Yilmaz A T, Arslan M, Demirkiliç U, Ozal E, Kuralay E, Tatar H, Oztürk O Y
Gülhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey.
Am J Surg. 1997 Feb;173(2):110-4. doi: 10.1016/S0002-9610(96)00423-0.
Military vascular injuries frequently result from fragment wounds while civilian vascular injuries usually are caused by gunshot wounds. The natural history of untreated major injuries by small low velocity fragments is not well known. This study evaluated the nature of these wounds.
From 1990 to 1995, 40 patients with a delayed diagnosis of an arterial injury in the extremity, abdomen, or neck were treated. The median delay between injury and diagnosis was 60 days. All patients had been seen at other military hospitals immediately after trauma.
During initial hospitalization, immediate exploration had been performed in 23 patients and arteriogram in 3 patients. According to analysis of the records of patients, none of them had hard signs of vascular injury at the time of initial evaluation after trauma. Complications of missed arterial injuries included the following: false aneurysm, 21 (52.5%); arteriovenous fistula, 14 (35%); and occlusion, 5 (12.5%). The superficial femoral artery (n = 11) was the most commonly injured vessel. The remaining arteries included the following: carotid, 2; vertebral, 1; subclavian, 5; axillary, 2; brachial, 3; radial or ulnar, 2; internal iliac, 2; common femoral, 1; profunda femoris, 2; popliteal, 1; tibioperoneal, 8. Thirty-eight patients had penetrating wounds (21 fragments, 9 gunshot, 3 shotgun, 5 stab wounds), and only 2 patients had blunt trauma. All patients underwent surgery. There were no deaths and no loss of extremity, but 10 patients had fair results and only 4 patients required later reoperation.
Traumatic arterial injuries that particularly are caused by low-velocity small fragment wounds can result in serious delayed complications months or even years after the injury. Patients with penetrating injuries must be closely monitored, and arteriography is recommended to evaluate the conditions of patients with potential vascular injury even when overt clinical signs or symptoms of vascular injury are absent.
军事血管损伤常由弹片伤导致，而民用血管损伤通常由枪伤引起。小的低速弹片所致未治疗的严重损伤的自然病程尚不为人所知。本研究评估了这些伤口的性质。
1990年至1995年，对40例在四肢、腹部或颈部动脉损伤诊断延迟的患者进行了治疗。受伤与诊断之间的中位延迟时间为60天。所有患者在创伤后均立即在其他军事医院就诊。
在初次住院期间，23例患者进行了即刻探查，3例患者进行了动脉造影。根据患者记录分析，他们在创伤后初次评估时均无血管损伤的硬体征。漏诊动脉损伤的并发症包括：假性动脉瘤21例（52.5%）；动静脉瘘14例（35%）；闭塞5例（12.5%）。股浅动脉（n = 11）是最常受伤的血管。其余动脉包括：颈动脉2例；椎动脉1例；锁骨下动脉5例；腋动脉2例；肱动脉3例；桡动脉或尺动脉2例；髂内动脉2例；股总动脉1例；股深动脉2例；腘动脉1例；胫腓动脉8例。38例患者有穿透伤（21例弹片伤、9例枪伤、3例霰弹枪伤、5例刺伤），仅2例患者有钝性创伤。所有患者均接受了手术。无死亡病例，无肢体缺失，但10例患者效果尚可，仅4例患者需要后期再次手术。
特别是由低速小弹片伤引起的创伤性动脉损伤可在受伤数月甚至数年后导致严重的延迟并发症。穿透伤患者必须密切监测，即使没有明显的血管损伤临床体征或症状，建议进行动脉造影以评估潜在血管损伤患者的情况。
