Health  Vol.6 No.6 , March 2014
Abstract: Introduction: Vascular injuries are among the main mechanisms of death in trauma. In Brazil, the general surgeon is in charge of emergencies procedures in most hospitals, but many times these surgeons are not familiarized with more complex vascular surgical techniques that often require a vascular surgeon. Pará State is the most populated one in the Brazilian Amazon region and a single hospital with vascular surgeons permanently on call is available. Objectives: To evaluate demographic data on vascular trauma victims; to establish the mechanism, anatomic location, injury pattern and surgical techniques used to manage the vascular lesions treated at the Metropolitan Emergency Hospital; to ascertain associated non-vascular injuries and victim’s clinical outcome. Methods: Retrospective analysis of medical records of patients treated for vascular injuries from February 2011 to February 2013 at the institution in case. All arterial and venous injuries were analyzed. Patients who were not operated by the vascular surgery team, iatrogenic injuries and those who underwent primary or sustained traumatic amputation were excluded. Results: 173 cases; 95.95% were male; 54.90% were between 25 and 49 years; penetrating trauma mechanisms were found in 88.44%; lower limb was the most affected topography (41.50%); the most injured vessels were the superficial femoral and ulnar arteries (in 15.75% of cases each) and the superficial femoral vein (17.77 %); autologous vein graft was the most performed technique for arterial repair (36.57%) and ligature was performed in 85.00% of venous trauma; amputation rate was 15.60% and mortality rate was 6.35%. Conclusions: Vascular injuries occurred predominantly in men from 24 to 49 years old; penetrating mechanisms were most frequent; lower limb was the most affected topography; the most frequently injured vessels were the ulnar and superficial femoral arteries and the superficial femoral vein; complete vessel transection was the most common injury pattern; arterial trauma was most frequently treated by autologous venous graft interposition and ligature was performed for most of venous injuries; fractures were the most common associated lesions; the majority of patients recovered uneventfully, ischemic and infectious complications were the most frequent ones; deaths were caused by hypovolemic and septic shocks.
Cite this paper: de Oliveira Góes Jr., A. , Rodrigues, A. , Braga, F. , de Andrade, M. and de Campos Vieira Abib, S. (2014) VASCULAR TRAUMA IN THE AMAZON REGION: A TWO YEARS CASES REVIEW FROM A SINGLE INSTITUTION. Health, 6, 517-530. doi: 10.4236/health.2014.66071.

[1]   World Health Organization (WHO) (2010) Injuries and Violence: The Facts. World Health Organization, Geneva.

[2]   Fatimi, S.H., et al. (2012) Major Thoracic Vessels and Cardiac Trauma: Case Series from a Centre in a Developing Country. Ulus Travma Acil Cerrahi Derg, 18, 490-494.

[3]   Brasil. Secretaria de Políticas de Saúde—Ministério da Saúde (2000) PolíticaNacional de Redução da MorbimortalidadeporAcidentes e Violência. Revista de Saúde Pública, 34, 427-430.

[4]   Brasil. Ministério da Saúde. Departamento de Informáticado SUS (2013) Morbidade Hospitalar do SUS por Causas Externas—Por Local de Internação—Brasil. Datasus. Disponívelem.

[5]   Moreira, R.C.R. (2008) Trauma Vascular. Jornal Vascular Brasileiro, 7, 185-186.

[6]   Bilgen, S., et al. (2009) Peripheral Vascular Injury-Related Deaths. Ulusal Travma ve Acil Cerrahi Dergisi, 15, 357-361.

[7]   Salas, C.D. (2011) Trauma Vascular, Visión del Cirujano Vascular. Revista médica Clínica Las Condes, 22, 686-696.

[8]   Silva, M.A.M., et al. (2012) Trauma Vascular Napopulaçãopediátrica. Jornal Vascular Brasileiro, 11, 199-205.

[9]   Jawas, A., et al. (2013) Management of War-Related Vascular Injuries: Experience from the Second Gulf War. World Journal of Emergency Surgery, 8, 22.

[10]   Westphal, F.L., De Lima, L.C., Netto, J.C.L., Da Silva, De Souza da Silva, J., Dos Santos Jr., V.L. and Westphal, D.C. (2009) Thoracic Trauma: Analysis of 124 Patients Who Underwent Thoracotomy. Revista do Colégio Brasileiro de Cirurgiões, 36, 482-486.

[11]   Casey, E., et al. (2009) Vascular Injuries in the Lower Limb of Athletes. Nerve and Vascular Injuries in Sports Medicine, 183-198.

[12]   Fernandes, R.F., et al. (2011) Tratamento Endovascular de Lesõesarteriaistraumáticas. Angiologia e Cirurgia Vascular, 7, 21-28.

[13]   Antunes, L.F., et al. (2011) Traumatismosvascularesrevisão de 5 Anos. Angiologia e Cirurgia Vascular, 7, 86-93.

[14]   Jaha, L., et al. (2012) A Decade of Civilian Vascular Trauma in Kosovo. World Journal of Emergency Surgery, 7, 24.

[15]   Staeheli, G.R., Fraser Jr., M.R. and Morgan, S.J. (2012) The Dangers of Damage Control Orthopedics: A Case Report of Vascular Injury after Femoral Fracture External Fixation. Patient Safety in Surgery, 6, 7.

[16]   Costa-Val, R., et al. (2008) Reflexões sobre o trauma cardiovascular civil a partir de um estudo prospectivo de 1000 casos atendidos em um centro de trauma de nível I. Revista do Colégio Brasileiro de Cirurgiões, 35, 162-167.

[17]   Rasouli, M.R., Moini, M. and Khaji, A. (2009) Civilian Traumatic Vascular Injuries of the Upper Extremity: Report of the Iranian National Trauma Project. Annals of Thoraacic and Cardiovascular Surgery, 15, 389-393.

[18]   Jong-Woo, K.I.M., et al. (2010) Vascular Injury Associated with Blunt Trauma without Dislocation of the Knee. Yonsei Medical Journal, 51, 790-792.

[19]   Medeiros, C.A.F., et al. (2008) Tratamento Endovascular do Trauma Arterial dos Membros. Jornal Vascular Brasileiro, 7, 56-61.

[20]   Fox, C.J., et al. (2005) Contemporary Management of Wartime Vascular Trauma. Journal of Vascular Surgery, 41, 638-644.

[21]   Nitecki, S.S., et al. (2013) Management of Combat Vascular Injuries Using Modern Imaging: Are We Getting Better? Emergency Medicine International, 2013, Article ID: 689473.

[22]   Van Waes, O.J.F., et al. (2013) Treatment of Penetrating Trauma of the Extremities: Ten Years Experience at a Dutch Level 1 Trauma Center. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21, 2.

[23]   Kshirsagar, A.Y., et al. (2013) Management of Vascular Injury in Rural Setup. International Journal of Health Sciences & Research, 3, 12-16.

[24]   Ganie, F.A., et al. (2012) The Increasing Rate of Secondary Amputation in Popliteal Arterial Injury Associated with Multi-Organ Injuries and Hypo-tension. International Cardiovascular Research Journal, 6, 124-127.

[25]   Brasil, InstitutoBrasileiro de Geografia e Estatística (IBGE) (2010) Censo Demográfico.

[26]   Brasil, Governo do Estado do Pará, Secretaria de Estado de Saúde, Hospital Metropolitano de Urgência e Emergência, Departamento de Ensino e Pesquisa, 2013.

[27]   Caixeta, C.R., et al. (2010) Morbidadeporacidentes de Transporte Entre Jovens de Goiania, Goiás. Ciência & Saúde Coletiva, 15, 2075-2084.

[28]   EUA, Centers for Disease Control and Prevention (2011) Violence-Related Firearm Deaths among Residents of Metropolitan Areas and Cities—United States, 2006-2007. Morbidity and Mortality Weekly Report, 60, 573-578.

[29]   Miller, T.E. (2013) New Evidence in Trauma Resuscitation—Is 1:1:1 the Answer? Perioperative Medicine, 2, 13.

[30]   Gonsaga, R.A.T., et al. (2013) Characteristics of Care Provided by the Emergency Mobile Care Service in the Municipality of Catanduva, São Paulo state, Brazil, 2006-2012. Epidemiologia e Serviços de Saúde, 22, 317-324.

[31]   González, A.H.R., Molina, J.L.C. and Martínez, M.R.L. (2013) Trauma Vascular. Experiencia de 30 años en el Estado de Michoacán. Revista Mexicana de Angiología, 41, 55-61.

[32]   Palu, L.A. (2013) O Custo Social dos Acidentescommotocicletas e Suacorrelação com Osíndices de Trauma. 92f. Dissertação (MestradoemClínicaCirúrgica), Faculdade de Medicina, Universidade Federal do Paraná, Curitiba.

[33]   Hancock, H.M., et al. (2011) Hemorrhagic Shock Worsens Neuromuscular Recovery in a Porcine Model of Hind Limb Vascular Injury and Ischemia-Reperfusion. Journal of Vascular Surgery, 53, 1052-1062.

[34]   Murad, M.K., et al. (2012) Prehospital Trauma Care Reduces Mortality. Ten-Year Results from a Time-Cohort and Trauma Audit Study in Iraq. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 20, 13.

[35]   Topal, A.E., Eren, M.N. and Celik, Y. (2010) Lower Extremity Arterial Injuries over a Six-Year Period: Outcomes, Risk Factors, and Management. Vascular Health and Risk Management, 6, 1103-1110.

[36]   Ranney, M.L., Whiteside, L., Walton, M.A., Chermack, S.T., Zimmerman, M.A. and Cunningham, R.M. (2011) Gender Differences in Characteristics of Adolescents Presenting to the Emergency Department with Acute Assault-Related Injury. Academic Emergency Medicine, 18, 1027-1035.

[37]   Malta, D.C., Mascarenhas, M.D.M., Bernal, R.T.I., De Araújo Andrade, S.S.C., Das Neves, A.C.M., De Melo, E.M. and Da Silva Jr., J.B. (2012) Causas Externas em Adolescentes: Atendimentos em Services Sentinelas de Urgência e Emergência nas Capitais Brasileiras-2009. Ciência & Saúde Coletiva, 17, 2291-2304.

[38]   Ascari, R.A., Chapieski, C.M., Da Silva, O.M. and Frigo, J. (2013) Perfil Epidemiológico de Vítimas de Acidente de Transito. Revista Enfermagem Da UFSM, 3, 112-121.

[39]   Zabeu, J.L.A., Zovico, J.R.R., Júnior, W.N.P. and Neto, P.F.T. (2013) Perfil de Vítima de Acidente Motociclístico na Emergência de um Hospital Universitário. Revista Brasileira de Ortopedia, 48, 242-245.

[40]   Copuroglu, C., Heybeli, N., Ozcan, M., Yilmaz, B., Ciftdemir, M. and Copuroglu, E. (2012) Major Extremity Injuries Associated with Farmyard Accidents. The Scientific World Journal, 2012, Article ID: 314038.

[41]   Nafissi, N., Saghafinia, M. and Balochi, K. (2008) Improving Trauma Care in Rural Iran by Training Existing Treatment Chains. Rural and Remote Health, 8, 881.

[42]   Mishwani, A.H., Ghaffar, A. and Janjua, S. (2012) Combat Related Vascular Trauma. Journal of the College of Physicians and Surgeons-Pakistan, 22, 213-217.

[43]   Aslanturk, O., Ertem, K., Karakaplan, M. and Korkmaz, M.F. (2013) Pseudoaneurysm Discovered during Reverse Radial Forearm Flap after a Gunshot Injury: A Case Report. Medicine Science, 2, 414-422.

[44]   Kaczynski, J., Wilczynska, M. and Fligelstone, L. (2013) Flail Upper Limb Due to Delayed Presentation of a Traumatic Brachial Artery Pseudoaneurysm. BMJ Case Reports, 1-3.

[45]   Yavuz, C., Demirtas, S., Caliskan, A., Ertas, F., Kaya, H., Aydin, M., Benli, E.D., Celik, Y. and Eren, M.N. (2013) The Predictors of Poor Outcomes in Patients with Femoral Artery Injuries. European Review for Medical and Pharmacological Sciences, 17, 1901-1908.

[46]   Küçükarslan, N., Oz, B.S., Ozal, E., Yildirim, V. and Tatar, H. (2007) Factors Affecting the Morbidity and Mortality of Surgical Management of Vascular Gunshot Injuries: Missed Arterial Injury and Disregarded Vein Repair. Ulusal Travma ve Acil Cerrahi Dergis, 13, 43-48.

[47]   Dobson, P.F., Purushothaman, B., Michla, Y., England, S., Krishnan, M.K. and Tourret, L. (2013) Delayed Ulnar Nerve Palsy Secondary to Ulnar Artery Pseudoaneurysm Distal to Guyon’s Canal Following Penetrating Trauma to the Hand. Annals of the Royal College of Surgeons of England, 95, 75-76.

[48]   Markov, N.P., DuBose, J.J., Scott, D., Propper, B.W., Clouse, W.D., Thompson, B., Blackbourne, L.H. and Rasmussen, T.E. (2012) Anatomic Distribution and Mortality of Arterial Injury in the Wars in Afghanistan and Iraq with Comparison to a Civilian Benchmark. Journal of Vascular Surgery, 56, 728-736.

[49]   Sohn, V.Y., Arthurs, Z.M., Herbert, G.S., Beekley, A.C. and Sebesta, J.A. (2008) Demographics, Treatment, and Early Outcomes in Penetrating Vascular Combat Trauma. JAMA Surgery, 143, 783-787.

[50]   Santana, J.C.B., Dutra, B.S., Viana, J.A., Vieira, L.S. and Cardoso, C.M.L. (2012) Vítimas de Agressöes Por Arma Branca: O Que Retrata a Demanda de um Serviço de Urgência. Cogitare Enferm, 17, 78-84.

[51]   Zandomenighi, R.C., Mouro, D.L. and Martins, E.A.P. (2011) Ferimento Por Arma Branca: Perfil Epidemiológico Dos Atendimentos em um Pronto Socorro. Revista da Rede de Enfermagem do Nordeste, 12, 669-677.

[52]   Nitecki, S.S., Karram, T., Hoffman, A. and Bass, A. (2007) Venous Trauma in the Lebanon War 2006. Interactive CardioVascular and Thoracic Surgery, 6, 647-650.

[53]   Pourzand, A., Fakhri, B.A., Azhough, R., Ali Hassanzadeh, M., Hashemzadeh, S. and Bayat, A.M. (2010) Management of High-Risk Popliteal Vascular Blunt Trauma: Clinical Experience with 62 Cases. Vascular Health and Risk Management, 6, 613-618.

[54]   Kauvar, D.S., Sarfati, M.R. and Kraiss, L.W. (2011) National Trauma Databank Analysis of Mortality and Limb Loss in Isolated Lower Extremity Vascular Trauma. Journal of Vascular Surgery, 53, 1598-1603.

[55]   Brown, K.V., Ramasamy, A., Tai, N., MacLeod, J., Midwinter, M. and Clasper, J.C. (2009) Complications of Extremity Vascular Injuries in Conflict. Journal of Trauma, 66, S145-S149.

[56]   Costa, C.A., et al. (2005) Traumatismos de Veia Cava Inferior. Revista do Colégio Brasileiro de Cirurgiçes, 32, 244-250.