Outcome of Surgical intervention in vascular injuries inAl-Fallujah General Hospital 2010

Abstract

Background: Vascular trauma is one of the most challenging aspects in the care of the injured patient, presenting a unique array of problems in diagnosis , decision – making & surgical technique (1).The focus of contemporary trauma surgery is the need to maintain correct priorities , the first of which is to save the patient's life ( 1 ).Objective & Aim: To focus on the incident, mechanism of injury, management & outcome of vascular injury.Materials & Methods: This is a descriptive study of 56 cases presented with vascular trauma referred to thoracic & vascular ward in Al-Fallujah General Hospital (FGH), over a period of one year (1st of January 2010- last day of same year). In the diagnosis of vascular injury we depended mostly on physical examination because the site of injury was usually obvious, and in doubtful cases, specific investigations were not available. Some of the patients were stable at presentation, and others were presented with severe bleeding and in shock state .All of patients were resuscitated in the casualty unit that includes control of hemorrhage and volume replacement. All of them were explored at the operative theatre, when vascular injury was dealt with, either by simple or complicated procedures. Results: Out of the 56 patients operated upon. The most common mechanism of injury seen was penetrating in 51 (90.9%). Non-penetrating in 5 (9.1%) patients. The surgical intervention within 6 hrs in 41 (73.21%) patients. 43 ( 68.25 %) cases were associated with extremities vessel as 24 ( 38.09%) cases with upper limbs including radial artery most vessel injured ,then brachial & ulnar artery. 19 (30.15%) cases with lower limbs were the femoral artery most vessel injured. While truncal vessel in 20 (31.74%) cases & intercostal vessel more injured. The vascular intervention includes ligation in 34 procedures (53.96%) to save life rather than to save limb as a priority especially in non-end artery , end to end anastomosis in 14(22.22%) , graft interposition in 8 (12.69%) cases & lateral repair in 7(11.11%) cases (7 patients had 2 vascular injuries) . The results of surgical intervention were good. Thoracotomy was needed in 7 (12.5%) patients , Intercostal arteries injury was found in all .Only 2 ( 3.57%) patient dead. Two (3.57%) cases ended with above knee amputation due to delay presentation after injury.