Vascular Traumatism of Limbs in Civil Practice in Dakar

Abstract

Introduction: Vascular limb trauma refers to any traumatic lesion involving a blood vessel; an artery or vein; located in the limbs, caused by laceration, contusion, section, crush, puncture or other mechanisms. They constitute a medico-surgical emergency that involves both vital and functional prognosis. Material and methods: We conducted a retrospective and descriptive study on the vascular trauma of the limbs in civilian practice supported in the department of Thoracic and CardioVascular Surgery of the National University Hospital of Fann at Dakar. The study period is 7 years, from September 2010 to August 2017. Results: The number of patients was 107 with a sex ratio of 7.92. The average age of the population was 27.8 years [5 months-82 years]. The brawls and aggressions with the domestic accidents were the most represented etiological contexts with a frequency of 38.3% and 21.5% respectively. Vascular lesions by glass breakage (40.2%) and stabbing (32.71%) were mostly represented. Eighty-seven traumas affected the upper limb (81.3%) and the lower limb (18.7%). Arterial lesions was present in 97 patients (90.6%) while venous lesions was present in 48 patients (44.8%). The most affected arteries were the radial artery (33.6%), the ulnar artery (27.1%) and the brachial artery (16.8%). Sixty-five patients (60.7%) were received within 6 hours and another 24 (22.4%) after 6 hours. The main reason for consultation or hospitalization was the occurrence of externalized bleeding in 86% of cases. The immediate or distant occurrence of swelling traumatism is also a reason in 13.1% of cases.Signs of hypovolemic shock were found in 15 patients (14%). Seventy-one patients (66.4%) presented another lesions as nerve damage in 46 patients (43%), musculotendinous lesions in 64 cases (59.8%). Arterial and venous Doppler ultrasonography was performed in 5 patients (4.67%). Computer Tomodensitometry angiography was performed in 7 patients (6.54%). The management was medicosurgical. The types of procedure performed in our series in order of frequency are: 59 sutures per termino-terminal anastomosis (55.1%), 17 single lateral sutures (15.9%), 12 venous interpositions (11.2%), 9 arterial ligations (8.4%), 3 venous patch suturent (2.8%). Venous repair was performed in 46 cases (42.9%). It consisted of 28 ligations against 25 sutures, one by venous interposition. The immediate postoperative course was favorable in 86 patients (80.4%). The other 21 patients had complications such as neurological disorders (10.3%), infectious syndrome (8.4%), early thrombosis (2.8%), compartment syndrome (2.8%), a revascularization syndrome with electrolyte disorders (1.9%) and acute renal failure (0.9%). Six patients underwent reintervention (3 aponevrotomy, one leg amputation, femoro-popliteal bypass). Early mortality was 2 cases. Neurological sequelae such as paresthesia and paralysis were observed in 15% of cases.