title: Missed vascular injuries: presentation and outcome.
abstract: OBJECTIVE
  To describe the different presentation, diagnostic evaluation, management and outcome of complications of missed vascular injuries.
  
  
  METHODS
  A case series.
  
  
  METHODS
  Combined Military Hospital, Rawalpindi and Combined Military Hospital, Kharian Cantt, from June 2009 to June 2012.
  
  
  METHODS
  All the patients with vascular injuries missed at the time of causative trauma who reported during this study period were included. Patients presented with acute vascular injuries and iatrogenic aneurysm at the vascular anastomosis site were excluded. All cases were evaluated with either CT or conventional angiography and managed with various open vascular surgical techniques and their results were assessed.
  
  
  RESULTS
  Twenty eight patients with missed vascular injury underwent various vascular repairs. Age of patients ranged from 16 to 78 years (mean = 33.7 ± 15.4 years). Male to female ratio was 6:1. Twelve (42.8%) patients presented with pseudoaneurysm alone, 10 (35.7%) with traumatic arteriovenous fistulae, 4 (14.3%) with post-traumatic thrombosis and occlusion and 2 (7.1%) with pseudoaneurysm and hemorrhage. Penetrating injuries were the commonest cause in 19 (67.8%). The time interval between injury and presentation in hospital ranged from 2 to 1300 weeks (mean 228 weeks). Lower limb vessels were affected in 20 (71.4%), the upper limb in 5 (17.8%) and neck vessels in 3 (10.7%). Superficial femoral artery was the most frequently involved artery in 9 (32.1%) cases. Interposition reverse autogenous saphenous vein graft was most common type of repair in all types of missed vascular injuries. One (3.5%) patient had amputation after secondary hemorrhage.
  
  
  CONCLUSIONS
  Low velocity penetrating trauma was the common cause of missed vascular injury. Pseudoaneurysm was the most common presentation.
authors: Department of Surgery, Combined Military Hospital, Kharian.
authors: Muhammad Khalid
authors: MK
authors: Siddique
authors: Department of Surgery, Combined Military Hospital, Kharian.
authors: Shahid
authors: S
authors: Majeed
authors: Department of Medicine, Combined Military Hospital, Kharian.
authors: Muhammad
authors: M
authors: Irfan
authors: Department of Surgery, Combined Military Hospital, Kharian.
authors: Nisar
authors: N
authors: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery*; D000792:Angiography; D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery; D001158:Arteries / Q000293:injuries*; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D006772:Hospitals, Military; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D057772:Vascular System Injuries / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014950:Wounds, Penetrating / Q000209:etiology / Q000601:surgery*; D055815:Young Adult