature said that <6 h is appropriate for limbs salvage but our study said that this time limitation can be extended to a greater extent. We have chosen this study because our adverse geographical conditions-desert, hilly and tribal, and roads conditions are not so apt that patients get accessible to surgical intervention in the time limit as stated in the literature. Hence, we consider these patients for surgery even after delayed presentation as limb loss is emotionally/psychological deterrent as well as economic hardship to the patient. To the best of our knowledge, this is the first report on delayed vascular trauma repair from our region of India. Materials and Methods: Prospective analyses of 100 patients operated for peripheral vascular injuries between August 2011 and April 2014 were done. Diagnosis tools included physical examination, pulse oximeter and handheld Doppler alone or in combination with computed tomography angiography. Primary end-to-end vascular repairs or embolectomies were carried out where possible; if not possible, interposition vein graft was placed. Patients with injury > 48 h, with obviously unsalvageable lower extremity injury requiring primary amputation, severe other body organ injury, on ventilator support, vascular injury below trifurcation of popliteal artery, and having ischemic line of demarcation were excluded from the study. Results: Of the 100 patients, 86 were males (86%) and 14 (14%) were females (14%), and their age ranging from 5 to 80 years. Mean duration of the presentation of our study cases was 56 hours after the injury. The most common etiological reason was road traffic accidents; nearly 67% of the patients in penetrating trauma group and 58% among blunt traumas. The incidence of concomitant orthopedic injuries was 74%. The most common injured artery was brachial artery 36%, followed by popliteal artery 30% and femoral artery 22%. Surgical intervention included primary repair with end-to-end anastomosis in 45%, and embolectomy in 15%, whereas interposition of vein graft were placed in 40% cases. Final outcome was – 77% had viable and functional limbs and 15% had viable, but nonfunctional limbs and amputation after repair was 8%. Conclusions: Delayed surgery in vascular injuries has a prognostic value for salvaging the extremity/limb and life of the patient as well as vascular injuries require immediate surgical intervention, regardless of localization but the extent of time limitation for vascular intervention can be widened. Patients suffering from vascular injuries to the extremities should be transferred to vascular surgery centers as soon as possible and consider the patient for surgery even after the delayed presentation.


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