Abstract
A 20-year review documented 248 vascular injuries in 210 patients from principally rural areas. The average time between injury and treatment from 1970 to 1983 was 6 hours. Between 1983 to 1990, when 46% of patients were transported by helicopter, the average delay was 4 hours. Blunt trauma (41%, with 29% motor vehicle accidents and 12% farm/industrial accidents) caused the most severe injuries and accounted for most amputations (89%) and deaths (80%). All of the blunt trauma patients had associated injuries. Penetrating injuries occurred in 59% of the patients and accounted for 11 % of the amputations and 20% of the deaths. Extremity vessels were injured 73% of the time (upper extremity, 47%; lower extremity, 26%). Eightyseven percent of the vessels injured were arteries and 13% were major venous injuries. Preoperative arteriograms were obtained in 30% of our patients. Vascular injury was determined in the others at the time of operative exploration. Vascular repair included direct anastomosis or lateral suture repair (51%), autogenous vein graft (16%), synthetic graft (6%), and ligation (19%). Primary amputation and thrombectomy were other (8%) initial treatments. In the past 10 years concomitant major peripheral venous injuries were repaired in six patients (one amputation) and ligated in one patient (no amputation). The mortality rates (4.8% total) for patients with blunt and penetrating trauma were 9.3% and 1.6%, respectively. Survival rates have not improved since the implementation of a helicopter transport system in 1983, but the amputation rate declined from 18% to 7%.
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References
Robbs JV, Baker LW. Vascular trauma. Curr Probl Surg 1984;21:1–75.
Feliciano DV, Bitondo CG, Mattox KL, et al. Civilian trauma in the 1980s. A one-year experience with 456 vascular and cardiac injuries. Ann Surg 1984;199:717–724.
Drapanas T, Hewitt RL, Weichert RF, et al. Civilian vascular injuries. A critical appraisal of three decades of management. Ann Surg 1970;172:351–360.
Rich NM, Spencer FC. Vascular Trauma. Philadelphia: WB Saunders, 1978, pp 12–21.
Marberry TA, Hartsuck JM, Williams GR. Civilian vascular injuries: A clinical review. Oklahoma State Med Assoc 1975;68:3–7.
Perry MO, Thal ER, Shires GT. Management of arterial injuries. Ann Surg 1971;173:403–408.
O'Gormon RB, Feliciano DV, Bitondo G, et al. Emergency center arteriography in the evaluation of suspected peripheral vascular injuries. Arch Surg 1984;119:568–573.
Lynch K, Johansen KJ. Can doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma. Ann Surg 1991;214:737–741.
Frykberg ER, Dennis JW, Crump JM, et al. The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: Results at one year. J Trauma 1991;31:502–511.
Bynoe RP, Miles WS, Bell RM, et al. Noninvasive diagnosis of vascular trauma by duplex ultrasonography. J Vasc Surg 1991;14:346–352.
Johansen K, Bandyk D, Thiele B, et al. Temporary intraluminal shunts: Resolution of a management dilemma in complex vascular injuries. J Trauma 1982;22:395–401.
Nichols JG, Svoboda JA, Parks JN. Use of temporary intraluminal shunts in selected peripheral arterial injuries. J Trauma 1986;26:1094–1096.
Wagner WH, Calkins ER, Weaver FA, et al. Blunt popliteal artery trauma: One hundred consecutive injuries. J Vasc Surg 1988;7:736–748.
Stone KS, Walshaw R, Sugiyama GT, et al. Polytetrafluoroethylene versus autogenous vein grafts for vascular reconstruction in contaminated wounds. Am J Surg 1984;147:692–695.
Shah DM, Leather RP, Corson JD, et al. Polytetrafluoroethylene grafts in the rapid reconstruction of acute contaminated peripheral vascular injuries. Am J Surg 1984;148:229–233.
Feliciano DV, Mattox KL, Graham JM, et al. Five-year experience with PTFE grafts in vascular wounds. J Trauma 1985;25:71–82.
Rich NM, Hughes CW, Baugh JH. Management of venous injuries. Ann Surg 1970;171:724–730.
Hardin WD, Adinolfi MF, O'Connell RC. Management of traumatic peripheral vein injuries: Primary repair or vein ligation. Am J Surg 1982;144:235–238.
Pasch AR, Bishara RA, Schuler JJ, et al. Results of venous reconstruction after civilian vascular trauma. Arch Surg 1986;121:607–611.
Mullins RJ, Lucas CE, Ledgerwood AM. The natural history following venous ligation for civilian injuries. J Trauma 1980;20:737–743.
Johansen K, Daines M, Howie T, et al. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 1990;30:568–573.
Gregory RT, Gould RJ, Peclet M, et al. The mangled extremity syndrome (MES): A severity grading system of multisystem injury of the extremity. J Trauma 1985;25:1147–1150.
McNutt R, Seabrook GR, Schmitt DD, et al. Blunt tibial artery trauma: Predicting the irretrievable extremity. J Trauma 1989;29:1624–1627.
Mahoney WD, Whelan TJ. Use of obturator foramen in iliofemoral artery grafting: Case reports. Ann Surg 1966;163:215–220.
Feliciano DV, Accola KD, Burch JM, et al. Extraanatomic bypass for peripheral arterial injuries. Am J Surg 1989;158:506–510.
Ledgerwood AM, Lucas CE. Biological dressings for exposed vascular grafts: A reasonable alternative. J Trauma 1975;15:567–574.
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Humphrey, P.W., Nichols, W.K. & Silver, D. Rural vascular trauma: A twenty-year review. Annals of Vascular Surgery 8, 179–185 (1994). https://doi.org/10.1007/BF02018867
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DOI: https://doi.org/10.1007/BF02018867