Arterial injuries in lower leg fractures, a rare but severe complication]

Vascular injuries of the popliteal or crural arteries complicating tibial fractures are rare. They often lead to acute critical limb ischaemia requiring immediate invasive diagnostic procedures and surgical repair. To illuminate the acute situation of this combined injury two case histories are presented. A comprehensive surgical approach is mandatory to salvage the injured limb.     

Arterial tortuosity

Vessel curvature or tortuosity has usually been ignored in haemodynamic studies of the vasculature, vessels are commonly assumed to be straight and axisymmetric. This assumption is generally not valid and even for those vessels which are relatively straight in early life, such as the abdominal aorta, there is a tendency to develop tortuosity with increasing age. This paper proposes a quantitative evaluation of tortuosity based on the standard deviation of the incremental displacements of the midline of a vessel. The tortuosity coefficients for the abdominal aorta were determined from the aortograms of 92 patients. For the majority of patients aged less than 40 years of age, the tortuosity coefficients were close to those expected for a straight vessel, i.e. less than 0.20. Above that age there is a rising incidence of tortuosity with, in some cases coefficients several times greater than those expected for the straight vessel case. This tortuosity is likely to be due to an aging of the vessel wall leading to loss of longitudinal stiffness. The haemodynamic implications of tortuosity are that it is likely to create flow profile asymmetries leading to abnormal wall shear stress and predispose the vessel to atherosclerosis. As a consequence tortuosity may be considered as a geometrical risk factor in the development of the disease.     

Arterial injury

Urban violence, collision of high-speed vehicles, acts of terrorism and military conflict continue to present difficult arterial injuries. The immediate threat of exsanguination, combined often with multiple trauma, and the challenge of limb salvage makes speedy effective management essential to improve the outcome for victims, who are frequently young adults.     

Ozone-Induced Arterial Lesions

Microscopic studies carried out on the lungs of rabbits exposed to 0.4 ppm of ozone for six hours a day, five days a week, for a calendar period of ten months showed both emphysematous and vascular lesions. Small pulmonary arteries (exterior diameters of 105µ to 1,050µ) showed a marked mural thickening. The mean ratio of the thickness of the wall to the diameter of the lumen was greatly reduced in the exposed animals as compared with that of the controls.