OUTCOME IN THE MANAGEMENT OF PENETRATING VENOUS INJURY

The authors report on the management of 33 patients with penetrating v enous injuries, 25 due to gunshot wounds and 8 due to stab wounds. Dur ing the period of this study we treated 35 venous injuries and two pat ients, both following femoral artery and vein repairs and limb salvage were lost to follow-up and are excluded. Thirty-two had associated th oracic, intraabdominal, or arterial injuries. Duplex imaging was perfo rmed in 14 patients and venography in 12. They assessed all 27 survivo rs for postoperative sequelae. Mean follow-up time was twenty months, ranging from three months to three years. Four patients had suprarenal inferior vena cava injuries. All 4 underwent repair and 2 survived. S even others had infrarenal vena cava injuries. Three of 5 survived fol lowing repair and the other 2 survived after caval ligation. Three pat ients had iliac vein injuries. Two died after repair and 1 survived wi th ligation. Seventeen patients had injuries of the femoral vein. Thir teen underwent repair, 7 of whom remained patent. Four had ligations p erformed. There were 2 injuries of the popliteal vein; both were repai red, but neither remained patent. All 19 patients with femoral and pop liteal vein injuries survived with limb salvage. Postoperative sequela e (persistent edema, skin discoloration) were observed in 4 failed ven ous repairs-2 femoral and 2 popliteal. Ligation of the infrarenal vena cava and iliac veins, as compared with repair, yielded a greater pati ent salvage rate. There was no increased morbidity with ligation of th e femoral veins, which was undertaken only on unstable patients.