Vascular Trauma

Background: Managing patients with Vascular Trauma (VT) is essential. This study aimed to
determine the prevalence of VT and its related factors in Iran.
Methods: This systematic review was performed by two skilled researchers. To access all the
Persian and English articles on VT and its influencing factors (from 2000 to August 2019),
in addition to Google Scholar search engine, other international databases, such as PubMed/
Medline, Scopus, Embase, Cochrane Library, Science Direct, Web of Science (ISI), and
domestic databases, such as Magiran, IranDoc, National Library of Iran Organization, SID,
and Barakatkns were used. Data analysis was conducted by MA (CMA) software.
Results: The incidence of lower Lower Vascular Trauma (LVI) trauma was equal to 58.4
(95%CI: 41.1-73.8) (I2= 94.67, Q=112.57, P<0.001); the prevalence of upper LVI trauma was
measured to be 31.5 (95%CI: 17.7-49.7) (I2=94.48, Q=108.70, P<0.001); the prevalence of
penetrating trauma was calculated as 61.3 (95% CI: 49.5-71.9); the prevalence of ulnar nerve
injury equaled 9.8 (95%CI: 2.8-28.6); the prevalence of radial nerve trauma was equal to 7.7
(95%CI: 1.2-35.4); the prevalence of death cases was reported as 12.3 (95%CI: 5.1-26.9);
the prevalence of amputation rate was observed as 8.8 (95%CI: 5.7-13.4); the prevalence
of fasciotomy rate was equal to 22.2 (95%CI: 13.2-34.5); the prevalence of complete artery
cutting equaled 55.7 (95% CI: 35.4-74.3),and the prevalence of incomplete artery cutting was
measured as 25.5 (95%CI: 12.1-45.9).
Conclusion: According to the study results, VT has led to various complications in patients;
thus, it is critical to provide the necessary conditions to preserve the patient’s life and prevent
life-threatening complications. Such goals could be achieved by preventing this type of trauma
and its related complications.

Penetrating neck injuries account for 5 % to 10 % of all trauma admissions globally. The management of these injuries is controversial. Due to improvement in imaging modalities selective neck exploration is now accepted as a standard of care in resource rich countries; while mandatory neck exploration remains a viable option for injuries penetrating platysma in limited resource setting. However; mandatory neck exploration poses a challenge to surgeons in low trauma volume centers.
Objective: To share our experience and high light challenges.
Methodology: Records of 6 patients with penetrating neck injuries managed by our team over the last 6 months (Jan 2017-July 2017), were reviewed for biodata, mechanism of injury, Zones of injury, types of injury, intervention, and outcome.
Results: All 6 cases were male with five adults and one child. Three patients sustained intentional knife injuries, while two patients sustained un-intentional sharp objects injuries. Two patients had internal jugular lacerations in zone two of the neck. One child and adult sustained various injuries including parotid and vessels in zone three. One patient had retained foreign body long the trachea-esophageal groove and one patient with tracheal injury. One patient died from exsanguination and the other had threatened airway with tracheostomy on the table.
Conclusion: Management of penetrating neck injury in resource limited settings remains a serious challenge. Lack of equipment and surgeon inexperience may lead to poor outcome. Combining both clinical physical assessment and appropriate interpretation of hard and soft signs of neck injury may be helpful in neck exploration decisions.

Objectives: To evaluates the management and outcome of non-iatrogenic pediat-ric and adolescence extremity arterial injuries in a resource-challenged setting. Methods: A retrospective study of the surgical management for non-iatrogenic extremity arterial trauma in pediatric and adolescence during the period from January 2008 to December 2015. This study was performed in two different countries at tertiary referral university and teaching hospitals having a specialized emergency and trauma centers. A thorough study of each patient record was collected from these centers including, the original demographic data and their clinical presentations. Operative data of each patient was also reported. Results: During the 8-year period of the study, 149 pediatric and adolescent extremity arterial trauma patients were treated. They were 93.3% male, and 6.7% female, respectively. The age ranged from 2 to 18 years with a mean of 10.25 AE 4.05 years. Lower extremity arterial trauma was recorded in 51%, while 49% were having upper extremity injuries. Primary repair with end-to-end vascular anastomosis was performed in 51.7%, while an interposition reversed saphe-nous vein graft was performed in 48.3%. The operative procedures were performed by an experienced vascular surgeon and well-trained pediatric surgeons and general surgeons. Pseudoaneurysms was recorded in 9% of cases. Fasciotomy was performed in 15% of cases. Conclusion: Treatment of pediatric and adolescent extremity arterial injuries with primary end-to-end vascular anastomoses or with the use of an interposition reversed saphenous vein graft is a reliable, feasible, and more cost-effectiveness technique with good results. Moreover , it should be adopted for all vascular trauma patients, whenever possible.