[Vascular system injuries].

PURPOSE OF THE STUDY: The aim of this retrospective study is to present our experience with the management of injuries to the vascular system at the Trauma Centre, University Hospital in Plzeň. We show the most frequent mechanisms of injury, diagnostic pitfalls, therapeutic options and evaluate both the short-term and long-term results of surgical treatment and interventional radiology procedures.

MATERIAL AND METHODS: We evaluated a group of patients with a serious vascular injury who were treated at the Traima Centre during the five-year period from January 2006 to December 2010. The group included 82 patients, 59 men and 23 women, with the average age of 34.5 years. We assessed the success rate of vascular reconstruction, primary and secondary graft patency and mortality and morbidity rates. Recovery of function in the injured extremities and return of the patient to normal daily activities were considered the most important parameters. In 28 patients (34%) vascular injury was due to polytrauma, in nine (11%) it was part of a combined injury, and 45 patients (55 %) sustained monotrauma. Most of the patients (68; 83%) were managed surgically. The most frequent procedures included direct suture of a lesion, resection and replacement of an injured artery or bypass grafting. In 13 patients we used interventional radiology procedures (in most cases it was for thoracic endovascular aortic repair). In one patient we were able to use a conservative treatment.

RESULTS: The 30-day mortality rate was 8.5%, i.e., seven patients died of polytrauma. The morbidity rate was 35% (29 patients). The most frequent complications included respiratory failure in polytrauma (13%), transient leg/arm swelling (6%) and wound infection (4%). Primary and secondary graft patencies were 100% and 95.5%, respectively. Vascular reconstruction failed in three patients and, in two of them, we had to carry out limb amputation.

CONCLUSIONS: From the viewpoint of vascular surgery, even very serious injuries of upper and lower extremities can be managed, if possible associated injuries of the skeletal and nerve structures allow for it. The key to success is good co-operation of the orthopaedic trauma surgeon, vascular surgeon and neurosurgeon.