Lower limb vein trauma: A long-term clinical and physiological assessment

Abstract

The aim of this study was to assess the long-term clinical and physiological sequelae of lower limb venous trauma in a civilian practice. Twenty-six patients who had undergone surgery for lower limb venous trauma (median elapsed time 19.5 months) underwent assessment. Injuries had been sustained to the external iliac, common femoral superficial femoral and popliteal veins in two, four, nine and eleven limbs respectively. Using clinical assessment, photoplethysmography recovery time, the presence of popliteal reflux and venographic evidence of thrombosis, the final outcome was graded as good, fair or poor. Fourteen patients had pedal oedema, including two with a postphlebitic limb. The overall photoplethysmography recovery time (mean and s.d.) was 20.6 (8.7) s in the injured and 32.1 (6.7) s in the non-injured limbs (P = 0.002). Patients with a venographically occluded vein had a shorter photoplethysmography recovery time than those in whom the vein was patent (13.4 (5.6) versus 21.6 (8.7) s; P = 0.07). Popliteal reflux was present in 12 injured limbs. Seven of 12 venograms performed on limbs with a vein repair had evidence of previous thrombosis. Vein ligation carried considerable morbidity and all end-to-end anastomoses initially failed. In retrospect, saphenous vein grafts were too narrow for the recipient veins and panel grafts might have been more appropriate. Overall 11 of 26 patients (42 per cent) had a poor result. The repair of choice is a saphenous vein patch for lesser injuries and a saphenous panel graft for major injuries. Vein ligation should be avoided unless another life-threatening injury demands priority.

Outcome of iatrogenic injuries to the abdominal and pelvic veins

“…Although ligation is an option, the results of reconstruction of injured veins are better in both the short term and long term. 13 Several investigators 14,15 have reported a higher incidence and greater severity of postoperative edema after ligation than after reconstruction of veins. Thus, ligation may be the last option for vein injuries; its major advantages being that it saves operative time, which is important in a hemodynamically unstable patient.…”

“…13 Moreover, continuous running sutures can narrow a venous repair, causing size mismatch. 14 Sharma et al 16 reported the value of phlebography in identifying technical errors in these reconstructions. Some authors recommend creating a distal arteriovenous fi stula after venous reconstruction.…”

Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage

“…Several studies have reported a higher incidence and severity of postoperative edema associated with venous ligation in comparison with venous reconstruction. 18,19 Others reported similar results with both ligation and reconstruction with the liberal use of fasciotomies, bed rest, elevation of the limb, and a compression stocking. 20,21 Others recommended repair in cases of major vein (iliac or femoral) injury and in patients without prolonged shock or extensive soft tissue damage.…”

Handlebar injury to femoral vein: case report and review

“…Evidence from both physiological and clinical studies favour repair with significant co-morbidity associated with ligation than repair. 3 Though thrombosis and failure of repair can occur in up to 15%, femoral vein ligation can result in post-phlebitic limb. There have been reports of increased incidence of pulmonary embolism following ligation but numbers reported is small.…”