PERIPHERAL VASCULAR INJURIES IN THE POLYT RAUMATIC PATIENT

Between 1972 und 1993 a total of 68 patients were treated at the Depar tment of Surgery of the University Clinic of Mannheim for peripheral v ascular injury resulting from multiple trauma. The average age of thes e patients was 31.3 years, and most of them were male (88.2%; n=60). T he injured Vessels were localized evenly in all the extremities: 31 pa tients (45.5%) presented with arterial damage of the upper extremity, and 37 (54.5%) showed lesions along the femoro-popliteal arteries. The most frequent location of injured vessels in the multiply traumatized patient was the popliteal artery (n=18, 26.5%), the distal part of th e superficial femoral artery (n=12, 17.6%), the brachial artery (n=14, 20.6%) and the axillary artery (n=10, 14.6%). The dominant cause, of trauma was road traffic accidents (72%), and 20 patients (29%) acquire d their vascular injuries as motorcyclists. There were also 13 occupat ional accidents (19%) involving vascular injuries. In addition to a va scular trauma 34 patients (50%) had complicated fractures, and a furth er 34 patients (50%) had multiple fractures: 12 (17.6%) had head and b rain damage, 5 (7.3%) had blunt abdominal trauma and 6 (8.8%) had blun t thoracic injury. The general amputation rate was 2.9% (n=2). One pat ient died on the table of a torn off subclavian artery combined with m ultiple other injuries. Paresis of the plexus is a particular problem after vascular lesions of the upper extremity: in 22 patients (71%) pa resis of the plexus persisted after successful vascular reconstruction (follow-up period between 3 months and 16 years, median time 3.45 yea rs). Diagnostic preoperative angiography is only indicated in the comp ensated patient with injury of the supra-aortal vessels or for diagnos is of peripheral injuries in patients in whom simultaneous peripheral vascular sclerosis is suspected.