An Experience of Surgical Management of Peripheral Vascular Injuries at Pakistan Institute of Medical Sciences, Islamabad

Abstract

Background: Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan. Material and Methods: This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size < 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Collected data included age, gender, duration of injury, nature of injury, operative findings, other associated injuries, type of definitive repair, involvement of artery, complications including amputations, infections, re-exploration, ligation or death. Statistical Package for Social Sciences (SPSS) version 23 was used to analyze data. Results: Out of total 60 patients, 53 (88.3%) were males and 7 (11.7%) were females, with a mean age of 27.8±14.1 years. Most of the patients presented after 6 hours of trauma (n=36; 60%). Blunt trauma accounted for 37 (61.7%) while penetrating trauma was seen in 23 (38.3%) patients. Per operatively, 33 (55%) patients had intimal injury, 7 (11.7%) had partial tear and 20 (33.3%) had complete transection of artery. Primary repair was performed in 9 (15%) patients and reverse vein graft in 51 (85%) patients. Most commonly injured arteries were femoral (n=21; 35%), brachial (n=18; 30%) and popliteal (n=12; 20%) arteries, respectively. Amputations were significantly related to presentation of patients later than 6 hours (P=0.035). Conclusion: Patients who present with vascular trauma need an early diagnosis, referral and timely management in order to save both limb and life of patients with special concern for good quality of life and cost-effective management.