Upper Limb Vascular Injury
Keywords:
Trauma, vascular injury, upper limbs, IraqAbstract
Background: Upper extremity vascular injuries had high incidence in current surgical practice dueto increased incidence of terrorist action.
Aim of study: Is to highlight the Medical City experience as major referral center and to assess
morbidity and mortality of injured patient, also analyzes the causes of injuries, presentations,
surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of
limited hospital resources.
Methods: From October 2014 to November 2015 (56) cases were collected from Ghazi Al-Harreri
Martyr Hospital, Thoracic and Vascular Department, Medical City, Baghdad. All patients
underwent full physical examination, resuscitation and evaluation were performed according to
Advanced Trauma Life Support (ATLS) guidelines.
Result:
Fifty six patients with upper limb vascular injury were prospectively followed, of them 51 males
(91%) and 5 females about (9%) with age range from (7-46) with a mean age of 22 years. The
mechanism of trauma was mostly penetrating (bullet, shells and stabbing injury) in 50 patients
(89%), blunt trauma was in 6 patients (11%).
Conclusion:
Upper extremity vascular injuries carry better prognosis and lower complication. Early referral of
injuried patients affects the outcome of these patients especially when associated with other
injuries.
References
Hammond DC, Gould JS, Hanel DP. Management of acute and chronic vascular injuries to the
arm and forearm. Indications and technique. Hand Clin 1992; 8: 453-63.
DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II. Ann Surg 1946;
:534-579.
Hughes CW. The primary repair of wounds of major arteries: an analysis of experience in Korea
in 1953. Ann Surg 1955; 141:297-303
Orcutt MB, Levine BA, Gaskill HV, et al. Civilian vascular trauma of the upper extremity. J
Trauma 1986; 26:63-67.
Fox CJ, et al: Contemporary management of wartime vascular injury. J Vasc Surg 2005;41:638-
,.
Kragh JF, Jr, et al: Survival with emergency tourniquet use to stop bleed- ing in major limb
trauma. Ann Surg 2009;249:1-7,.
Frykberg ER, et al: The reliability of physical examination in the evaluation of penetrating
extremity trauma for vascular injury: results at one year. J Trauma 1991;31:502-511,.
Frykberg ER, et al: A reassessment of the role of arteriography in penetrating proximity
extremity trauma: a prospective study. J Trauma 1989;29:1041-1050; discussion 1050-1052,.
Mullenix PS, et al: Limb salvage and outcomes among patients with traumatic popliteal vascular
injury: an analysis of the National Trauma Data Bank. J Vasc Surg 44:94-100, 2006.
Wagner WH, et al: Blunt popliteal artery trauma: one hundred consecutive injuries. J Vase
Surg 1988.;7:736-743,
Bosse MJ, et al: The insensate foot following severe lower extremity trauma: an indication for
amputation? J Bone Joint Surg Am 2005;87:2601- 2608,.
Bynoe RP, et al: Noninvasive diagnosis of vascular trauma by duplex ultrasonography. J Vase
Surg 1991;14:346-352,. Upper limb vascular injury
Schwartz MR, et al: Refining the indications for arteriography in penetrating extremity trauma:
a prospective analysis. J Vase Surg 17:116- 122; discussion 1993;122-124.
Starnes BW, et al: Extremity vascular injuries on the battlefield: tips for surgeons deploying to
war. J Trauma 2006;60:432-442.
White PW, et al: Sixty-four slice multi-detector computed tomography angiography in the
evaluation of vascular trauma. J. Trauma 2010;68:96-102.
Kragh JF, Jr, et al: Practical use of emergency tourniquets to stop bleeding in major limb
trauma. J Trauma 2008;64(Suppl):S38-$49.
Stain SC, et al: Selective management of nonocclusive arterial injuries. Arch Surg
;124:1136-1140; discussion 1140-1141,.
Reuben BC, et al: Increasing use of endovascular therapy in acute arte- rial injuries: analysis of
the National Trauma Data Bank. J Vasc Surg 2007; 46:1222-1226.
Worni M, et al: Use of endovascular therapy for peripheral arterial lesions: an analysis of the
National Trauma Data Bank from 2007 to 2009. Ann Vase Surg, 2013; 27:299-305.
Katsanos K, et al: Peripheral endografts for the treatment of traumatic arterial injuries. Emerg
Radiol, 2009;16:175-184.
Piffaretti G, et al: Endovascular treatment for traumatic injuries of the peripheral arteries
following blunt trauma. Injury , 2007;38:1091-1097.
Mavili E, et al: Endovascular treatment of lower limb penetrating arterial traumas. Cardiovase
Intervent Radiol, 2007; 30:1124-1129.
Lopera JE, et al: Crural artery traumatic injuries: treatment with embo- lization. Cardiovase
Intervent Radiol, 2008;31:550-557.
Orcutt MB, et al: Civilian vascular trauma of the upper extremity. J Trauma, 1986; 26:63-67.
Asensio JA, et al: Femoral vessel injuries: analysis of factors predictive of outcomes. J Am
Coll Surg, 2006;203:512-520. Upper limb vascular injury
Rich NM. et al: The fate of prosthetic material used to repair vascular injuries in contaminated
wounds. J Trauma, 1972; 12:459 - 467.
Feliciano DV, et al: Five-year experience with PTFE grafts in vascular wounds. J Trauma,
;25:71-82.
Veith FJ, et al: Six-year prospective multicenter randomized comparison of autologous
saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial
reconstructions. J Vasc Surg, 1986; 3:104-114.
Clouse WD, et al: Upper extremity vascular injury: a current in-theater wartime report from
Operation Iraqi Freedom. Ann Vasc Surg, 2006;20:429-434.
Dennis JW, et al: New perspectives on the management of penetrating trauma in proximity to
major limb arteries. J Vasc Surg, 1990;11:84-92; discus- sion 92-93.
McKinley AG, et al: Management of proximal axillary and subclavian artery injuries. Br J
Surg, 2000; 87:79-85.
Zelenock GB, et al: Nonpenetrating subclavian artery injuries. Arch Surg, 1985;120:685-692.
Degiannis E, et al: Penetrating injuries of the axillary artery. Aust N Z J Surg, 1995; 65:327-
Demetriades D, et al: Penetrating injuries to the subclavian and axillary vessels. J Am Coll
Surg, 1999;188:290-295.
Piffaretti G, et al: Endovascular treatment for traumatic injuries of the peripheral arteries
following blunt trauma. Injury , 2007;38:1091-1097.
Shalhub S, et al: Repair of blunt thoracic outlet arterial injuries: an evolution from open to
endovascular approach. J Trauma, 2011;71:114-E121.
Muthana D.R. Alasal, Sabah N.Jaber, Mohammed H.Nemat,Uday Hussain:extra-anatomic
prosthetic bypass graft in management of subing.
Infection.Al-Kindy college medic Journal 2014:vol. 10,No.2,page: 19-20 Upper limb vascular
injury
Hyre CE, Cikrit DF, Lalka SG, et al. Aggressive management of thoracic injuries of the
thoracic outlet. J Vase Surg. 1998; 27:880--884.
Weaver FA, Papanicolaou G, Yellin AE. Difficult peripheral vascular injuries. Surg Clin North
Am. 1996; 76:843-859.
Orcutt MB, et al: Civilian vascular trauma of the upper extremity. J Trauma, 1986;26:63-67.
Smith LM, et al: The natural history of extremity venous repair performed for trauma. Am
Surg, 1999;65:116-120.
Quan RW, et al: The effect of vein repair on the risk of venous thromboembolic events: a
review of more than 100 traumatic military venous injuries. J Vase Surg, 2008; 47:571-577.
Moini M, Hamedani K, Rasouli MR, Nouri M. Outcome of delayed brachial artery repair in
patients with traumatic brachial artery injury: prospective study. Int J Surg 2008; 6: 20-2.
Iriz E, Kolbakir F, Sarac A, Akar H, Keceligil HT, Demirag MK. Retrospective assessment of
vascular injuries: 23 years of experience. Ann Thorac Cardiovase Surg. 2004; 10:373-8.
McHenry TP, Holcomb JB, Aoki N, Lindsey RW. Fractures with major vascular injuries from
gunshot wounds: implications of surgical sequence. J Trauma. 2002; 53:717-21
Cihan HB, Gülcan O, Hazar A, Türköz R. Periferik damar yaralanmalari. Ulus Travma Derg
; 7: 113- 6.
Johansen K, Lynch K, Paun M, Copass M. Non-inva- sive vascular tests reliably exclude occult
arterial trauma in injured extremities. J Trauma 1991; 31: 515-22.
Shalabi et al:vascular trauma, upper extremity vein interposition J vasc Bras 2006; vol
(4):271-6.
Fingerhut A, Leppaniemi AK, Androulakis GA, et al. The European experience with vascular
injuries. Surg Clin North Am. 2002;82:175-88. Upper limb vascular injury
O'Gorman RB, Feliciano DV, Bitondo CG, Mattox KL, Burch JM, et al. Emergency center
arteriography in the evaluation of suspected peripheral vascular injuries. Arch Surg 1984; 119:
-73.
Shanmugam V, Velu RB, Subramaniyan SR, Hussain SA, Sekar N. Management of upper limb
arterial injury without angiography Chennai experience. Injury 2004; 35: 61-4.
Rasouli et al:trauma, vascular injury, upper extremity, Ann thorac cardiovasc surg; (2009); vol
, no.6.
Murad et al: vascular trauma management. J Arab soc. Med Res; ,2013;8:43-47.
M.Dragas et al: factor influencing out come/upper extremity arterial injury.J.care injuried
(2009) :40,815-819.
Peck et al: awar time report. Balad air force theater hospital, journal of vasc surgery; june
45,6(1204-1205)
Clouse et al: Upper Extremity Vascular Injury: A Current In-Theater Wartime Report from
Operation Iraqi Freedom; Ann Vasc Surg 2006 DOI: 10.1007/10016-006-9090-3 Annals of
Vascular Surgery Inc.
Shaw AD, Milne AA, Christie J, Jenkins AM, Murie JA, et al. Vascular trauma of the upper
limb and associated nerve injuries. Injury 1995; 26: 515-8
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