Diagnosis and Surgical Treatment of Extremity Vascular Injuries: Error Analysis

Abstract


Relevance
Early diagnosis and treatment of acute major vascular injuries are an open issue of vascular surgery in peacetime. It is
characterized by an increasing number of surgical errors, high mortality and frequent primary amputations, and caused by a lack
of knowledge and practical skills of clinicians that do not have enough expertise in medical aid organization to this patient category
during the evacuation stage.
The purpose of the study
To search for efficient methods of preventing surgical events and complications during extremity vascular
injury treatment.
Material and methods
We retrospectively reviewed 606 records and angiograms of patients who underwent surgeries for injured
extremity arteries in the surgical units in Tver and Tver Region (1966 -2013). 593 of the cases were male, 13 were female. The age
of the patients was 5-76 years. Single injuries accounted for 19.3% of the cases, associated injuries – 80.7%. Of the injuries treated,
sharp injuries and firearm wounds comprised 41.6%, blunt injuries – 54.8%, iatrogenic injuries -- 2%, vascular arrosions -- 1.6%.
Results and their discussion
Reparative surgeries were performed on 47.5% of the patients, ligation surgeries – on 32.2%, primary
amputations – on 20.3%. Of all the cases reviewed, 96.9% had a positive outcome, 3.1% of the patients died. In 222 cases (36.6% of
the total number of vascular injuries) we revealed 41.4% of diagnostic errors, 33.8% of tactic errors and 24.8% of technical errors.
Surgical errors were most commonly caused by major vascular injuries combined with the damage to the nerve stems, bones and
muscle groups.
Conclusions
A large number of errors in the diagnosis and treatment of extremity vascular injuries are mainly caused by inadequate
emergency and urgent care, lack of qualified and specialized medical care. Clinical presentation of wounds and major vascular
injuries combined with angiographic findings allows clinicians to accurately and informatively evaluate the arterial flow and
function of collaterals. The percentage of negative outcomes associated with treatment of extremity arterial injuries can be reduced
by decreasing the number of diagnostic, tactic, technical and organization errors. Reparative surgeries on the major arteries of
extremities are to be performed by vascular surgeons or traumatic surgeons specializing in angiology and having experience in
vascular surgery.
Key words
major vessels of extremities, injuries, diagnostic and treatment errors, clinical presentation, arteriography

Tver State Medical University. Tver, 170100, 4 Ul. Sovetskaya, Russian Federation

Author for correspondence.
Email: mokh2011@mail.ru
д.м.н., проф., зав. кафедрой травматологии и ортопедии Тверского государственного медицинского университета;

Tver State Medical University. Tver, 170100, 4 Ul. Sovetskaya, Russian Federation

Email: mokh2011@mail.ru
д.м.н., проф., зав. кафедрой общей хирургии Тверского государственного медицинского университета;

Tver State Medical University. Tver, 170100, 4 Ul. Sovetskaya, Russian Federation

Email: admin@vestnik-surgery.com
очный аспирант кафедры травматологии и ортопедии Тверского государственного медицинского университета

  1. Belevitin A.B., Samohvalov I.M., Fomin N.F., Pronchenko
  2. A.A., Reva V.A. Problema vremennoj ostanovki naruzhnogo
  3. krovotecheniya pri raneniyah magistralnyh sosudov
  4. konechnostej ot N.I. Pirogova do nashih dnej[The problem
  5. of temporary stopping external hemorrhage caused by great
  6. vessels of the limbs wounds from N.I. Pirogov to our time].
  7. Vestnik Rossiyskoj voenno-meditsinskoj akademii. 2010;
  8. Spetsvypusk; 13-18 (in Russ.).
  9. Bocharov S.M., Belozerov G.E., Chernaya N.R., Klimov
  10. A.B. Angiographicheskaya semiotika ranenij i povrezhdenij
  11. arterij. Diagnosticheskaya i interventsionnaya radiologia.
  12. ; 1:1: 88-92 (in Russ.).
  13. Ermolayev A.S., Lemenyov V.L. Lecheniye bolnyh
  14. s travmoj sosudov v usloviah krupnogo megapolisa.
  15. Okazaniye spetsializirovannoj hirurgicheskoj pomoshchi
  16. pri travmah i raneniyah sosudov[Treatment of patients
  17. Efimenko N.A., Kohan E.P., Galik N.I. Okazaniye
  18. hirurgicheskoj pomoshchi ranenym s povrezhdeniem
  19. sosudov konechnostej[Rendering surgical treatment to
  20. wounded with damaged vessels of the limbs]. Angiologia i
  21. sosudistaya hirurgiya. 2008; 4: 129-132 (in Russ.).
  22. Zhigunov A.K., Aslanov A.D., Abazova I.S., Logvina
  23. O.E. Hirurgicheskoye lecheniye povrezhdenij sosudov
  24. konechnostej[Surgical treatment of vessels of the limbs
  25. injuries]. Vestnik hirurgii im. Grekova. 2006; 2: 45-47 (in
  26. Russ.).
  27. Kazakov Y.I., Kiselyov V.Y., Evstifeev L.K., Kazakov A.Y.
  28. Diagnostika i lecheniye povrezhdenij magistralnyh sosudov
  29. konechnostej[Diagnostics and treatment of damaged great
  30. vessels of the limbs].“GERS”. 2013; 138 (in Russ.).
  31. Korolyov M.P., Urakcheev Sh.K., Pastuhova N.K.
  32. Hirurgicheskoye lecheniye krupnyh sosudov[Surgical
  33. treatment of great vessels]. Vestnik hirurgii im. Grekova.
  34. ; 6: 56-58 (in Russ.).
  35. Lemenyov V.L., Mihailov I.P., Isaev G.A. Lecheniye
  36. bolnyh s travmoy magistralnyh arterij nizhnih
  37. konechnostej[Treatment of patients with injury of main
  38. arteries of the lower limbs]. Angiologia i sosudistaya
  39. hirurgiya. 2005; 3: 108-114 (in Russ.).
  40. Perehodov S.N., Kohan E.P., Glyantsev S.P., Galin
  41. N.I. Okazaniye hirurgicheskoj pomoshchi ranenym s
  42. povrezhdeniem magistralhyh sosudov[Rendering surgical
  43. treatment to wounded with damaged great vessels]. Voenno-
  44. meditsinskij zurnal. 2010; 6: 78-81 (in Russ.).
  45. Samohvalov I.M., Reva V.A., Pronchenko A.A., Seleznyov
  46. A.B. Dogospitalnaya pomoshch pri raneniyah magistralnyh
  47. sosudov konechnostej[Prehospital treatment for injuries of
  48. great vessels of the limbs]. Voenno-meditsinskij zhurnal.
  49. ; 9: 4-11 (in Russ.).
  50. Rudstrom H., Berqvist D., Orgen M. et al. Iatrogenic
  51. vascular injuries in Sweden. A Nationwide Study 1987-
  52. Eur. J. Vasc. Endovas. Surg. 2008; 35: 131-138.

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