[Late sequelae after arterial injuries].
Of 57 patients with arterial injuries, three died, eight had an amputation and 14 experienced various kinds of late sequelae. Four of the sequelae were due to inadequate primary surgical treatment: 1) A 16 year-old girl developed incapacitating claudicatio intermittens after a traffic accident causing serious contusions to the right leg. Angiography four years later showed occlusion of the popliteal artery, which was successfully reconstructed. 2) A 16 year-old boy had a femoral fracture with injuries to the femoral artery and vein. The vessels were reconstructed and circulation was restored, but fasciotomies were not performed. He developed a flexion contracture of the 1st toe which required resection of the proximal phalanx. This was interpreted as a Volkmanns contracture due to a compartment syndrome in the deep, posterior compartment of the leg. 3) A 18 year-old man had a fracture of the leg. Angiography demonstrated a minimal leak from the posterior tibial artery, but this was not surgically explored. Six weeks later a pseudoaneurysm ruptured and produced a large hematoma. Circulation was restored by arteriotomy and a patch plasty. 4) A 24 year-old man was hit in the groin by a 22 caliber rifleshot. An arteriovenous fistula was diagnosed but not surgically treated. Six years later he experienced cardiac failure and venous insufficiency. The fistula was closed, whereafter the symptoms disappeared. Blood flow in the fistula was 7,500 ml/min and the pressure in the distal femoral vein 37 mm Hg. These complications can be avoided by proper investigation and surgery at the time of initial treatment.
Dedichen
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D000293:Adolescent; D000328:Adult; D000792:Angiography; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D005121:Extremities / Q000098:blood supply* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*
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