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Giornale Italiano di Chirurgia Vascolare 2001 September;8(3):243-58

Copyright © 2002 EDIZIONI MINERVA MEDICA

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


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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.

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