Department of Vascular Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Eur J Vasc Endovasc Surg. 2010 Feb;39(2):160-4. doi: 10.1016/j.ejvs.2009.11.019. Epub 2009 Dec 7.
In contrast to upper extremity stab and gunshot wounds, data on management and outcome in blunt trauma (BT) are limited by small numbers and short follow-up periods.
This study is a retrospective data analysis. All patients who had undergone arterial repair after upper-limb BT were included. Exclusion criteria were artery ligation and/or primary limb amputation. Endpoints included the following: peri-operative death, limb salvage, primary and secondary patency, vascular re-operation and/or intervention.
Eighty-nine patients (71 male; median age: 34.6 years, range: 2.5-81.7) underwent reconstruction of 96 arteries after BT since 1989: subclavian (n=16), axillary (n=22), brachial (n=48) and forearm (n=10). Concomitant arm vein lesions were present in 15 patients (17%) and accompanying nerve (n=38; 43%) and/or orthopaedic injuries (n=64; 72%) in 77 patients (87%). The 30-day mortality rate was 2% with the limb-salvage rate being 98%. Six reconstructions occluded during the first week (primary/secondary patency rate: 93%/99%). After a median follow-up time of 5.1 years, 67% of the patients were followed: There were no secondary amputations and no arterial re-interventions.
Arterial repair in upper extremity BT has excellent early and long-term outcome. In contrast to a significant risk of early occlusion, limb loss after repair, late vascular re-intervention and late arterial occlusion or stenosis are rare.
与上肢刺伤和枪击伤相比，有关钝性创伤（BT）的管理和结果的数据受到数量少和随访时间短的限制。
本研究是一项回顾性数据分析。所有接受过上肢 BT 后动脉修复的患者均被纳入。排除标准为动脉结扎和/或肢体一期截肢。主要终点包括围手术期死亡、肢体保全、一期和二期通畅率、血管再次手术和/或介入。
自 1989 年以来，共有 89 例（71 例男性；中位年龄：34.6 岁，范围：2.5-81.7）患者接受了 96 例 BT 后动脉重建：锁骨下动脉（n=16）、腋动脉（n=22）、肱动脉（n=48）和前臂动脉（n=10）。15 例患者同时存在手臂静脉损伤（17%），77 例患者（87%）存在伴随的神经（n=38；43%）和/或骨科损伤（n=64；72%）。30 天死亡率为 2%，保肢率为 98%。6 例重建在第一周内闭塞（一期/二期通畅率：93%/99%）。中位随访时间为 5.1 年后，有 67%的患者得到了随访：没有发生二次截肢，也没有进行动脉再次介入。
上肢 BT 中的动脉修复具有极好的早期和长期效果。与早期闭塞、修复后的肢体丧失、晚期血管再次介入以及晚期动脉闭塞或狭窄的风险显著相比，这些并发症较为罕见。
