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 repairwas 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.