VASCULAR TRAUMA IN CIVILIAN PRACTICE

Vascular trauma is associated with major morbidity and mortality, but little is known about its incidence or nature in Britain. A retrospect ive study of 36 patients requiring operative intervention for vascular trauma under one vascular surgeon over a C-year period was undertaken . Twenty-four patients suffered iatrogenic trauma (median age 61 years ); including cardiological intervention (19), radiological interventio n (2), varicose vein surgery (1), umbilical vein catherisation (1) and isolated hyperthermic limb perfusion (1). There were 23 arterial and three venous injuries. Twelve patients had accidental trauma (median a ge 23 years). Three of the ten patients with blunt trauma were referre d for vascular assessment before orthopaedic intervention, two after a n on-table angiogram and five only after an initial orthopaedic proced ure (range of delay 6 h to 10 days). Injuries were arterial in nine, v enous in two and combined in one. Angiography was obtained in six pati ents, and in two patients with multiple upper limb fractures identifie d the site of injury when clinical localisation was difficult. A varie ty of vascular techniques were used to treat the injuries. Two patient s died postoperatively and one underwent major limb amputation. Thirty -two (89%) remain free of vascular sequelae after a median follow-up o f 48 months (range 3-72 months). Vascular trauma is uncommon in the Un ited Kingdom. To repair the injuries a limited repertoire of vascular surgery techniques is needed. Therefore, vascular surgical assessment should be sought at an early stage to prevent major limb loss.