Nuove metodiche di trattamento nei traumi vascolari complessi degli arti

Objective:. Complex limb vascular injuries are associated with a high degree of limb loss and an high mortality rate . Despite successful arterial repair and advance in intensive care support, traumatic ischaemia and reperfusion injury conditioning an high incidence of limb loss and the systemic inflammatory response and multiple organ dysfunction syndrome can lead to an high mortality rate. A new policy centred on early intraluminal shunting of both artery and vein, restoring arterial inflow and venous outflow,routinary vein repair and endoscopic saphenous vein harvesting seems to be significantly reduces total ischemic time, complications, repeat operations, amputation, and hospitalization. The purpose of this study was to determine the possible benefits of these approach in patients with complex vascular trauma of the limbs. Methods: From January 2001 to December 2010 29 complex blunt and penetrating vascular trauma, with arterial, venous and bone involvement that required stabilization , with complete limb ischemia or bleeding were submit to emergency operation. Over 5 years 16 vascular trauma ( 7 upper limb, 9 lower limb) were managed with arterial and venous shunt insertion, vein repair and endoscopic saphenous vein harvesting ( Group B). Data from these procedures was analyzed and compared with collected data from 13 complex vascular trauma ( 6 upper limb, 7 lower limb) treated without shunts, vein repair and endoscopic saphenous vein harvesting during the preceding 5 years ( group A). Results: Comparisons between the group A and group B showed that shunting, vein repair and Endoscopic saphenous vein harvesting in both penetrating and blunt injuries significantly reduced the incidence, contracture, nerve plasy, postoperative complications, repeat operations and the incidence of amputation and the mortality rate (p<0.05). Mean ischemic time for preoperative, intraoperative, and total ischemic time in the group A and B were recorded and difference was significant for intraoperative and total ischemic time(p<0.05). Conclusion: This new approach can lead to great advantage in terms of significantly improved outcomes, reducing total ischemic time, ischemic contracture, ischemic nerve plasy and amputation and mortality rates. We recommend a routine use of this approach in all the cases of complex vascular trauma with synchronous involvement of the artery, the vein and the bone.