Factors affecting the morbidity and mortality of surgical management of vascular gunshot injuries: missed arterial injury and disregarded vein repair

BACKGROUND
The aim of this study was to establish the clinical course and importance of missed arterial injuries and disregarded venous repair after surgery for gunshot injuries.
METHODS
This retrospective study was performed on the operative results of 275 shotgun vascular injury patients’ presented to our clinic between January 1992 and December 2004. All patients were analyzed from their medical files and operative notes. The incidence of missed arterial injuries and ignored venous repair, localization and type of vascular complications, limb loss and mortality outcomes were documented.
RESULTS
Seventy-five patients (27.27%) for a delayed diagnosis of a missed arterial injury and 91 patients (33.09%) for an ignored venous repair were treated. Complications of missed arterial injuries were determined as followings: false aneurysm n=43 (57.33%), arteriovenous fistula n=20 (26.66%), occlusion n=12 (16%). The missed vascular injury was most commonly observed in superficial femoral artery (n=20). The venous injury was present in 167 patients. Complications of disregarded venous repair were determined as venous edema and deep vein thrombosis.
CONCLUSION
Missed arterial injuries and disregarded venous repairs during initial diagnosis or operation affect the morbidity and mortality in gunshot injury patients. After haemodynamic stabilization, gunshot patients should be evaluated by arteriography and venography to determine the anatomic localization of vascular injuries. All vascular continuity should be restored either by primary repair or by an autolog graft. All venous injuries located in popliteal and femoral area should be repaired.

Ateþli silahla oluþan vasküler yaralanmalarýn cerrahisinde morbidite ve mortaliteyi etkileyen faktörler: Gözden kaçan arteryel yaralanma, ihmal edilmiþ ven tamiri

AMAÇ
Ateþli silah yaralanmasý cerrahisi sonrasýnda gözden kaçan arteryel yaralanmalar ve ihmal edilen ven tamirlerinin klinik gidiþ ve önemini ortaya koymaktýr.
GEREÇ VE YÖNTEM
Bu retrospektif çalýþma Ocak 1992-Aralýk 2004 tarihleri arasýnda ateþli silaha baðlý vasküler yaralanma sonucu kliniðimize müracaat eden 275 hastanýn (269 erkek, 6 kadýn; ort. yaþ 23±5) ameliyat sonuçlarý üzerinden gerçekleþtirildi. Hastalar ameliyat notlarý ve dosya kayýt sistemi üzerinden araþtýrýldýlar. Gözden kaçan arteryel yaralanma, ihmal edilen ven tamirlerinin sýklýðý, vasküler komplikasyonlarýn tip ve lokalizasyonlarý, ekstremite kaybý ve mortalite sonuçlarý ortaya konuldu.
BULGULAR
Hastalarýn 75’i (%27,27) gözden kaçmýþ arteryel yaralanma, 91’i (%33,09) ihmal edilen ven tamiri dolayýsýyla tedavi edildi. Gözden kaçan vasküler yaralanma komplikasyonlarý, yalancý anevrizma (n=43, %57,33), arteriyovenöz fistül (n=20, %26,66) ve týkanýklýk (n=12, %16) olarak belirlendi. Gözden kaçan vasküler yaralanma en sýk süperfisyel femoral arterde idi (n=20). Venöz yaralanma 167 hastada mevcuttu. Venöz komplikasyonlar, venöz ödem ve derin ven trombozu olarak saptandý.
SONUÇ
Ateþli silahla oluþan vasküler yaralanmalarda ilk tanýda veya ameliyat anýnda gözden kaçan arteryel yaralanmalar, ihmal edilen ven tamirleri mortalite ve morbiditeyi etkilemektedir. Ateþli silah yaralanmalý hasta hemodinamik stabilizasyonun ardýndan vasküler yaralanmasýnýn anatomik lokalizasyonunun belirlenmesi için arteriyografi ve venografi ile deðerlendirilmelidir. Tüm vasküler devamlýlýklar primer veya otolog greft ile yeniden saðlanmalýdýr. Popliteal ve femoral bölgedeki tüm venöz yaralanmalar tamir edilmelidir.