title: Rural vascular trauma: a twenty-year review.
abstract: A 20-year review documented 248 vascular injuries in 210 patients from principally rural areas. The average time between injury and treatment from 1970 to 1983 was 6 hours. Between 1983 to 1990, when 46% of patients were transported by helicopter, the average delay was 4 hours. Blunt trauma (41%, with 29% motor vehicle accidents and 12% farm/industrial accidents) caused the most severe injuries and accounted for most amputations (89%) and deaths (80%). All of the blunt trauma patients had associated injuries. Penetrating injuries occurred in 59% of the patients and accounted for 11% of the amputations and 20% of the deaths. Extremity vessels were injured 73% of the time (upper extremity, 47%; lower extremity, 26%). Eighty-seven percent of the vessels injured were arteries and 13% were major venous injuries. Preoperative arteriograms were obtained in 30% of our patients. Vascular injury was determined in the others at the time of operative exploration. Vascular repair included direct anastomosis or lateral suture repair (51%), autogenous vein graft (16%), synthetic graft (6%), and ligation (19%). Primary amputation and thrombectomy were other (8%) initial treatments. In the past 10 years concomitant major peripheral venous injuries were repaired in six patients (one amputation) and ligated in one patient (no amputation). The mortality rates (4.8% total) for patients with blunt and penetrating trauma were 9.3% and 1.6%, respectively. Survival rates have not improved since the implementation of a helicopter transport system in 1983, but the amputation rate declined from 18% to 7%.
authors.affiliation: Department of Surgery, University of Missouri-Columbia.
authors.forename: P W
authors.initials: PW
authors.lastname: Humphrey
authors.forename: W K
authors.initials: WK
authors.lastname: Nichols
authors.forename: D
authors.initials: D
authors.lastname: Silver
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009104:Multiple Trauma / Q000453:epidemiology; D012423:Rural Health / Q000706:statistics & numerical data*; D015996:Survival Rate; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D014950:Wounds, Penetrating / Q000150:complications / Q000453:epidemiology* / Q000401:mortality