Zarin M, Samson Griffin, Ejaz Ahmad, Ismail Akbar, Haider Kamran.
A short experience of managing vascular injuries at Abbottabad, NWFP.
Pak J Surg Jan ;19(2):93-6.

This prospective study was carried out in Surgical-A ward at Ayub Hospital Complex, Abbottabad from November 1999 to August 2001, to evaluate the outcome of different surgical procedures in cases of acute vascular injuries. After brief examination all patients were initially resuscitated. Category-I patients (with shock from on going bleeding) were operated upon immediately while those in Category-II & III underwent surgery after necessary investigations and resuscitation. Ten patients, seven males and three females with acute vascular injury were admitted during the study period. Four patients had femoral artery injury; two brachial artery injury and one each had popliteal artery, portal vein, external iliac vein and inferior vena caval injury. Firearms, except one that was due to bomb blast, caused all these injuries. Five patients presented within first five hours of injury, and the rest with a delay of 8-12 hours. At the time of admission five patients were in Brink`s Category-I, three in Category-II and two in Category-III. Two cases had associated bony injuries while one case with inferior vena caval injury had also a perforation in the antimesenteric border of mid-ileum. All patients underwent surgery. In five cases there was complete transaction of the vessel, four patients had partial injury to the vessel wall and one patient had sub-intimal haematoma secondary to severe contusion of the vessel wall. Three patients with partial vascular tears were treated by closing the rents in the wall; in two cases end to end anastomosis was done while in five cases vascular repair was done by interposing autogenous reverse venous grafts. One patient ended up with below knee amputation of the leg, in whom popliteal artery repair was done and one patient with femoral artery grafting had secondary bleeding due to sloughing of the graft that was treated by ligation of the vessel. The success rate of vascular repair in our study was 80%.

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