Late Complications of Civilian Vascular Injuries of the Extremities in Cameroon

Abstract

To describe the different presentations, diagnostic evaluations, management, and outcome of late complications of vascular trauma of the extremities (LCVTE) in civilian practice. All the patients with LCVTE who reported at the Yaounde General Hospital from January 2010 to December 2019 were included. Patients presenting with acute vascular injuries, neck vessel injuries, and iatrogenic lesions or late complications of vascular access for hemodialysis were excluded. All cases were evaluated with ultrasound and/or computer tomography and managed with various open vascular surgical techniques and their results were assessed. Fifteen patients with 17 LCVTE underwent various vascular repairs. There were 2 women and 13 men. The mean age was 30.28 years (median 22, range 8 months to 54 years). The time interval between injury and presentation in the hospital was 3 weeks to 15 years with a mean of 3 months (median 6 months). Penetrating injuries secondary to stabs were the commonest cause in 94.11%. Lower limb vessels were affected in 12/17 (70.58%), with the superficial femoral artery being the most frequently involved artery in 6 (35.29%) cases. Sixteen (94.11%) patients presented with pseudoaneurysm, 1 with solely traumatic arteriovenous fistula. Some pseudoaneurysms presented with complications such as infection (2 cases), bleeding (3 cases), and rupture with hypovolemic choc (1 case). The only non-vascular injuries associated were 1 brachial plexus injury and 1 fracture of the distal femur shaft. For the 15 lesions that underwent surgery, the most frequent surgical techniques used were simple suturing (66.66%) followed by resection and end-to-end anastomoses (26.66%). Unfortunately, one postoperative mortality was registered. After a follow-up from 6 months to 10 years, no late complications were detected (no recurrence, no wound infection). Only the patient with the brachial plexus injury ended up with a flail limb that did not improve and the patient with a femoral fracture with a shortening of the limb. Penetrating wounds secondary to stabs were the main injuries and pseudoaneurysm was the most common late complication. Ameliorating the management environment could reduce morbidity.