Peripheral vascular injuries

Yıl 2009, Cilt: 36 Sayı: 3, 161 - 164, 01.09.2009

Celal Yavuz Yunus Nazlı

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

• Weaver FA, Hood DB, Yelhin AE. Vascular injuries of the extremities. In: Rutherford RB, ed. Vascular Surgery. Phila- delphia: Sounders Company, 2000:862-871.
• Martin LC, McKenney MG, Sosa JL, et al. Management of lower extremity arterial trauma. J Trauma 1994;37:591-599.
• Cargile JS, Hunt JL, Purdue GF. Acute trauma of the femo- ral artery and vein. J Trauma 1992;32:364-371.
• Pretre R, Bruschweiler I, Rossier J, et al. Lower limb trau- ma with injury to the popliteal vessels. J Trauma 1996;40:595
• 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.
• 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.
• Yavuz Ş, Tiryakioğlu O, Celkan A, ve ark. Periferik damar yaralanmalarında acil cerrahi girişimler. Damar Cerrahisi Der- gisi 2000;1:15-20.
• Tünerir B, Beşoğlu Y, Yavuz T, ve ark. Periferik arteriyel yaralanmalar ve tedavi sonuçları. GKDC Derg 1998;6:151
• Memiş Z, Kurt N, Gülhan Y, ve ark. Damar yaralanmaları. Damar Cer Derg 1994;3:108-112.
• 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.
• Payne WK, Gabriel RA, Mossoud RP. Gunshut wound to the thigh. Orthop Clin of North America 1995;26:147-154.
• 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.
• 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.
• 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.
• Timberlake GA, Kerstein MD. Venous injury: to repair or ligate, the dilemma revisited. Am Surg 1995;61:139-145.
• Meyer J, Wals J, Schuler J, et al. The early fate of venous repair after civilian vascular trauma. Ann Surg 1987;206:458
• 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.
• Starr AJ, Hunt JL, Reinert CM. Treatment of femur frac- ture with associated vascular injury. J Trauma 1996;40:17-21.
• Winkelaar GB, Taylor DC: Vascular trauma associated with fractures and dislocations. Semin Vasc Surg ;11:261-273