A Study on Emergency Peripheral Vascular Reconstruction for Traumatic Vascular Injury

Abstract

Introduction: Explosions and projectiles can produce traumatic vascular damage, which can impact the arteries and veins of the limbs and cause bleeding and ischemia. The increased employment of high-energy weaponry in modern warfare has been linked to serious vascular damage. The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Vascular injuries are classified as contusion, intimal disruption, puncture, lateral disruption, transections with hemorrhage or occlusion, arteriovenous fistula and spasm, and pseudoaneurysms. Any type of bleeding, whether internal or external, is an indication of vascular trauma. Bleeding, swelling and/or discomfort, bruising, and a lump beneath the skin are all symptoms of vascular trauma. The therapy of vascular damage is evolving in tandem with the passage of time. Patients with vascular damage can now benefit from sophisticated medical devices. Meanwhile, conventional therapies continue to be effective. If vascular trauma is not treated promptly, it can result in impairment or even death, especially in cases of limb vascular damage. Physical examination and basic bedside pulse pressure examinations are critical in the early detection of injuries. Vascular reconstruction with blood flow restoration is a significant surgical intervention among several procedures. The study aimed to analyze the role of emergency peripheral vascular reconstruction for a traumatic vascular injury.
Methods: This retrospective study was carried out among fifty cases who attended at the National Institute of Cardiovascular Disease (NICVD, Sher-e-Bangla Nagar, Dhaka and casualty department of Dhaka Medical College Hospital, with vascular injury from January 2008 to January 2009. Result: A total of 50 cases were studied. These included 41 male and 9 female patients. Various types of repairments were done to arteries and veins. Primary suturing was needed in 10 arteries and 16 veins. The primary anastomosis was done in 15 arteries and in 3 veins, 17 arteries needed saphenous vein grafting, 4 arteries required prosthetic grafts, and ligation was needed for 2 arteries and 9 veins. These results indicated that primary suture was the mostly done procedure. Concerning the mechanism of injury, bullet injuries were the most found type of injury which occurred in 25 (50%)
patients, followed by shrapnel injuries in 15 (30%) patients, and the least cases were of blunt injuries (20%) Regarding regional distribution radial artery was the most affected site including 12 (24%) patients. An equal number of patients (7,14%) came with ulnar and brachial artery injuries. Both radial and ulnar artery injuries occurred in 10 (20%) patients. Popliteal artery injury was sustained in 8 (16%) patients followed by femoral artery with inferior vena cava (IVC) injury in 3 (6%) patients. Axillary and carotid artery injury was seen in 2 (4%) and 1 (2%) patients respectively. Conclusion: This study observed immediate vascular reconstruction followed by delayed tissue coverage provides a high limb salvage rate after combat trauma. Patients should be surgically intervened even after the golden period has passed. A few complications may arise following reconstruction if a patient is brought to the hospital after several hours after injury. To get robust data multicenter studies are in great need to analyze the salvage rate of limbs.