Derin femoral arter yaralanmalarının tanısında klinik gözlemin önemi ve ligasyonun tedavideki yeri

Amaç: Derin femoral arter (DFA) yaralanması olan hastaların tanısında ilk fizik muayene bulgularına ek olarak klinik gözlemin önemi ve tamirin mümkün olmadığı durumlarda tedavide ligasyon seçeneği değerlendirildi. Çalışma planı: Derin femoral arter yaralanması nedeniyle tedavi gören ve ligasyon uygulanan 11 erkek hasta (ort. yaş 27.5±11.4; dağılım 17-49) geriye dönük olarak incelendi. Hastaların demografik özellikleri, yaralanmanın etyolojisi, hastaneye geliş süresi, acil servisteki fizik muayene bulguları, kullanılan tanı yöntemleri, yapılan cerrahi girişimler ile erken ve orta dönem klinik takip sonuçları araştırıldı.Bulgular: Etyoloji altı hastada (%54.6) ateşli silah yaralanması, beş hastada (%45.5) kesici-delici alet yaralanması idi. Yaralanma sonrası hastaneye geliş süresi dokuz hastada (%81.8) 0-2 saat idi. Tüm hastalarda ayak bileği/brakiyal basınç indeksi (ABİ) 1 olarak ölçüldü. Tüm hastalarda yaralanmaya DFA’nın dallarını da içine alacak şekilde geniş vasküler defekt eşlik etmekteydi. Beş hastada izole arter yaralanması, altı hastada eşlik eden venöz yaralanma vardı. Aktif kanaması olan dört hasta (%36.4), fizik muayene bulguları tanı için yeterli olduğundan doğrudan ameliyata alındı. Yedi hasta (%63.6) fizik muayene bulguları sonrası yapılan klinik gözlemi takiben (ort. 6.7 saat; dağılım 2-17 saat) ameliyata alındı. Hastanede kalış süresi ortalama 9.3±7.1 gün (dağılım 4-24 gün) idi. Ameliyat sonrasında erken komplikasyon olarak iki hastada lokal yara enfeksiyonu görüldü. Ortalama 16.3±11.0 ay (dağılım 2-33 ay) takip süresince hiçbir hastanın muayenesinde patolojik bulgu saptanmadı.Sonuç: Derin femoral arter yaralanmalarında, arteriyel yaralanma bulgularının belirgin olmadığı hastalarda 24 saatlik klinik gözlem önemlidir. Bu hastalarda ABİ ölçümü tanıda güvenilir olmayabilir. Onarımın mümkün olmadığı genç hastalarda ligasyon tedavi seçeneği olabilir

The importance of clinical observation for the diagnosis of deep femoral artery injuries and the place of ligation as an alternative treatment option

Background: We evaluated the value of clinical observation in addition to physical examination findings for the diagnosis of deep femoral artery (DFA) injuries and the option of ligation in cases where surgical repair was not possible. Methods: Eleven male patients (mean age 27.5±11.4 years; range 17 to 49 years) who underwent ligation for DFA injuries were retrospectively evaluated with respect to demographic features, etiology, time from injury to presentation, physical examination findings at the emergency unit, diagnostic methods used, surgical procedures, and early and midterm results of treatment.Results: Etiology was gun shot injury in six patients (54.6%) and stab wound in five patients (45.5%). Nine patients (81.8%) presented within the first two hours after trauma. The ankle-brachial pressure index (ABI) was 1 in all the patients. A large vascular defect was present in all the patients, involving the branches of the DFA. Five patients had an isolated DFA injury, while six patients had accompanying venous injuries. Four patients (36.4%) with active bleeding were promptly submitted to surgery because physical examination findings were sufficient for diagnosis. Seven patients (63.6%) were operated on after clinical observation ranging from 2 to 17 hours (mean 6.7 hours). The mean hospital stay was 9.3±7.1 days (range 4 to 24 days). Early postoperative complications included local wound infection in two patients. No pathological findings were detected during a mean follow-up period of 16.3±11.0 months (range 2 to 33 months).Conclusion: Clinical observation up to 24 hours is important in patients whose manifestations of DFA injuries are not apparent. Measurement of ABI may not be a reliable tool for the diagnosis of DFA injuries. Ligation may be a treatment option in young cases in which surgical repair is not possible.

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