Emergency surgery of acute traumatic arteriovenous fistulas.
The purpose of this report was to analyze the clinical presentation, diagnosis, surgical and non-surgical treatment and the outcome of patients with acute AVFs seen during the last 8years. During 1991-98 we treated 47 patients with traumatic AVFs. Among these patients 11 were classified as 'acute' AVF. All the patients were male and they ranged in age from 17 to 64yr (mean 25yr). The time from injury to admission to our two institutions varied from 4h to 17days. Emergency surgery was performed in unstable patients and in those with an expanding haematoma base on clinical assessment alone. The acute surgery group consisted of stable patients that were operated after angiography examination. A ??? murmur and thrill were present in seven patients, and peripheral pulses were absent in four patients. The main blood vessels were reconstructed using various techniques in eight patients and minor blood vessel were ligated in three patients. Two lower limb amputations had to be performed, both after reconstruction of popliteal AVFs. In the remaining nine patients reconstruction of the axial vessels was successful and no signs of ischemia developed in patients after ligation of minor vessels. No neurological deficit developed in two patients whose AVFs were vaporised in the neck. The average hospital stay was 8. 6days. Emergency surgery is safe in unstable patients with traumatic AVFs. A thrill and murmur are characteristic signs even in the acute setting, but the examiner must be persistent in looking for them whenever there is a suspicion of a blood vessel injury. Angiography is a reliable diagnostic tool in stable patients, but whether it is essential when there is an expanding pulsating hematoma remains debatable.
Ilijevski
N
N
Dedinje Cardiovascular Institute, Belgrade, Yugoslavia.
Radak
D
D
Radević
B
B
Bojić
M
M
Kronja
G
G
Misović
S
S
Simić
A
A
Jevtić
M
M
D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004630:Emergencies; D005263:Femoral Artery / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D014857:Warfare; D015022:Yugoslavia