Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000400006
Jornal Vascular Brasileiro
Original Article

Vascular injuries of the upper extremity

Lesões vasculares de membros superiores

Raafat Shalabi; Yoysifh Al Amri; Elham khoujah

http://dx.doi.org/10.1590/S1677-54492006000400006 J Vasc Bras, vol.5, n4, p.271-276, 2006
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Abstract

OBJECTIVE: This study 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: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.

Keywords

Vascular trauma, upper extremity, vein interposition

Resumo

OBJETIVO: Este estudo analisa as causas de lesões, apresentação, abordagens cirúrgicas, desfechos e complicações do trauma vascular de membros superiores, apesar de recursos hospitalares limitados. MÉTODOS: Análise retrospectiva de 5 anos. De 01/01/2001 a 31/12/2005, 165 pacientes foram operados devido a lesões vasculares no King Fahd Hospital, Medina, Arábia Saudita. De todos os pacientes com trauma vascular periférico (115), trauma de membros superiores esteve presente em 58. O diagnóstico foi realizado por exame físico e Doppler manual isoladamente ou associado com ultra-som Doppler/angiografia. A restauração vascular primária foi realizada sempre que possível; do contrário, utilizou-se a interposição de veia. A fasciotomia foi considerada quando necessário. Pacientes com lesão de membro inferior não resgatável necessitando de amputação foram excluídos do estudo. RESULTADOS: Cinqüenta pacientes eram homens (86%) e oito eram mulheres (14%), com idade entre 2,5 e 55 anos (média de 23 anos). A duração média de apresentação foi 8 h pós-lesão. O fator etiológico mais comum foi acidente em estradas, sendo responsável por 50,5% no grupo de trauma contuso e 33% entre as lesões penetrantes e por arma branca. A incidência de lesões ortopédicas concomitantes foi muito alta em nosso estudo (51%). A artéria braquial foi a mais afetada (51%). A interposição de veias foi utilizada em 53% dos casos. A taxa de preservação de membros foi de 100%. CONCLUSÃO: Pacientes que sofrem lesões vasculares de membros superiores devem ser transferidos para centros de cirurgia vascular o mais rápido possível. O tratamento imediato do trauma vascular periférico aumentará a sobrevida dos pacientes e a preservação dos membros. Devem-se estabelecer prioridades no tratamento de lesões associadas e evitar o atraso quando alterações isquêmicas estiverem presentes.

Palavras-chave

Trauma vascular, membro superior, interposição de veia

References

Hood DB, Yellin AE, Weaver F. Vascular trauma. Current diagnosis & Treatment in Vascular surgery. 2000:405-28.

Wali MA. Upper limb vascular trauma in the Asir region of Saudi Arabia. Ann Thorac Cardiovasc Surg.. 2002;8:298-301.

Hunt CA, Kingsley JR. Vascular injuries of the upper extremity. South Med J.. 2000;93:466-8.

Creagh TA, Broe PJ, Grace PA, Bouchier-Hayes DJ. Blunt trauma-induced upper extremity vascular injuries. J R Coll Surg Edinb.. 1991;36:158-60.

Shaw BA, Kasser JR, Emans JB, Rand FF. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. J Orthop Trauma. 1990;4:25-9.

Kruse-Andersen S, Lorentzen JE, Rohr N. Arterial injuries of the upper extremities. Acta Chir Scand.. 1983;149:473-7.

Iriz E, Kolbakir F, Sarac A, Akar H, Keceligil HT, Demirag MK. Retrospective assessment of vascular injuries: 23 years of experience. Ann Thorac Cardiovasc Surg.. 2004;10:373-8.

Rutherford RB. Basic vascular surgical techniques. Vascular surgery. 2004:395-404.

Fogarty TJ. Fogarty catheter thrombectomy. Vascular surgery. 2004:410-4.

Subber SW. Contrast arteriography (excerpt). Vascular surgery. 2004:195-202.

Towne JG. The autogenous vein. Vascular surgery. 2004:482-91.

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.

Volgas DA, Stannard JP, Alonso JE. Current orthopaedic treatment of ballistic injuries. Injury. 2005;36:380-6.

Ferguson E, Dennis JW, Vu JH, Frykberg ER. Redefining the role of arterial imaging in the management of penetrating zone 3 neck injuries. Vascular. 2005;13:158-63.

Blackmore CC, Zweibel A, Mann FA. AJR Am J Roentgenol.Determining risk of traumatic aortic injury: how to optimize imaging strategy. 2000;174:343-7.

Keen JD, Keen RR. The cost-effectiveness of exclusion arteriography in extremity trauma. Cardiovasc Surg.. 2001;9:441-7.

Asfar S, Al-Ali J, Safar H. 155 vascular injuries: a retrospective study in Kuwait, 1992-2000. Eur J Surg.. 2002;168:626-30.

Razmadze A. Vascular injuries of the limbs: a fifteen-year Georgian experience. Eur J Vasc Endovasc Surg.. 1999;18:235-9.

Menakuru SR, Behera A, Jindal R, Kaman L, Doley R, Venkatesan R. Extremity vascular trauma in civilian population: a seven-year review from North India. Injury. 2005;36:400-6.

Lakhwani MN, Gooi BH, Barras CD. Vascular trauma in Penang and Kuala Lumpur Hospitals. Med J Malaysia. 2002;57:426-32.

Sugrue M, Caldwell EM, Damours SK, Crozier JA, Deane SA. Vascular injury in Australia. Surg Clin North Am.. 2002;82:211-9.

Morales-Uribe CH, Sanabria-Quiroga AE, Sierra-Jones JM. Vascular trauma in Colombia: experience of a level I trauma center in Medellin. Surg Clin North Am.. 2002;82:195-210.

Sonneborn R, Andrade R, Bello F. Vascular trauma in Latin America: a regional survey. Surg Clin North Am.. 2002;82:189-94.

Fingerhut A, Leppaniemi AK, Androulakis GA. The European experience with vascular injuries. Surg Clin North Am.. 2002;82:175-88.

Gupta R, Rao S, Sieunarine K. An epidemiological view of vascular trauma in Western Australia: a 5-year study. ANZ J Surg.. 2001;71:461-6.

Rich NM. Complications of vascular injury management. Surg Clin North Am.. 2002;82:143-74.

Fox CJ, Gillespie DL, O'Donnell SD. Contemporary management of wartime vascular trauma. J Vasc Surg.. 2005;41:638-44.

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