Management of Penetrating Femoral Artery Injury: Review of 100 Cases in Thi-qar \ Iraq (2013-2020)

Abstract

Background: Extremity arterial injury after penetrating trauma is common in military conflict or urban trauma centers. Most peripheral arterial injuries occur in the femoral and popliteal vessels of lower extremity. Physical examination identifies the majority of vascular injuries and findings are classified either hard signs or soft signs of vascular injury.  In general, hard signs constitute indications for operative exploration, whereas soft signs are indications for further testing or observation. Surgical exploration with end to end anastomosis or saphenous vein graft are effective methods in restoring blood flow and limb viability status. Aim of study:  Analysis of 100 cases of penetrating femoral artery injury and determination of ag, gender, mode of presentation, surgical procedures  and limb salvage after revascularization. Patients and Methods: This is a retrospective study on 100 patients had been admitted to the emergency department in Al-Hussain teaching hospital in Thi-qar governorate in Iraq over a period of 7 years from January 2013 to January 2020. All the patients were victims of penetrating injury to the thigh, patients’ data were collected from hospital records including age, gender, mode of presentation of vascular injury regarding limb perfusion, preoperative investigations, most common part injured from femoral artery and surgical procedures used for revascularization.  Results: We reviewed 100 cases of femoral artery injury, 90 patients ( 90%) were males and 10 patients ( 10%) females with mean age 33 years .Most commonly superficial femoral artery  (SFA) were involved in 78% , common femoral artery 13%, profunda femoris ( deep femoral artery ) in 9%. Pulse deficit and limb ischemia were the most common clinical findings in seventy five patients (78%), twenty two patients with soft signs (22%) from them (10% with proximity of injury to the major vessels, 8% with hematoma, 4 % with nerve injury). Preoperative imaging were performed in only 22 patients 22%) with subtle clinical findings i.e soft signs while patients with hard signs of limb ischemia (78%) admitted directly to the operative theatre. End to end anastomosis were performed in 55% , reversed saphenous vein graft in 36% , ligation in only 9 patients (9%) with profunda artery injury, no primary amputation was performed. Limb salvage rate were 98% while secondary amputation was done in only 2 patients due to advanced ischemia during presentation aggravated by long delay between time of injury and surgery. Conclusions: There is high rate of limb salvage after femoral artery injury whatever the type of surgical re-vascularization chosen. Pre- operative imaging is unnecessary   if there were hard signs for vascular injury.