Alt ve üst ekstremite damar yaralanmaları: On iki yıllık deneyimimiz
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Date
2020-11-09
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Bursa Uludağ Üniversitesi
Abstract
Ekstremite damar yaralanması nedeniyle merkezimize başvuran hastaları değerlendirme protokollerimizi, tedavi yöntemlerimizi ve sonuçlarımızı literatür eşliğinde retrospektif olarak değerlendirmeyi amaçladık. Ocak 2007-Aralık 2019 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniğinde periferik damar yaralanması nedeniyle ameliyat edilen hastaların yaş ve cinsiyet bilgileri, yaralanma ile ameliyata alınma arasında geçen süre, preoperatif değerlendirme bilgileri, yaralanan damar segmentleri, yaralanma mekanizmaları, damar onarım teknikleri, postoperatif erken dönem ve 30. günde ki kontrol bilgileri retrospektif olarak incelendi. Çalışmaya 102 hasta dahil edildi (%9.8’i kadın, %90.2’si erkek; yaş ortalaması 28.9). Hastaların 28’si ateşli silah yaralanması (%27.4), 37’si delici-kesici alet yaralanması (%36.3), 37’si künt yaralanmaydı (%36.3). Hastaların iskemi süreleri 1-8 saati. Seksen dört hastaya otojen greft ile (vena safena magna) baypas (%82.4), 7 hastaya PTFE sentetik ringli damar grefti ile baypas (%6.8), 10 hastaya uç-uca anastomoz, 1 hastaya da safen ven greftiyle patch-plast yapıldı (%1). Yirmi iki hastaya fasyatomi açıldı (%21.5). Beş hastaya amputasyon uygulandı (%4.9). İki hasta ex oldu (%1.9). Ekstremite damar yaralanmalı hastaları değerlendirme ve tedavi protokollerimiz ile cerrahi sonuçlarımız literatürdekilerle benzerlik göstermektedir Periferik damar yaralanmalarında mortalite ve morbidite oranlarını azaltmak için multidisipliner yaklaşımın, hızlı tanı ve tedavinin en önemli faktörler olduğunu düşünüyoruz. Ayrıca preoperatif görüntüleme gereken hastalarda ilk tercihin BT anjiografi olması gerektiğini, damar onarımında mümkün olan tüm hastalarda otojen greft kullanılmasının en doğru yaklaşım olduğunu ve uzun süreli iskemilerde ampütasyon oranlarını düşürmek için fasyatomi yapılması gerektiğini düşünüyoruz.
We aimed to retrospectively evaluate our evaluation protocols, treatment methods and results of patients admitted to our center with limb vascular injury in the light of the literature. Age and gender information of patients who were operated for peripheral vascular injury between January 2007 and December 2019 in Uludağ University Faculty of Medicine Cardiovascular Surgery Clinic, time between injury and operation, preoperative evaluation information, injured vessel segments, injury mechanisms, vessel repair techniques, early postoperative period, and control data on the 30th day were retrospectively analyzed. 102 patients were included in the study (9.8% female, 90.2% male; mean age 28.9). Twenty-eight of the patients were gunshot wounds injury (27.4%), 37 were sharp object injurie (36.3%), 37 were blunt injuries (36.3%). The ischemia times of the patients were 1-8 hours. Eighty-four patients underwent bypass with autogenous graft (vena saphena magna) (82.4%), 7 patients with PTFE synthetic ringed vein graft (6.8%), 10 patients underwent end-to-end anastomosis, 1 patient was performed patch-plasty with saphenous vein graft (%). one). Fasciotomy was performed in 22 patients (21.5%). Amputation was performed in five patients (4.9%). Two patients died (1.9%). Our evaluation and treatment protocols for patients with extremity vascular injury and our surgical results are similar to those in the literature. We think that multidisciplinary approach, rapid diagnosis and treatment are the most important factors in reducing mortality and morbidity rates in peripheral vascular injuries. In addition, we think that CT angiography should be the first choice in patients who require preoperative imaging, that the use of autogenous grafts is the most appropriate approach in all possible patients in vascular repair, and fasciotomy should be performed to reduce amputation rates in long-term ischemia.
We aimed to retrospectively evaluate our evaluation protocols, treatment methods and results of patients admitted to our center with limb vascular injury in the light of the literature. Age and gender information of patients who were operated for peripheral vascular injury between January 2007 and December 2019 in Uludağ University Faculty of Medicine Cardiovascular Surgery Clinic, time between injury and operation, preoperative evaluation information, injured vessel segments, injury mechanisms, vessel repair techniques, early postoperative period, and control data on the 30th day were retrospectively analyzed. 102 patients were included in the study (9.8% female, 90.2% male; mean age 28.9). Twenty-eight of the patients were gunshot wounds injury (27.4%), 37 were sharp object injurie (36.3%), 37 were blunt injuries (36.3%). The ischemia times of the patients were 1-8 hours. Eighty-four patients underwent bypass with autogenous graft (vena saphena magna) (82.4%), 7 patients with PTFE synthetic ringed vein graft (6.8%), 10 patients underwent end-to-end anastomosis, 1 patient was performed patch-plasty with saphenous vein graft (%). one). Fasciotomy was performed in 22 patients (21.5%). Amputation was performed in five patients (4.9%). Two patients died (1.9%). Our evaluation and treatment protocols for patients with extremity vascular injury and our surgical results are similar to those in the literature. We think that multidisciplinary approach, rapid diagnosis and treatment are the most important factors in reducing mortality and morbidity rates in peripheral vascular injuries. In addition, we think that CT angiography should be the first choice in patients who require preoperative imaging, that the use of autogenous grafts is the most appropriate approach in all possible patients in vascular repair, and fasciotomy should be performed to reduce amputation rates in long-term ischemia.
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Keywords
Amputasyon, Damar yaralanması, Vascular injury, Amputasyon, Fasciotomy, Amputation
Citation
Yolgösteren, A. vd. (2020). ''Alt ve üst ekstremite damar yaralanmaları: on iki yıllık deneyimimiz''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 46(3), 337-341.