4%) and brachial arteries (16.1%). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of a primary amputation. No prosthetic grafts were used in these patients. Types of venous
injuries and their management are shown in Table 4. There were a total of 17 venous injuries. 13 were managed by lateral suture repair and 4 by ligation. Table 3 Types and operative management of arterial injuries Tariquidar in vitro Artery Vein graft Vein patch Primary repair Ligation Total Common femoral 3 1 2 Protein Tyrosine Kinase inhibitor 1 7 Popliteal 1 3 2 6 Brachial 1 2 2 5 Superficial femoral 2 – 1 3 Tibial – - 2 2 Radial – - 1 1 2 Carotid – - 2 – 2 Subclavian 1 – - – 1 Ulnar – - – 1 1 Epigastric – - – 1 1 Iliac – - 1 – 1 Total 7 2 12 10 31 Table 4 Types and operative management of venous injuries Vein Primary repair Ligation Total Popliteal 2 1 3 Internal jugular 1 1 2 Femoral 2 – 2 Subclavian 2 – 2 Superficial femoral 2 – 2 Inferior vena cava 2 – 2 Iliac 1 – 1 Pulmonary 1 – 1 Brachial – 1 1 Tibial – 1 1 Total 13 4 17 Amputation was performed in nine patients. Six patients underwent primary
amputation for mangled extremities. These included, above knee amputation in two patients, below knee amputation in two patients and below elbow amputation in two patients. GW3965 molecular weight All primary repairs, except two, mafosfamide were performed on the same day of injury. The exact time between vascular injury and surgery was unknown in majority of the cases. Three patients had secondary amputation after
attempted vascular repair for 21 limbs (14.3%). One patient had a gunshot injury to the knee with multiple fractures, and popliteal artery, vein and nerve injuries. He underwent primary repair of the popliteal artery with end-to-end anastomosis and fasciotomy 24 hours after the injury. The patient subsequently developed thrombosis of the graft and limb ischemia which required above knee amputation. A 7-year-old boy was involved with a blast injury and transferred to our hospital from Iraq, underwent delayed primary repair of the femoral artery seven days after the injury. He had thrombectomy and end-to-end anastomosis but this ended with a below knee amputation because of delayed ischaemia. Another patient had a blast injury, underwent popliteal artery repair with interposition saphenous vein graft within six hours of injury. This was complicated by deep soft tissue infection and graft thrombosis that needed above knee amputation. The median (range) hospital stay of our patients was 8 (1–76) days. 5 patients died (14%). Discussion Blast and bullet injuries caused majority of vascular injuries in our study. Most occurred in extremities and head and neck.