Himura Hoshi, Uchida Kenichiro, Miyashita Masahiro, Mizobata Yasumitsu
Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka City, 545-8586, Japan.
Surg Case Rep. 2021 Aug 4;7(1):177. doi: 10.1186/s40792-021-01264-x.
Open complete transection of the femoral artery and vein following blunt trauma is extremely rare. Furthermore, even if the patient has been successfully resuscitated, it is sometimes difficult in most patients to preserve the injured limb, especially after damage control resuscitation. We report a case of open complete transection of the femoral artery and vein secondary to high-energy blunt trauma and a successful limb preservation treatment strategy.
A 57-year-old Asian man was transferred to hospital after having fallen from the 15th floor of a condominium. The patient was in cardiac arrest at the scene, but was successfully resuscitated by emergency medical services staff. On arrival, the patient's hemodynamics were completely collapsed with active external bleeding from the thigh, so we immediately started resuscitation including activation of massive transfusion protocol and temporarily ligated the transected proximal superficial femoral artery, deep femoral artery just distal after branching lateral femoral circumflex artery and the superficial femoral vein. Following radiological findings showing a potential pelvic fracture with active bleeding, we also performed retroperitoneal packing in the resuscitation room and moved the patient to the angiography room for transcatheter arterial embolization. The patient's consciousness was preserved and perfusion of the injured limb was barely maintained after his hemodynamics were adequately stabilized. As we detected weak perfusion of the lower limb via a potential collateral flow from the lateral femoral circumflex artery branches from deep femoral artery by pulse doppler of the dorsal pedis artery, we decided to reconstruct superficial femoral artery and vein at 24 h after injury using great saphenous vein bypass grafts. The patient was transferred to a rehabilitation hospital with good neurological and limb outcome after hospitalization for 52 days.
We successfully preserved the patient's lower limb after cardiac arrest and complete transection of the femoral artery and vein and achieved a good neurological outcome. Even if a femoral artery needs to be ligated temporarily, careful observation and assessment should be performed so as not to lose the chance to salvage the limb even during damage control resuscitation.
钝性创伤后股动脉和股静脉开放性完全离断极为罕见。此外，即使患者已成功复苏，但在大多数患者中，尤其是在损伤控制复苏后，保全受伤肢体有时仍很困难。我们报告一例因高能钝性创伤导致股动脉和股静脉开放性完全离断的病例以及成功的肢体保全治疗策略。
一名57岁的亚洲男性从公寓15楼坠落后来院就诊。患者在现场心脏骤停，但经急救人员成功复苏。入院时，患者血流动力学完全崩溃，大腿有活动性外出血，因此我们立即开始复苏，包括启动大量输血方案，并临时结扎离断的股浅动脉近端、旋股外侧动脉分支远端的股深动脉以及股浅静脉。经影像学检查发现有潜在骨盆骨折伴活动性出血，我们还在复苏室进行了腹膜后填塞，并将患者转至血管造影室进行经导管动脉栓塞术。患者意识得以保留，血流动力学充分稳定后，受伤肢体的灌注勉强维持。由于通过足背动脉脉搏多普勒检测到来自股深动脉分支的旋股外侧动脉的潜在侧支血流使下肢灌注微弱，我们决定在受伤后24小时使用大隐静脉旁路移植术重建股浅动脉和静脉。患者住院52天后转至康复医院，神经功能和肢体恢复良好。
我们在患者心脏骤停以及股动脉和股静脉完全离断后成功保全了下肢，并取得了良好的神经功能结果。即使需要临时结扎股动脉，也应进行仔细观察和评估，以便即使在损伤控制复苏期间也不失去挽救肢体的机会。
