Management of distal femoral and popliteal arterial injuries: an update

Huynh, Thi Thanh Tam; Pham, Mai Khanh; Griffin, Lance W; Villa, Martin A.; Przybyla, J. Alan; Torres, Ricardo H.; Keyhani, Kourosh; Safi, Hazim J.; Moore, Frederick A.

doi:10.1016/j.amjsurg.2006.08.043

Cited by 69 publications

(58 citation statements)

References 17 publications

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“…The limb salvage rate was 92%. 17 In Northern Ireland, Barros D'Sa et al noted in 2006 that complex lower limb vascular injuries in high-energy penetrating or blunt trauma wounds are associated with an unacceptably high incidence of complications, including amputation. They proposed that early artery and vein shunting led to significantly improved outcomes.…”

Section: Discussionmentioning

confidence: 99%

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

Ramdass

Harnarayan

2017

annals

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INTRODUCTION Trinidad and Tobago is a trans-shipment point for the illegal trade of drugs, arms and ammunition and, as such, has a high incidence of gang-related warfare and drug-related crimes. This has led to a high incidence of gunshot and stab wounds, with associated major vascular injuries. We describe our management strategies learned from a decade of vascular trauma experience. METHODS A retrospective analysis of age, gender, type of trauma, vessel injured, procedure and outcome for all cases of vascular trauma between 2006 and 2015 at two surgical units in Trinidad and Tobago. RESULTS There were 198 vascular trauma cases (232 procedures), involving 159 (80%) males at a mean age of 33 years. Gunshots accounted for 103 (52%) cases, followed by stabs/chops (n=50; 25%) and lacerations (n=15; 8%). The most commonly injured vessels were the radial/ulnar arteries (n=39; 20%) and the superficial femoral artery (n=37; 19%). There were seven pseudoaneurysms and three traumatic arteriovenous fistulae. Repair techniques included primary (n=82; 35%), reversed vein (n=63; 27%), polytetrafluoroethylene (n=58; 25%), oversew (n=24; 10%) and endovascular (n=5; 2%) techniques. There were eight (4%) secondary amputations and eight (4%) deaths. CONCLUSIONS Major vascular trauma causes significant morbidity and mortality in Trinidad and Tobago, with the majority of cases due to gunshot injuries secondary to gang-related warfare and civilian violence. We compare our experience with that in the literature on the epidemiology and management of vascular trauma.

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Section: Discussionmentioning

confidence: 99%

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

Ramdass

Harnarayan

2017

annals

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“…Prolonged ischemia is a well-recognized predictor of cell death, but the tolerance period varies between persons and depends on the severity of the ischemia and the presence of collateral flow. 8 In our case, the patient had delayed revascularization for 42 hours with compartment syndrome as a comorbid condition. However, he had minimal soft tissue damage without the involvement of skeletal damage (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Successful Late Repair of Popliteal Artery Rupture with Compartment Syndrome

Supomo

2017

JKKI

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“…This depends on the severity of the ischemia and the presence of collateral flow. 26 The fact that the patient"s upper limb was salvaged can be attributed to the collateral flow and it was also a prima facie factor as both his ulnar and radial artery were injured due to the trauma he had. Development of good collateral flow is supposed to be the most important reason for salvage of limbs in cases of delayed revascularization.…”

Section: 10mentioning

confidence: 99%

Revascularisation of left hand after 33 hours of warm ischemia: a case report

Gharwade

Alegaonkar²,

Jawade

et al. 2016

Int Surg J

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‘Revascularisation’ or ‘replantation’ is a limb saving procedure. In case of severe limb injury compromising its vascularity, before considering amputation, one should always consider these surgical procedures after thoroughly assessing the status of the patients injury and his hemodynamic status. Delayed revascularisation has proven successful in cases and there are substantial evidences based on some case studies published recently. There are very few reports and case studies documented on successful salvage of upper limb /forearm traumatic vascular injuries after considerable delay in revascularisation / replantation. Here we present a case of delayed revascularisation of left hand after 33 hours of warm ischemia which turned out to be a successful surgery without any dreadful complication and consequences in a year’s follow-up. We believe and recommend that efforts must be made by every well-equipped health care system in salvaging the limb by revascularisation technique. We also want to mention that delayed revascularisation can be done successfully with constant monitoring of limb and patients hemodynamic status to rule out reperfusion injury and septicaemia. We recommend, one should always consider revascularisation/ Replantation as an option before planning amputation which can be debilitating for the patient.

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Management of distal femoral and popliteal arterial injuries: an update

Cited by 69 publications

References 17 publications

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

Successful Late Repair of Popliteal Artery Rupture with Compartment Syndrome

Revascularisation of left hand after 33 hours of warm ischemia: a case report

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