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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2001 September;8(3):243-58
language: English, Italian
Lower limbs vascular trauma
Talarico F., Reina N., Lipari R., Riggi M., Fallea F., Salvo G., Ruscazio A., Calì F., Bajardi G.
From the Vascular Surgery Unit University of Palermo, Palermo, Italy
Background. Lower limb vascular trauma usually involves bone, nerve and muscle tissues, thus involving multidisciplinary skills that entail a variety of diagnostic choices and therapeutic procedures. Diagnosis is often difficult because patients have often undergone multiple traumatic lesions and are sometimes in severe shock. Misdiagnosis of arterial peripheral trauma prolongs ischemic damage, often jeopardising limb salvage. The aim of this study was to evaluate the diagnostic procedures, the indication, therapeutic approach and methodological choices. The follow-up ranged between one month and 5 years.
Methods. A retrospective study was made of 21 patients with lower limb vascular trauma, of whom 19 (90.4%) were male and 2 (9.6%) were female, operated between March 1993 and March 1999. The mean age of patients was 38 years (15-78). Road accidents were the cause of peripheral ischemia in 10 cases (47.6%), penetrating wounds in 5 cases (23.8%), industrial accidents in 3 (14.3%) and iatrogenic lesions in 3 (14.3%). The popliteal artery was affected in 11 cases (52.4%), the tibial vessels in 6 cases (14.5%) and the femoral artery in 4 cases (19.4%). Routine therapeutic approach took the form of preoperative angiography (19 cases), priority of vascular reconstruction, preference for reversed saphenous vein bypass (14 cases), complementary leg fasciotomy.
Results. No primary amputation was required, and only one patient underwent secondary amputation.
Conclusions. A rapid diagnosis and prompt surgery aimed at reducing ischemic time are the key factors for the treatment of vascular trauma. The extensive use of preoperative angiography, preference for direct angioreconstruction using reversed saphenous vein bypass and fasciotomy are considered fundamental for limb salvage.