Delayed revascularization of extremities following vascular injuries: Challenges and outcome

Abstract

Purpose: In developing countries delayed presentation following major vascular injury is common due to limited vascular trauma units; delay in diagnosis and time lost in transit which pose a major challenge for limb salvage. Aim of this study was to assess limb survival and complications after delayed revascularization of extremity following major vascular injury.

Method: 20 patients, (19 males and 1 female, mean age 31.55 years) with major extremity vascular injury who presented >8 h after vascular trauma were included in this study. All patients had road traffic accidents as the cause of extremity injury. These patients were operated by primary vascular repairs, thrombectomy and/or interposition vein graft along with fixation of concomitant skeletal trauma.

Results: The commonest vessel injured was popliteal artery. The mean time of limb revascularization was 30.8 h. Limb salvage rate was 95% and there was no perioperative mortality. 9 patients developed postoperative complications including sloughing of leg muscles (4), foot drop (3) pseudo aneurysm (1) and reperfusion injury (1). At 6 months follow-up all the patients were able to walk with full weight bearing and there was no chronic ischemia, pain or sinuses.

Conclusion: Limb salvage can be achieved with good results in patients with delayed revascularization in selected cases. However; delayed revascularization leads to long and protracted postoperative course with high chances of vascular and neurological complications.

Keywords: Compartment syndrome; Delayed presentation; Extremity; Fracture; Reperfusion injury; Vascular injuries.

Fig. 1

Fig. 1 Good collateral flow seen as reformation of distal vessel on CT angio.

Fig. 2

Fig. 2 Showing fracture fixation by plate.

Fig. 3

Fig. 3 Reversed vein graft was used to reconstruct popliteal artery.

Fig. 4

Fig. 4 Showing CONSORT diagram.

Fig. 5

Fig. 5 Pseudo aneurysm was treated by radiologically placed intravascular stent.

Fig. 6

Fig. 6 Algorithm for management in delayed presentation of vascular trauma.