Arterial trauma of the extremities. An Ivorian surgical experience(C te d’Ivoire)

Objective: The goal of this retrospective study is to present our epidemiological , clinical and surgical experience of the arterial injuries of extremities for 23 years(1977 to 2000). Materials and Methods: 35 patients were operated on over the study period. Their case files have been reviewed and forms the subject of this study Results: 30 were men and 5 women with an age range of 14 months - 63 years and a median age of 25.4 years. The etiology of these injuries were side-arms(n=15), fire arms (n=5) , road or work accident (n=6) and iatrogenic (n=9 ). The injured arteries were: the femoral artery 18 , the popliteal artery 2 , the subclavian artery 2 the axillary artery 1 , the brachial artery 10 , the ulnar artery 1 ,the radial artery 1patient . Complete arterial rupture was the most frequent lesion n = 14. An incomplete arterial rupture was noted in 6 patients , and arterial thrombosis 6, a thrombosis coexisting with an intima damage in 1 case, and avulsion in 1, an arteriovenous fistula (n = 3) and a false aneurysm (n = 3). Adjacent Injuries were encountered :Bone fractures (n = 9), muscle tear (n = 10), nerve section(n = 12), vein section (n = 11), tendon section (n = 1), and haemothorax (n = 1) . Clinically most patients presented with complete or partial limb ischemia (28 patients). The arterial repair was by end to end anastomosis with saphenous vein (8 patients), or without graft (5 patients), lateral suture (8 patients), arterial clot extraction by balloon catheter (8 patients), direct vessel suture via longitudinal venotomy (2 patient) or arterotomy (1 patient), an aneurysmectomy 1 case. In one patient the limb was amputated because arterial repair was not possible; . There two 2 operative deaths due to reperfusion injury (1 case) and biliary peritonitis(1 case). Conclusion Arterial injury is a true surgical emergencies and repair should be urgent to avoid limb loss and even death.