Management of the lower extremity arterial injuries

Abstract

Objective:  The incidence of vascular injuries has
increased considerably during the past 40 years.
However, although they represent less than 1% of all
injuries, they deserve special attention because of their
severe complications.
Method: From May 1999 to March 2003, 30 patients with
lower limp vascular injury were surgically treated in
our clinic. Diagnosis was made by physical
examination alone, or in combination with angiography.
Primer vascular repair was carried out where possible;
if not possible the interposition graft was used. When
an interposition graft was necessary either
polytetrafluoroethylene (PTFE) or saphenous vein was
used for vascular reconstruction.
Results: The study group consisted of 24 males and 6
females, ranging in age from 14 years to 39 years with
a mean age of 26.2±8.1 years. Penetrating trauma was
the cause of a high proportion of cases. There were 31
arterial injuries. Only one patient had bilateral arterial
injuries (right and left tibial arteries). Arterial injuries
were most common in the femoral artery area, followed
by the tibial and popliteal arteries. Surgical procedures
performed were primary repair in 12 arterial injuries,
saphenous vein interposition graft in 15, and PTFE
interposition graft in 4. There were 18 patients with
associated venous injury, of which 11 cases had
primary repair, and 7 had vein graft interposition. There
were concomitant femur fracture in 3 patients, and
fibula fracture in 1.
Conclusion:  Patients who suffer lower extremity
arterial injury should be transferred to vascular surgery
centers as soon as possible.  Anticoagulant treatment
should be started as soon as possible to prevent the
propagation of the thrombosis. Early fasciotomy is
warranted if there is any suspicion of occurrence of
compartment syndrome.
Key words: Arterial injuries, management

Keywords

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