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Results of reconstruction in major pelvic and extremity venous injuries.

Abstract：

PURPOSE:Outcome and venous patency after reconstruction in major pelvic and extremity venous injuries was studied. METHODS:We retrospectively reviewed 46 patients with 47 venous injuries. RESULTS:Injuries were caused by penetrating trauma in 37 extremities, blunt trauma in 6 patients, and were iatrogenic in 4 patients. Pelvic veins were injured in 4 patients, lower-extremity veins were injured in 39 limbs in 38 patients, and upper-extremity veins were injured in 4 patients. Concomitant arterial injuries occurred in 37 patients. Venous repairs were mostly of the complex type and included spiral or panel grafts in 15 (32%) reconstructions, interposition grafts or patch venoplasty in 19 (40%) reconstructions, end-to-end and lateral repair in 11 patients, and ligation in 2 patients. Two patients underwent early amputation. Early transient limb edema occurred in 2 patients, and postoperative venous occlusions were documented in 4 patients. Full function was regained in 39 (81%) extremities. No variable, including 4 retrospectively applied extremity injury scores (mangled extremity severity score [MESS], limb salvage index [LSI], mangled extremity syndrome index [MESI], predictive salvage index [PSI]), correlated with outcome. High values on all 4 scores were significantly associated with reexplorations (P <.02), which were done in 8 patients for debridement (5), arrest of bleeding (2), and repair of a missed arterial injury (1). Follow-up of 28 +/- 6 months on 27 patients (57%; duplex scan in 18, continuous-wave Doppler and plethysmography in 9, and venography in 3) showed 1 occlusion 6 weeks after the injury and patency of all other venous reconstructions. CONCLUSION:Reconstructions of major venous injuries with a high rate of complex repairs result in a large proportion of fully functional limbs and a high patency rate. A high extremity injury score predicts the need for reexploration of the extremity. Mostocclusions occur within weeks of injury, and the subsequent delayed occlusion rate is very low.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Zamir G,Berlatzky Y,Rivkind A,Anner H,Wolf YG

doi

10.1016/s0741-5214(98)70068-0

subject

Has Abstract

pub_date

1998-11-01 00:00:00

pages

901-8

issue

eissn

0741-5214

issn

1097-6809

pii

S0741521498003425

journal_volume

pub_type

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Results of reconstruction in major pelvic and extremity venous injuries.