Diagnosis and Surgical Treatment of Extremity Vascular Injuries: Error Analysis


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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

About the authors

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

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