Peripheral vascular injuries

Öz

Aim: To determine etiology and management in patients with peripheral vascular trauma. Materials and Methods: From 2005 to 2006 with a diagnosis of peripheral artery injury, 69 cases admitted to Diyarbakır State Hospital Department of Cardiovascular surgery. Results: These cases have been respectively reviewed. The causes of injuries were; penetrating injuries in 60 cases (87%), blunt trauma in seven cases (10%) and gunshot injuries in two cases (3%). In 53 cases (74%) upper extremity, in 15 cases (21%) lower extremity was involved. As a surgical procedure, in 34 cases (47%) end-to-end anastomosis, in 28 cases (39%) lateral suture, in five cases (7%) venous graft interposition, in five cases (7%) ligation was performed. Conclusion: Early intervention, transfusion of fluid and blood, systemic anticoagulation, preoperative and postoperative detailed debridement decreased the morbidity and mortality rates.

Anahtar Kelimeler

• Femoral artery, femoral vein, injury

Periferik damar yaralanmaları

Öz

Amaç: Periferik vasküler travma ile basvuran hastaların etyoloji ve uygulanan tedavilerin irdelenmesi amaçlandı. Gereç ve Yöntem: Diyarbakır Devlet Hastanesi Kalp ve Damar Cerrahisi Kliniğinde 2006–2008 yılları arasında periferik arter yaralanması nedeniyle basvuran 69 olgu incelendi. Bulgular: Yaralanma nedenlerinin 60'ının (%87) kesici-delici alet yaralanması, yedisinin (%10) künt travma, ikisinin (%3) atesli silah yaralanması sonucu olduğu belirlendi. 53 (%74) olguda üst ekstremitede, 15 (%21) olguda ise alt ekstremitede arter yaralanması tespit edildi. Tedavi olarak, 34'ünde (%47) ucuca anastamoz, 28'inde (%39) lateral sutur, besinde (%7 ven grefti interpozisyonu, besinde (%7) ligasyon uygulandı. Sonuç: Periferik vaskuler yaralanmalarda erken müdahale, kan ve volum açığının kapatılması, sistemik antikoagulan kullanımı, nekrotik dokuların peroperatif ve postoperatif debritmanı morbidite ve mortaliteyi asağıya çekecektir.

Anahtar Kelimeler

• Femoral arter, femoral ven,Yaralanma

Kaynakça

1. Weaver FA, Hood DB, Yelhin AE. Vascular injuries of the extremities. In: Rutherford RB, ed. Vascular Surgery. Phila- delphia: Sounders Company, 2000:862-871.
2. Martin LC, McKenney MG, Sosa JL, et al. Management of lower extremity arterial trauma. J Trauma 1994;37:591-599.
3. Cargile JS, Hunt JL, Purdue GF. Acute trauma of the femo- ral artery and vein. J Trauma 1992;32:364-371.
4. Pretre R, Bruschweiler I, Rossier J, et al. Lower limb trau- ma with injury to the popliteal vessels. J Trauma 1996;40:595
5. Menzolian JO, Doyle JE, Cantelmo NL, et al. A compre- hensive approache to extremity vascular trauma. Arch Surg ;120:801-805. Oller DW, Rutledge R, Clancy T, et al. Vascular injuries in a rural state: a review of 978 patients from a state trauma reg- istry. J Trauma 1992;32:740-746.
6. Ceviz M, Yekeler İ, Ateş A,ve ark. Periferik arter yaralan- malarında cerrahi tedavi: 175 vakanın değerlendirilmesi. Da- mar Cer Derg 1996;2:66-72.
7. Yavuz Ş, Tiryakioğlu O, Celkan A, ve ark. Periferik damar yaralanmalarında acil cerrahi girişimler. Damar Cerrahisi Der- gisi 2000;1:15-20.
8. Tünerir B, Beşoğlu Y, Yavuz T, ve ark. Periferik arteriyel yaralanmalar ve tedavi sonuçları. GKDC Derg 1998;6:151

9. Memiş Z, Kurt N, Gülhan Y, ve ark. Damar yaralanmaları. Damar Cer Derg 1994;3:108-112.
10. Solak H, Yeniterzi M, Yüksek T, et al. Injuries of the pe- ripheral arteries and their surgical treatment. Thorac Cardio- vasc Surg 1990;38:96-98.
11. Payne WK, Gabriel RA, Mossoud RP. Gunshut wound to the thigh. Orthop Clin of North America 1995;26:147-154.
12. Kluger Y, Gonze MD, Paul DB, et al. Blunt vascular in- jury associated with closed mid-shaft femur fracture: a plea for concern. J Trauma 1994;36:222-225.
13. Melton SM, Croce MA, Patton JH, et al. Popliteal artery trauma systemic anticoagulation and intraoperative throm- bolysis improves limb salvage. Ann Surg 1997;225:518-529.
14. McCready RA, Logan NM, Daugherty ME, et al. Long term results with autogenous tissue repair of traumatic extrem- ity vascular injuries. Ann Surg 1987;206:804-809.
15. Timberlake GA, Kerstein MD. Venous injury: to repair or ligate, the dilemma revisited. Am Surg 1995;61:139-145.
16. Meyer J, Wals J, Schuler J, et al. The early fate of venous repair after civilian vascular trauma. Ann Surg 1987;206:458
17. Pappas PJ, Haser PB, Teehan EP, et al. Outcome of com- plex venous reconstruction in patients with trauma. J Vasc Surg 1997;25:398-404.
18. Starr AJ, Hunt JL, Reinert CM. Treatment of femur frac- ture with associated vascular injury. J Trauma 1996;40:17-21.
19. Winkelaar GB, Taylor DC: Vascular trauma associated with fractures and dislocations. Semin Vasc Surg ;11:261-273