Tabriz Experience in the Management of Extremity Vascular Trauma

Epidemiologic studies on civilian vascular trauma in developing countries are rather few. Although Iran encounters vascular injury far more frequently than developed countries, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper retrospectively reviews a tertiary referral center experience of extremity vascular trauma. All individuals who presented to the Imam Khomeini Hospital, Tabriz/Iran, with a vascular injury between March 1998 and February 2000 were retrospectively identified from a trauma database. The aim was to study the etiology, signs and symptoms, pattern of injuries, the implemented treatment strategies, and the mortality and morbidity rates due to vascular trauma in our population. During the study period, 124 patients (5 female) with a mean age of 23 years (7-65 years) sustained vascular injuries. The most common injury was arterial and isolated venous injuries were seen in only 15 cases. Penetrating injuries were the causes in 63% of patients, blunt trauma in 21%, and both in 16% of the rest. The commonest injured artery and vein were the femoral artery and the popliteal vein, respectively. All of the patients underwent surgical repair in 1-48 hours (mean 9.5 hours) after trauma, with the most common procedure being the end-to-end anastomosis. Three underwent primary amputation and 3 required secondary amputation, mostly due to infection. The mortality rate was 3.2% (4 cases) with a median hospital stay of 13 days. Most vascular injuries due to limb trauma can be managed successfully unless associated with severe damage to bones, nerves or soft tissues. The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting.