Clinical Patterns and Outcomes in Patients After Penetrating Lower Limb Vascular Injury in Taiz, Yemen

Abstract

Background: Popliteal arterial injury is associated with a high risk of limb loss of any peripheral vascular injury. The purpose of this study was to review our experience with complex penetrating popliteal arterial injuries, thereby focusing on initial presentation and early outcomes.

Methods: We conducted a retrospective study of 85 patients with popliteal arterial injuries who underwent surgical treatment from 2015 to 2019 at Authority of Althawra hospital in Taiz, Yemen. Variables were retrospectively collected included patient demographics, mechanism and type of injury, limb ischemia time, clinical status at presentation, type of vascular reconstruction, associated complications, limb salvage, and mortality.

Results: Reconstructions were performed for 85 patients with penetrating popliteal arterial injuries, consisting of 78 (92%) males and 7 (8%) females with an age range 3–75 years with a mean of 27.7 ± 12 years. There were 71 (83.5%) penetrating gunshot high-velocity injuries, and 14 (16.5%) blast injuries.Nearly more than half 54 (63.5%) of the patients sustained complex popliteal vascular injuries (arterial and venous injuries) and 31 (36.5%) isolated arterial injuries. Management of popliteal arterial injury was repaired by saphenous venous interposition graft in 68 (80%), end-to-end anastomosis in 16 (18.8%), and venous patch in 1(1.2%). Venous injury was repaired in 40 (74%) and ligated in 14 (30%). Less than 6 hours’ time from injury to completed revascularization was achieved in 46 (54.1%) patients. The overall fasciotomy was 28 (33%) which significantly increased the length of hospital stays (17 days vs 6 days, P=0.0003). The overall limb-salvage rate in our study was 93%. During study period, the most common complication was 14 (16.5%) graft thrombosis, 12 (14.1%) wound infection, 12 (14.1%) compartment syndrome, 7 (8.2%) lower limb edema. Early limb loss occurred in 6 (5.8%). In our study, amputation rate was 6 (7%) and mortality rate was 1 (1.2%).

Conclusions: Wartime penetrating PAI is complex dilemma and associated with a high rate of amputation. However, team approach and promptly vascular repair found to associate with remarkable limb salvage rate 93%. This study represents the clinical pattern and early outcomes of popliteal arterial injuries during the contemporary war in Taiz, Yemen. We found that wound and graft infection, graft thrombosis, and the need for embolectomy are significantly had high risk for amputation.