Management of the lower extremity arterial injuries

Abstract

Objective: The incidence of vascular injuries hasincreased considerably during the past 40 years.However, although they represent less than 1% of allinjuries, they deserve special attention because of theirsevere complications.Method: From May 1999 to March 2003, 30 patients withlower limp vascular injury were surgically treated inour clinic. Diagnosis was made by physicalexamination alone, or in combination with angiography.Primer vascular repair was carried out where possible;if not possible the interposition graft was used. Whenan interposition graft was necessary eitherpolytetrafluoroethylene (PTFE) or saphenous vein wasused for vascular reconstruction.Results: The study group consisted of 24 males and 6females, ranging in age from 14 years to 39 years witha mean age of 26.2±8.1 years. Penetrating trauma wasthe cause of a high proportion of cases. There were 31arterial injuries. Only one patient had bilateral arterialinjuries (right and left tibial arteries). Arterial injurieswere most common in the femoral artery area, followedby the tibial and popliteal arteries. Surgical proceduresperformed were primary repair in 12 arterial injuries,saphenous vein interposition graft in 15, and PTFEinterposition graft in 4. There were 18 patients withassociated venous injury, of which 11 cases hadprimary repair, and 7 had vein graft interposition. Therewere concomitant femur fracture in 3 patients, andfibula fracture in 1.Conclusion: Patients who suffer lower extremityarterial injury should be transferred to vascular surgerycenters as soon as possible. Anticoagulant treatmentshould be started as soon as possible to prevent thepropagation of the thrombosis. Early fasciotomy iswarranted if there is any suspicion of occurrence ofcompartment syndrome.Key words: Arterial injuries, management