Large vessel injuries - own experience

Abstract

Background. The aim of the authors was to present the characteristics of large vessel injuries in patients wounded during 1966-2004 and their management in the Department of General, Oncological and Vascular Surgery and Department of General, Oncological and Thoracic Surgery of the Military Institute of Health Service in Warsaw.
Material and methods. Retrospective analysis was performed on the medical records of 249 patients treated for large vessel injuries e.g. vessels of the neck, chest, abdomen and extremities. According to the type of injury and vessel localization, different types of reconstruction were performed. All possible methods of vessel reconstruction were done.
Results. A total of 249 patients presenting large vessel injuries were recorded. 59% (115/193) presented femoral artery injuries, 24% (47/193) - popliteal artery injuries, 10% (20/193) - brachial artery injuries, 1% (2/193) - common carotid artery injuries, 1% (2/193) - aorta injuries, 1% (2/193) pulmonary artery injuries and 0.5% (1/193) mesenteric artery injuries. Then 32% (25/76) of inferior vein cava injuries, 21% (16/76) - popliteal vein, 11% (9/76) - femoral vein injuries, 5% (4/76) - brachial vein injuries, 5% (4/76) - subclavian vein injuries, 5% (4/76) - axillary vein injuries, 5% (4/76) - renal vein injuries, 5% (4/76) - iliac vein injuries, 2.5% (2/76) - jugular vein injuries, 2.5% (2/76) - pulmonary vein injuries and 2.5% (2/76) - transverse vein of neck were treated. The time from injury and hospital admittance ranged from 40 minutes up to 87 hours. In 4 cases, facing evident peripheral necrotic lesions of the leg, amputation was performed.
Conclusions. These injuries require prompt treatment to save life. The wounds have to be treated individually. Early and adequate primary treatment, combined with early reparation and reconstruction of vessel wall, establishment of circulation and closure of soft tissue defects gives the best functional and aesthetic results, decreased mortality, morbidity and cost of treatment.