Femoral venous trauma in a university referral center

Therapeutic results from extremity vascular injuries have been improved by early definitive care by surgeons trained in peripheral vascular techniques. Serious venous injuries are uncommonly seen other than in large urban referral centers or military installations. Seventeen patients with major femoral venous injuries were evaluated over the past 25 years at the North Carolina Memorial Hospital. The records from these patients were analyzed regarding mechanisms of injury, time delay for definitive care, clinical presentation, significant associated injuries, operative management of the venous injury, early and long-term morbidity, and mortality. Major femoral venous injury was associated with simultaneous arterial injury in 59% of cases. Primary venous repair was performed in seven cases with a satisfactory functional result in all instances. Chronic venous insufficiency developed in five patients (29%), all of whom had arterial injuries and venous ligation. Postoperative complications were commonly related to associated injuries. No patient in this series developed thrombophlebitis or a pulmonary embolus. Isolated femoral vein injuries are usually associated with both early and late favorable results. Femoral vein ligation in the presence of arterial injuries usually leads to serious long-term venous disability. When technically feasible, operative repair of major femoral vein injuries is advocated.