MISSED VASCULAR INJURIES

Abstract

Objective: To evaluate vascular injuries for the cause, site of injury, presentation and treatment.
Design: Descriptive study.
Place and duration of study: Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical Unit 2, Combined Military Hospital, Lahore. 1st August 2005 to 30th June 2010.
Subjects and Methods: All cases of missed vascular injuries (MVI) who presented to a single vascular surgeon, between 1st August 2005 and 30th June 2010 were examined in detail. Only cases with viable limbs and reversible ischaemia were included in the study. Patients with gangrene of the limbs of any extent were excluded. Record was made of the cause, site, mode of presentation and treatment. MVI was defined as vascular injury which was missed in the initial evaluation, operative procedure or intervention.
Results: Out of 41 cases, 31(75.6%) were due to gunshot or splinter injuries, 3(7.3%) external fixator injuries, 2(4.8%) carotid stentings , 2(4.8%) cardiac angiographies, 1(2.4%) fine needle biopsy, 1(2.4%) metallic rod penetrating injury and 1(2.4%) elective lumbar disc surgery. Neck was affected in 9(21.9%), upper limb in 7(17%) and lower limb in 25(60.9%) patients. There were 20(48.7%) false aneurysms, 8(19.5%) traumatic arteriovenous fistula (AVF), 5 (12.1%) false aneurysms with traumatic AVF, 3(7.3%) thrombosis, 1(2.4%) stenosis, 3(7.3%) hematoma and 1(2.4%) hemorrhagic shock. In 39(95.1%) cases surgical intervention was done. In 2(4.8%) cases, vascular injury was missed in polytrauma and mass casualty situation while 3(7.3%) cases were of polytrauma only.
Conclusion: Penetrating trauma was the commonest cause of MVIs. Lower limbs were mostly affected. Most of the cases presented with pseudoaneurysms. Few cases had polytrauma/mass casualty situation at the time of initial presentation indicating that vascular injuries were missed either due to low index of suspicion by clinician or not following the proper protocol to avoid these injuries.