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Vascular injuries of the extremities are a major challenge in a third world country
Fahad H Khan1, Kamal M Yousuf2, Anel R Bagwani3
1General Surgery, Civil Hospital, Baba-e-Urdu Road, Karachi, 75200 Pakistan.
Insights
Traumatic vascular injuries in Pakistan pose a significant threat to limb salvage. Delays in presentation, often exceeding 8 hours, are the primary cause of limb loss in these cases.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Public Health
Background:
- Traumatic vascular injuries of the extremities present a significant challenge, particularly in developing nations.
- Causes include poor traffic law enforcement, street crime, firearms, and blast injuries.
- This study shares 10 years of experience managing vascular injuries in Pakistan.
Purpose of the Study:
- To analyze the outcomes of managing traumatic vascular injuries of the extremities.
- To identify factors contributing to limb loss and mortality.
- To provide insights into improving vascular care in resource-limited settings.
Main Methods:
- Retrospective observational study conducted at Liaquat National Hospital, Karachi, Pakistan.
- Inclusion criteria: patients with upper and lower limb vascular injuries presenting within 12 hours with salvageable limbs.
- Exclusion criteria: patients presenting after 12 hours or with primary amputation.
Main Results:
- 328 patients met the inclusion criteria.
- Limb salvage rate was 41%, with a 30-day perioperative mortality of 5.48%.
- Delayed presentation (>8 hours) was the major cause of limb loss. Popliteal artery (41.76%) and femoral artery (27.43%) were most frequently involved.
Conclusions:
- Vascular injuries are a major cause of limb loss in developing countries due to violence and limited access to vascular facilities.
- Improving law and order, emergency response systems, and vascular services in remote areas can reduce morbidity.
- Reducing delays in presentation is crucial for improving limb salvage rates.
Background:
Traumatic vascular injuries of the extremities are a major challenge especially in the third world countries. These injuries are mostly due to poor traffic laws, street crimes, firearms and blast associated injuries. We therefore would like to share our 10 years of experience in dealing with vascular injuries in Pakistan.
Methods:
This was a retrospective observational study conducted in the department of vascular surgery of Liaquat National Hospital, Karachi, Pakistan. Patients' records were retrieved from the department and were reviewed. Cases with vascular injuries of upper and lower limb that presented with signs of salvageable limb and presented within 12 hours of injury were included in the study. Patients with more than 12 hours of presentation and in whom primary amputation was done, were excluded from the study.
Results:
There were 328 patients who presented with vascular injuries of the extremities that fell in the inclusion criteria. Limb salvage rate was 41 %, whereas 30-days perioperative mortality was 5.48 %. The major cause of limb loss was delay in presentation of more than 8 h of injury. Major vessels involved were popliteal artery (41.76 %), followed by femoral artery (27.43 %).
Conclusion:
Vascular injuries are becoming a major contributor of limb loss in third world countries due to violence, terrorism and unavailability of vascular facilities. This morbidity can be reduced by improving law and order situation, evolving an effective emergency ambulatory system and with better training and provision of vascular services in remote areas so that the delay factor can be reduced.
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