Pattern of extremity arterial injury and outcome of repair in Southwest, Nigeria

Abstract

Background: Extremity arterial injuries are an important cause of loss of life/limb after trauma. Early intervention is important for the good outcome. Objectives: The objective of this study is to review the pattern of presentation and study the factors that influences the outcome of extremity arterial injuries in our hospital. Patients and Methods: This is a retrospective study of all patients with injuries to the extremity arteries requiring surgical intervention from July 2007 to June 2015. Data obtained included biodata, ischemic time, arteries involved, surgical intervention, and outcomes and analyzed using SPSS version 22. Setting: Our hospital is the main referral hospital for vascular trauma serving four adjoining states in Nigeria and is linked to major cities by at least 3 Trunk-A federal roads. Subjects: The subjects are patients who were managed in our cardiovascular surgical unit for the study duration (July 2007–June 2015) who had extremity arterial injuries. Results: A total of 36 patients presenting with 40 arterial injuries in 37 limbs were studied. The mean age was 28.4 ± 10.3 years with male preponderance (88.9%). Gunshot injuries were the most common cause of arterial injuries (37.8%), followed by assault (27%). The mean time from injury to presentation for acute injuries was 20.4 h but 23 of the patients (63.8%) presented to the accident and emergency department within 12 h of injury. A limb salvage rate of 64.9% was achieved though ischemic times of ≥12 h were associated with poor outcomes. Conclusion: Prolonged ischemic time is associated with poor outcomes. Efforts should be put in place to reduce the limb ischemic times.

A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up

“…The clinical-based decision was employed in 55.3% of patients in the current study. The commonly injured vessel in our study was the brachial artery accounting for 36.5% followed by a femoral artery with 22.4%; in which Onakpoya, et al [19] . and De Silva, et al [32] .…”

“…Vascular trauma to the extremity predominantly occurs in males than females with the range of 70 to 95% [4,[19][20][21][22] Our study also shows a male predominance of 90.6%. Trauma in general is more common in the younger age group; accounts for the majority of mortality in the younger population of the USA [1] .…”

“…The most frequent type of vascular injury as reported by Sah B, et al [22] . and Onakpoya, et al [19] . was complete transection with 62% & 67.5%, respectively.…”

“…This is facilitated by rapid transportation and the availability of a nearby trauma center or health facility which is lacking in most lowincome countries. A Nigerian [19] and Nepalese [22] study demonstrated that only 33% and 48%, respectively, of extremity vascular trauma patients presented within the golden hour. Our study also showed that a small proportion of patients(32.9%), presented within 6 hours.…”

“…In the Latin American survey, 78% of patients were managed within 6 hours of injury [31] . Because of the urgent need for prompt management and lack of available diagnostic technology, most decisions in lowincome countries are mainly based on clinical criteria [19,31] . The clinical-based decision was employed in 55.3% of patients in the current study.…”