Med J Bakirkoy. 2020; 16(3): 224-230 | DOI: 10.5222/BMJ.2020.77486

Penetrating Injuries of Peripheral Vascular Structures: Short Term Follow-up Study

Yusuf Kuserli¹, Mehmet Ali Yeþiltaþ¹, Ali Aycan Kavala¹, Saygýn Türkyýlmaz¹, Ahmet Ozan Koyuncu^2
1Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
²Istanbul University Cerrahpasa Institute of Cardiology, Istanbul, Turkey

Objective: Penetrating vascular injuries are medical conditions that we often come across and require urgent treatment. Early diagnosis and treatment play a big role reducing the mortality and morbidity in patients suffering from penetrating vascular injuries. Method: We retrospectively observed 168 patients who were operated by us between January 2016 and September 2019 because of peripheral vascular injuries. Demographic features, clinical findings at diagnosis and follow-up and 3rd month arterial duplex ultrasound (DUS) findings were evaluated. Results: In our study, 244 vascular structures were repaired in 168 patients. The most commonly injured vascular structure was femoral artery in 54 (22%) cases. Other injured vascular structures were radial artery in 47 (19%), superficial femoral vein in 33 (14%), deep femoral vein in 28 (11%), ulnar artery in 23 (9%), brachial artery in 21 (9%), popliteal artery in 12 (5%), posterior tibial artery in 9 (4%) and the anterior tibial artery in 3 (1%) cases When it comes to surgical techniques, while primary repair was performed in 57 (23%), and end-to-end anastomosis in 92 patients (38%). As a graft material saphenous vein was used in 60 (25%) and PTFE (polytetraflorethylene) in 35 patients (14%). Two patients (1.19%) with femoral artery repair had suffered from compartment syndrome and fasciotomy had to be done. In a patient with bone fracture accompanied to vascular injury, amputation was performed by the orthopedic clinic due to severe osteomyelitis and necrosis after discharge. At follow-up control after 3 months, stenosis above 70% was not detected with arterial duplex ultrasound (DUS) in any patient and no intervention was required. Conclusion: Immediate arrival of patients with penetrating injuries to the hospitals and approach to the patient in consideration of vascular injury in the emergency rooms are significantly important in reducing limb loss and mortality.

Keywords: peripheral vessel, vascular injury, penetrating injury

---

Periferik Vasküler Yapýlarýn Delici Kesici Alet Yaralanmalarýnýn Kýsa Dönem Takibi

Yusuf Kuserli¹, Mehmet Ali Yeþiltaþ¹, Ali Aycan Kavala¹, Saygýn Türkyýlmaz¹, Ahmet Ozan Koyuncu^2
1Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Kalp ve Damar Cerrahisi Kliniði, Ýstanbul, Türkiye
²Ýstanbul Üniversitesi Cerrahpaþa Kardiyoloji Enstitüsü, Ýstanbul, Türkiye

Amaç: Delici kesici alet yaralanmalarý (DKAY) sýk gördüðümüz ve acil tedavi gerektiren bir durumdur. Erken taný ve tedavi bu hasta grubunda mortalite ve morbiditeyi azaltýr.
Yöntemler: Çalýþmamýzda 2016 Ocak ile 2019 Eylül arasýnda DKAY sebebiyle ameliyat ettiðimiz 168 hastayý retrospektif olarak inceledik. Hastalarýn demografik özellikleri, taný ve izlem sýrasýndaki klinik bulgularý ile 3. ay doppler ultrason bulgularý deðerlendirildi.
Bulgular: Çalýþmamýzda 168 hastada, 244 vasküler yapý onarýmý yapýldý. 54 olgu (%22) ile en sýk yaralanan vasküler yapý femoral arter olarak saptandý. Yaralanan diðer vasküler yapýlar sýrasýyla 47 olguda (%19) radial arter, 33 olguda (%14) yüzeyel femoral ven, 28 olguda (%11) derin femoral ven, 23 olguda (%9) ulnar arter, 21 olguda (%9) brakial arter, 12 olguda (%5) popliteal arter, 9 olguda (%4) posterior tibial arter ve 3 olguda (%1) anterior tibial arterdi. Cerrahi teknik olarak 57 hastada (%23) primer onarým, 92 hastada (%38) uç-uca anastomoz tercih edildi, 60 hastada (%25) safen ven greft ve 35 hastada (%14) PTFE (polytetrafloretilen) greft interpozisyonu uygulandý. Femoral arter tamiri yapýlan 2 hastada (%1.19) kompartman sendromu geliþti ve fasyotomi ihtiyacý oldu. Kemik fraktürü ve vasküler yaralanmasý olan bir hastaya ise taburculuk sonrasý osteomyelit ve nekroz sebebiyle ortopedi kliniði tarafýndan amputasyon uygulandý. 3. ay doppler kontrollerinde hiçbir hastada %70 üzeri darlýk saptanmadý ve herhangi bir giriþim gereksinimi olmadý.
Sonuç: Delici kesici alet yaralanmasý olan hastalarýn hastaneye vakit kaybetmeden ulaþmasý ve acil serviste vasküler yaralanma þüphesi ile yaklaþým, uzuv kaybýný ve mortaliteyi azaltmak için önemlidir.

Anahtar Kelimeler: periferik damar, damar yaralanmasý, kesici alet yaralanmasý

---