Document Detail

Venous trauma in the Lebanon War--2006.
MedLine Citation:
PMID:  17670724     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Reports on venous trauma are relatively sparse. Severe venous trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or external and rarely may lead to hypovolemic shock. Repair of major extremity veins has been a subject of controversy and the current teaching is to avoid venous repair in an unstable or multi-trauma patient. The aim of the current paper is to present our recent experience in major venous trauma during the Lebanon conflict, means of diagnosis and treatment in a level I trauma center. METHODS: All cases of major venous trauma, either isolated or combined with arterial injury, admitted to the emergency room during the 33-day conflict were reviewed. RESULTS: Out of 511 wounded soldiers and civilians who were admitted to our service over this period, 12 (2.3%) sustained a penetrating venous injury either isolated (5) or combined with arterial injury (7). All injuries were secondary to high velocity penetrating missiles or from multiple pellets stored in long-range missiles. All injuries were accompanied by additional insult to soft tissue, bone and viscera. The mean injury severity score was 15. Severe external bleeding was the presenting symptom in three cases of isolated venous injury (jugular, popliteal and femoral). The diagnosis of a major venous injury was made by a CTA scan in five cases, angiography in one and during surgical exploration in six cases. All injured veins were repaired: three by venous interposition grafts, four by end to end anastomosis, three by lateral suture and two by endovascular techniques. None of the injuries was treated by ligation of a major named vein. Immediate postoperative course was uneventful in all patients and the 30-day follow-up (by clinical assessment and duplex scan) has demonstrated a patent repair with no evidence of thrombosis. CONCLUSIONS: Without contradicting the wisdom of ligating major veins in the setup of multi-trauma or an unstable patient, our experience indicates that a routine repair of venous trauma can be safely and effectively performed in young patients. Postoperative course is not compromised and late sequelae of venous interruption may be prevented.
Samy S Nitecki; Tony Karram; Aaron Hoffman; Arie Bass
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Publication Detail:
Type:  Journal Article     Date:  2007-07-25
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  6     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-21     Completed Date:  2007-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  647-50     Citation Subset:  IM    
Department of Vascular Surgery, Rambam Medical Center, P.O. Box 9602, Haifa 36091, Israel.
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MeSH Terms
Anastomosis, Surgical
Arteries / injuries
Blood Vessel Prosthesis Implantation
Extremities / blood supply*
Forensic Ballistics
Hemorrhage / etiology*,  surgery
Middle Aged
Military Personnel
Patient Selection
Phlebography / methods
Severity of Illness Index
Suture Techniques
Tomography, X-Ray Computed
Trauma Centers
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Surgical Procedures / adverse effects*
Veins / injuries,  transplantation
Wounds, Penetrating / complications,  diagnosis,  surgery*
Comment In:
Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):651   [PMID:  17884858 ]
Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):650-1   [PMID:  17884857 ]

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