War Injuries of Major Extremity Arteries |
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Authors: | Nanobashvili Joseph Kopadze Teimuraz Tvaladze Merab Buachidze Teimuraz Nazvlishvili Georgi |
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Institution: | (1) Department of Vascular Surgery and Microsurgery, Tbilisi 1st Hospital, Tbilisi Medical Academy, Chavchavadze Ave. 33, Tbilisi, Georgia,;(2) Department of Vascular Surgery, University of Vienna, Medical School, AKH, Waehringer Guertel 18-20, A-1090, Vienna, Austria, |
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Abstract: | Abstract
During the period 1991–1994, 99 patients (all males, median age 35 years) with combat-related injuries of major limb arteries
were managed. Mechanism: mine fragments (40%), high-velocity projectiles (35%), and shotgun pellets (25%). Patients were admitted
1 hour to 16 hours (median 8 hours) after injury; 39% were in severe hemorrhagic shock. Arterial injury was diagnosed by clinical
findings. Preoperative angiography was usually not necessary. Of 99 injured patients, 50 (51%) showed signs of distal ischemia
and required arterial reconstruction. No primary amputation was performed. Reconstruction was always necessary in cases of
injury of axillary or popliteal arteries, but not of superficial femoral or brachial arteries. Ligation of injured single
forearm or crural arteries was well tolerated. End-to-end anastomosis by reconstruction was possible only in 38% of cases.
In 56% of patients, autologous venous bypass was performed. Uncontrolled wound infection developed in 22% of cases, leading
to a secondary hemorrhage compelling arterial ligature (8%), and thrombosis (6%). The secondary amputation rate after arterial
reconstruction was 10%. Injury of major vessels was associated with limb bone fractures, nerve damage, or major vein injuries
in 68% of cases, frequently on the forearm, the popliteal region, and the crural region. When limb ischemia was present, vascular
reconstruction had priority over orthopedic immobilization. Arterial injury was almost always associated with the venous damage
in the forearm, the popliteal region, and the crural region. Injured veins of the upper limb were ligated; venous repair was
more often indicated in lower limb injury (52%). The method of choice was lateral suture/patch. Gunshot damage to peripheral
nerves was rarely treated with primary repair. |
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