Farro-Moreno A, Fabián-Mijangos W, Carbajal-Robles V, Moreno-Vargas HC, Martínez-Martínez J, Ziga-Martínez A

Language: Spanish
References: 13
Page: 29-32
PDF size: 233.89 Kb.

ABSTRACT

Background. Trauma is the third cause of death in general population, being wounds by projectile of firearm the main cause of injury in lower limbs in 56.4% of the cases, which conditions the development of pseudoaneurysms (PA) and arteriovenous fistulas (AVF). Historically, extremity injuries are associated with high amputation rates, and these rates may exceed 15%. The most frequent sites are in the femoral vessels (as in the patient described here) and the popliteal artery. It is important to know the hard and soft signs of vascular injury, if the patient has hard signs: it is necessary to make an immediate vascular exploration, in case of presenting soft signs: There is the probability of vascular lesion in 10% of cases, reason why we are obliged to carry out studies of extension and to maintain in close monitoring to the pacient. The approach of open surgery with PA resection and primary artery repair and AVF ligation, as used here, is the most commonly used treatment in our environment. Placement of coated stents is a new approach to this type of injury, but there are still no long-term studies comparing their efficacy compared to open surgery. In the case described here, the surgical approach was chosen by the late presentation of the AVF and PA in addition that is an effective and safe technique in vascular trauma.
Clinical case. A 22-year-old male, who comes to the Eemergency Department, referring to a 1 month evolution gunshot wound, develops pseudoaneurysm and surgically treated arteriovenous fistula with success and complications.
Conclusion. For the vascular surgeon the treatment of vascular trauma is a challenge, so the speed and expertise in its therapeutic management is vital to save the patient's limb and improve their quality of life.

REFERENCES

1. Girolami A, Foex B, Little R. Change in the causes of trauma in the last 20 years. Trauma 1999; 1(1): 3-11.

2. Hughes CW. Arterial repair during the Korean War. Ann Surg 1958; 147: 555-61.

3. Rodríguez López E, et al. Trauma vascular civil: Tres años de manejo en el Hospital General de México. Rev Mex Angiol 2017; 45(4): 154-62.

4. Topal AE, Eren MN, Celik Y. Lower extremity arterial injuries over a six-year period: Outcomes, risk factors, and management. Vasc Health Risk Manag 2010; 6(1): 1103-10.

5. Demetriades D, Murray J, Sinz B, et al. Epidemiology of major trauma and trauma deaths in Los Angeles County. J Am Coll Surg 1998; 187(4): 373-83.

6. Ball CG. Penetrating non-torso trauma: The extremities. Can J Surg 2015; 58(4): 286-8.

7. Mattox KL, Feliciano DV, Burch J, et al. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Ann Surg 1989; 209: 698-74.

8. Nguyen T, Kalish J, Woodson J. Management of Civilian and Military Vascular Trauma: Lessons Learned. Semin Vasc Surg 2010; 23(4): 235-42.

9. Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietman; 1000 cases. J Trauma 1970; 10(5): 359-69.

10. Lebreton G, Uzel AP, Celerien J, Roques F, Deneuville M. Popliteal arteriovenous fistula due to a gunshot injury. Ann Vasc Surg 2010; 24(7): 952.e17-21.

11. Davidovic LB, Banzic I, Rich N, Dragaš M, Cvetkovic SD, Dimic A. False traumatic aneurysms and arteriovenous fistulas: retrospective analysis. World J Surg 2011; 35(6): 1378-86.

12. Feld R, Patton GM, Carabasi A, Alexander A, Merton D, Needleman L. Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression. J Vasc Surg 1992; 16(6): 832-40.

13. Stewart DK, Brown PM, Tinsley EA, Jr, Hope WW, Clancy TV. Use of stent grafts in lower extremity trauma. Ann Vasc Surg 2011; 25(2): 264.e9-13.