ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Emergency vascular injuries: patient profile, management strategies and risk factors for mortality
Nihan Kayalar1, Kamil Boyacıoğlu1, Serkan Ketenciler1, Hüseyin Kuplay2, Bülent Mert1, Cihan Yücel1, Seçkin Sarıoğlu1, Vedat Erentuğ1
1Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey
2Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2017.13203
Background: This study aims to evaluate the mechanisms and localizations of injury, diagnosis, patient profile, treatment modalities, and risk factors for mortality, and to offer a guide for vascular surgeons for the management of emergency vascular injuries.

Methods: Between September 2009 and June 2013, a total of 161 patients (156 males, 5 females; mean age 30.3±11.8 years; range 8 to 80 years) were surgically treated for vascular injuries in our clinic. All patients were taken to the operation emergently after clinical assessment or after diagnostic imaging using Doppler ultrasound, computed tomography angiography or magnetic resonance angiography.

Results: Penetrating injuries (89.4%) were more common and most injuries involved the upper extremity (49.1%), followed by the lower extremity (41%), abdomen (5.6%), neck (2.5%), and thorax (1.9%). Simple ligation technique (14.3%) was used for small vessel injuries, whereas end-to-end anastomosis (49.7%) and repair with a saphenous vein (32.3%) or prosthetic graft (4.3%) was used for more complex cases. Mortality was seen in 10 patients (6.2%). Major risk factors for mortality were abdominal localization of injury (p<0.001), hemodynamic instability on admission (p<0.001) and low hematocrit levels before the operation (33.4±5.6 vs 18.1±9.1; p<0.001).

Conclusion: Vascular injuries should be diagnosed and treated promptly. The clinical status at the time of presentation, localization of injury, diversity of diagnostic and treatment options and concomitant injuries are important considerations. Only clinical assessment may be enough in many emergency cases. Patients with hemodynamic instability and major blood loss before the surgery should be managed with surgery and medical resuscitation simultaneously to prevent patient loss.

Keywords : Mortality; risk factors; surgical treatment; vascular trauma
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