[Factors affecting the morbidity and mortality of surgical management of vascular gunshot injuries: missed arterial injury and disregarded vein repair].
BACKGROUND
The aim of this study was to establish the clinical course and importance of missed arterial injuries and disregarded venous repair after surgery for gunshot injuries.


METHODS
This retrospective study was performed on the operative results of 275 shotgun vascular injury patients' presented to our clinic between January 1992 and December 2004. All patients were analyzed from their medical files and operative notes. The incidence of missed arterial injuries and ignored venous repair, localization and type of vascular complications, limb loss and mortality outcomes were documented.


RESULTS
Seventy-five patients (27.27%) for a delayed diagnosis of a missed arterial injury and 91 patients (33.09%) for an ignored venous repair were treated. Complications of missed arterial injuries were determined as followings: false aneurysm n=43 (57.33%), arteriovenous fistula n=20 (26.66%), occlusion n=12 (16%). The missed vascular injury was most commonly observed in superficial femoral artery (n=20). The venous injury was present in 167 patients. Complications of disregarded venous repair were determined as venous edema and deep vein thrombosis.


CONCLUSIONS
Missed arterial injuries and disregarded venous repairs during initial diagnosis or operation affect the morbidity and mortality in gunshot injury patients. After haemodynamic stabilization, gunshot patients should be evaluated by arteriography and venography to determine the anatomic localization of vascular injuries. All vascular continuity should be restored either by primary repair or by an autolog graft. All venous injuries located in popliteal and femoral area should be repaired.
Küçükarslan
Nezihi
N
Department of Cardiovascular Surgery, Gülhane Military Medicine Academy, Ankara, Turkey. nkucukarslan@gata.edu.tr
Oz
Bilgehan Savaş
BS
Ozal
Ertuğrul
E
Yildirim
Vedat
V
Tatar
Harun
H
D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005263:Femoral Artery / Q000293:injuries* / Q000601:surgery; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008499:Medical Records; D011152:Popliteal Vein / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D020246:Venous Thrombosis; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery*