- by Dr Mamata S.H.
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- Jun 01 2017
Trauma causing vascular injuries
It was my pleasure working at KLE’s Research and Medical center
It was a great opportunity to serve the people of north Karnataka and creating awareness of the dreadful problems related to peripheral vascular system of the body.
It was my privilege to start the vascular surgery department(unit of Heart Foundation), KLE’S medical and research center. The wonderful foresight of Mr Prabhakar Kore and my introduction to the institution as a consultant gives me immense pleasure .During this period I had wonderful experience and a great satisfaction to serve the people in and around Belgaum (including part of Maharashtra like Kolhapur, Miraj, Sangli). Dr M.M Dixit, a well-known Cardio-thoracic surgeon of the area was a great support in the initiation of my career in Belgaum.
This was absolutely not possible without the inspiration of my Doddappa - Uttara Kannadada Horatagara Nadojja Shri Dr Patil Puttappa, who introduced me to the institution.
I would like to share some of the interesting and rare cases of trauma to the vessels.
Appasaaheb, 35years old male patient, presented to me with bull bore injury to his left thigh due to which his major atery supplying the leg was damaged. He was the only breadwinner agriculturist in the family. If the patient was left untreated then he would have been handicapped forever losing his limb. The damaged artery in the thigh was non repairable, hence bypass to re-perfuse his limb was considered using the patient’s own vein (from the opposite limb).
Another interesting case of Md javeed, aged 34years, presented with Hip bone fracture and was referred to me for aneurysm (enlarged) external Iliac artery( main artery supplying the leg just above the groin). The decision was to treat the fracture or the aneurysm first. Anyhow fixing of the aneurysm was the priority because of its natureof impending rupture and for the orthopaedician assistance as it was in their working field. He was also a patient affected by immunodeficiency virus( AIDS). (Suspected aetiology for aneurysm).The decision of repairing the artery was considered -aneurysm exclusion with a bypass carried out on this patient with all the protection and care to prevent spread of virus.
At times the fractured segment can just cause external compression alarming a limb threatening situation. Here the fracture reduction helps to restore the circulation
.Impact of any form of injury on the blood vessels
Accidents – common in road traffic accidents, frequently associated with multiple/single level bone fracture. Sometimes there might be a blunt injury affecting the vessels without any major external injuries or the fracture of the bones.
1-The segment of the artery can be compressed externally by the fractured bone. In such cases the arterial blood flow is restored when the bone fracture is corrected.
2- The vessel might be punctured which needs to be repaired by simply suturing the vessel.
3- Complete transection of the artery - the impact is tremendous and the limb is not salvageable until the artery is being reconstructed.
4-The artery as a whole is intact but the wall within the vessel might be disrupted (Dissection). This type of injury also needs surgical repair to restore the blood flow to save the limb.
5-The punctured artery may present later as a bulge / out pouching with a false covering on it (Pseudo aneurysm).
In any of such injuries, especially when the vessel is transected the person can bleed to death. Whenever such injury is suspected adequate external compression is mandatory till the patient is shifted to the target hospital.
When the major arteries of the neck (carotid/vertebral) are injured its life threatening and the person can bleed to death before reaching the hospital. Any arterial injury can be expected in the abdomen too, which are treatable by prompt surgical intervention.
Similarly the vein can also be injured which has to be repaired and at times might present with clot within the deep veins which might be life threatening (Deep vein thrombosis with Pulmonary embolism).
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