Hasan SUNAR, İlker MATARACI, Adil POLAT, Burak KIRAN, Kaan KIRALİ, Murat SONGUR, Cevat YAKUT, Deniz ÇEVİRME

Amputation-free treatment of vascular trauma patients

Amaç: Bu çalışmada vasküler yaralanma nedeniyle cerrahi onarım işlemi uygulanan olgular ve tedavi sonuçları geriye dönük olarak değerlendirildi.Çalışma planı: Haziran 2005 - Eylül 2008 tarihleri arasında vasküler yaralanma nedeniyle kliniğimizde cerrahi onarım işlemi uygulanan 165 hasta (140 erkek 25 kadın; ort. yaş 30.1±11.5 yıl; dağılım 12- 73 yıl) çalışmaya dahil edildi. Vasküler travmaya yol açan yaralanmaların 96’sı alt ekstremitede, 61’i üst ekstremite ve sekizi ise batında idi.Bulgular: Yaralanmaların en sık nedeni penetran yaralanmalardı (n=110) ve hastaların 55’i ateşli silahla yaralanmıştı. Hastaların 145’inde arteriyel hasar saptandı. Yüz sekizinde izole arter ve 20’sinde izole ven hasarı tespit edildi. En sık yaralanan arterler femoral (n=47) ve popliteal (n=35) arterler idi. En sık hasar gören ven femoral ven (n=26) idi. En sık tercih edilen cerrahi tedavi primer onarım (n=105) idi. Ameliyat sonrası mortalite oranı iki hastanın kaybıyla %1.2 oldu. Ameliyat sonrası dönemde yedi hastaya (%4.2) fasyotomi açılması gerekti. Ortalama hastane kalış süresi 5.2±5.0 (dağılım 0-30) gün oldu.Sonuç: Erken cerrahi girişim, yaralanma şekli, yara yeri ve ek lezyon varlığı vasküler yaralanmalarda morbidite ve mortaliteyi etkileyen en önemli parametrelerdir.

Ampütasyon yapılmadan tedavi edilen vasküler yaralanmalı hastalar

Background: In this study we have retrospectively evaluated the patients who were surgically treated due to vascular trauma, and the results of the operations.Methods: One hundred and sixty-five patients (140 males 25 females; mean age 30.1±11.5 years; range 12to 73 years) who were operated on in our clinic due to vascular injuries between June 2005 and September 2008 were included in the study. Of the injuries causing vascular traumas, 96 were in the lower extremity, 61 in the upper extremity and eight in the abdomen.Results: The most frequent cause of injury was penetrating injury (n=110) and 55 patients had gunshot wounds. One hundred and forty-five patients had arterial injury. One hundred and eight patients had isolated arterial injury and 20 had isolated venous injury. The most frequently injured arteries were femoral (n=47) and popliteal arteries (n=35). The most frequently injured vein was femoral vein (n=26). The most frequently used repair was primary repair (n=105). Two patients died in the postoperative period, giving a mortality rate of 1.2%. Fasciotomies were necessary postoperatively in seven patients (4.2%). The mean duration of hospitalization was 5.2±5.0 (range 0-30) days.Conclusion: Early surgical approach, extent and site of the damage and presence of concomitant injuries are the most important factors affecting the morbidity and the mortality in vascular injuries.

PDF

___

1) Dattani RG, Richards T, Smith CD, Magee TR. Trauma calls: role of the general surgeon and CT scanning. Emerg Med J 2005;22:339-41.
2) Mansfield AO, Wolfe JH. ABC of vascular diseases. Trauma. BMJ 1992;304:439 42.
3) Galindo RM, Workman CR. Vascular trauma at a military level II trauma center. Curr Surg 2000;57:615-8.
4) Özkökeli M, Günay R, Kayacıoğlu İ, Sarıkaya S, Yazar M, Akçar M. Periferik damar yaralanmaları. GKDC Dergisi 1998;6:249-53.
5) Küçükarslan N, Oz BS, Ozal E, Yildirim V, Tatar H. Factors affecting the morbidity and mortality of surgical management of vascular gunshot injuries: missed arterial injury and disregarded vein repair. [Article in Turkish] Ulus Travma Acil Cerrahi Derg 2007;13:43-8.
6) Johnson ON 3rd, Fox CJ, White P, Adams E, Cox M, Rich N, et al. Physical exam and occult post-traumatic vascular lesions: implications for the evaluation and management of arterial injuries in modern warfare in the endovascular era. J Cardiovasc Surg (Torino) 2007;48:581-6.
7) Küçükarslan N, Süngün M, Yilmaz M, Ulusoy E, Us MH, Güler A, et al. Missed aortic transection following blunt trauma: a case report. [Article in Turkish] Ulus Travma Acil Cerrahi Derg 2007;13:158-61.
8) Doody O, Given MF, Lyon SM. Extremities-indications and techniques for treatment of extremity vascular injuries. Injury 2008;39:1295-303.
9) Peng PD, Spain DA, Tataria M, Hellinger JC, Rubin GD, Brundage SI. CT angiography effectively evaluates extremity vascular trauma. Am Surg 2008;74:103-7.
10) Aduful H, Hodasi W. Peripheral vascular injuries and their management in accra. Ghana Med J 2007;41:186-9.
11) Gaitini D, Razi NB, Ghersin E, Ofer A, Soudack M. Sonographic evaluation of vascular injuries. J Ultrasound Med 2008;27:95-107.
12) Yılık L, Türköz R, Özbay T. Ateşli silahla ekstremite damar yaralanmaları: ampütasyonsuz 29 vaka. Ulus Travma Acil Cerrahi Derg 1997;3:148-54.
13) Hirshberg A, Mattox KL. Vascular trauma. In: Ascher E, editor. Haimovici’s vascular surgery. 5th ed. Massachusetts: Blackwell Publishing; 2004. p. 421-36.
14) Nitecki SS, Karram T, Hoffman A, Bass A. Venous trauma in the Lebanon War 2006. Interact Cardiovasc Thorac Surg 2007;6:647-50.
15) Yavuz S. ICVTS on-line discussion B Traumatic venous injury: ligation or repair? Interact Cardiovasc Thorac Surg 2007;6:651.
16) Ünlü Y, Vural Ü, Özyazıcıoğlu A, Ceviz M, Karapolat S, Koçak H. Üst ekstremite vasküler yaralanmaları (98 olgunun değerlendirilmesi) GKDC Dergisi 1998;6:318-22.
17) Cakir O, Subasi M, Erdem K, Eren N. Treatment of vascular injuries associated with limb fractures. Ann R Coll Surg Engl 2005;87:348-52.
18) Çınar B, Göksel O, Şahin S, Şahin V, Aydoğan H, Filizcan U, et al. A Case of femoral arteriovenous fistula due to stab wound: consecutive failure to close with stent graft and the final surgery. Turkish J Thorac Cardiovasc Surg 2005;13:174- 6.
19) Nazlıel K, Salman E, Yörükoğlu Y, Hıdıroğlu M, Çetingök U, Özeren M, et al. Travmatik arteriovenöz fistüllerin cerrahi tedavi takip sonuçları. GKD Cer Derg 1995;3:127-30.
20) Durai R, Kyriakides C. Stenting as an alternative to open repair in traumatic superficial femoral artery injuries. South Med J 2008;101:963-6.
21) Erentuğ V, Bozbuğa N, Mansuroğlu D, Erdoğan HB, Mataraci I, Kirali K, et al. Surgical treatment of peripheral vascular injuries after cardiac catheterization. [Article in Turkish] Anadolu Kardiyol Derg 2003;3:216-20.