Review of intimal arterial injuries. Surgery versus conservative management

This retrospective review was carried out to see if there is any role for selective management for intimal arterial injuries found in the extremities. The study involved retrospective analysis of arterial injuries seen in the extremities during the past four years. A total of 49 vascular injuries were identified which were proved by angiographic finding. There were eight cases which involved intimal injury in the nature of intimal irregularity or a flap seen in the angiogram. Four of these cases were treated surgically. There were four cases treated by conservative follow-up with the patient being placed either on low molecular weight dextran and/or low-dose intravenous heparin if there were no contraindications for the above. All of these patients had a successful outcome with normal angiographic findings of the injured area. The angiograms were done a few weeks following the injuries. The decision to treat conservatively was based on the nature of the injury as well as location of the injury, in one case being the origin of the anterior tibial artery, which is difficult to explore surgically. In conclusion, we believe that in selected instances where there is no distal vascular insufficiency because of the injury or if the patient has a lesion in a surgically difficult area to explore or if there are any other serious life-threatening injuries, the intimal artery injury can be managed conservatively. This also avoids the morbidity and mortality associated with surgical intervention.