Late presented vascular trauma should be considered for surgical vascular repair

Abstract

Objective : The aim of this study was to analyze the mode of injury of extremity injuries involving large vessels, to assess the success of the various surgical interventions performed  and effect of time to revascularization on successful outcome.Methods This prospective study was conducted in the cardio thoracic vascular unit over a period of 3 years between Dec 2016 to Nov 2019. All the patients older than 16 years who were admitted with signs of vascular injury involving axillary and brachial artery in upper limb and femoral and popliteal artery in lower limb who underwent surgical vascular repair were included in this study. Patients with unsalvageable extremity injury and requiring primary amputation were excluded from the study. Clinical examination in combination with Color Doppler were used primarily for diagnosing vascular injuries Surgical intervention either primary repair or interposition autologous vein graft was done as depends on the extent of vascular injury. Results A total of 50 patients were evaluated of whom 45 (90 %) were males. The mean age was 30 ±8.0 years (range 18-65 years). Penetrating trauma was present in 30 patients (60%) and blunt trauma in 20 patients (40%).  Road Traffic Accidents was the single most common cause of extremity vascular injury in both penetrating and blunt trauma group (60%). In penetrating injury group, the commonest vessel injured was brachial artery in 18 out of 32 (56.25%). Popliteal artery was the most commonly involved vessel in 12 out of 26 (46.15%) cases who had non penetrating injuries. The median time to revascularisation was 10 hours. Interposition vein graft was the most common methods of repair in 31 out of 50 cases (62 %). Primary repair was done in 19 patients (38%). Associated venous injury was found in 08 patients. Limb was salvaged in 43 out of 50 patients (86%). Amputation of the limb was done in 2 patients (11.11%) in which revascularization was done within 6 hours while 5 (15.62%) in patients with time to revascularization more than 6 hours but it was not statistically significant. Conclusion:Early diagnosis and prompt surgical management is crucial in extremity vascular injuries. However, limb can be salvaged even if patient presented late with long trauma to revascularization time.