Changing patterns in civilian arterial injuries

A critical review of 185 patients with 211 arterial injuries over an eleven year period was performed to recognize the changing patterns in clinical findings, management and results. A ten fold increase in multiple arterial injuries as well as higher incidence of associated venous and visceral injuries occurred during the last five years. Despite this, the incidence of hypotension on arrival at hospital was reduced by half due to rapid transportation and resuscitation during transit. Shock in patients with only extremity injuries heralded dual injuries (arterial and venous). Lateral repair of both arterial and venous injuries has given way to end to end anastomoses, vein grafts and patch grafts. A greater tendency to repair all major arteries, most minor arteries, more liberal use of heparin, fasciotomy, intraluminal shunts, repair of venous injuries and extra-anatomic bypass has been noted. Rapid patient retrieval, early resuscitation, improved recognition and management of arterial injuries has not lead to better limb salvage or survival. The apparent lack of benefit in limb salvage is probably due to the higher incidence of multiple arterial injuries and associated venous injuries as well as the willingness to attempt repair all major arterial injuries and reluctance to advise primary amputation. Early patient retrieval, rapid transportation and resuscitation during transit has increased the number of potentially unsalvageable patients (who would otherwise be declared dead on arrival) resulting in an unchanging mortality.