VASCULAR TRAUMA EXPERIENCE AT LADY READING HOSPITAL, PESHAWAR

To evaluate vascular trauma management mainly on clinical assessment, at a less equipped set-up and compare the outcome in early and late arrivals. A prospective study of vascular trauma patients was conducted at Lady Reading Hospital, Peshawar. The nature, site, early and late presentation and outcome of surgery in vascular injuries presenting to our department between January 1995 to December 1998 were assessed. Out of these cases, only few stable neck injuries had pre-operative angiographies. There were 354 vascular injuries in 344 patients (mean age 29, range 5-60). Mechanism and nature of injuries were assessed Early presentations (group A: 111 cases < 8 hours) were compared with late presentations (group B: 232 cases > 8 hours). The hospital mortality, complications, associated injuries and outcome were accorded. Male accounted for 90% of patients. The majority of injuries (81.35%) were caused by bullets, followed by stab injuries (6.40%), blunt trauma (8.75%) and iatrogenic (3.38%). 61.29% were arterial, 10.16% were venous, 23.72% were mixed, 4.80% had in tack vessels. Upper limb injuries were 31.63%, lower limb (60.16%), remaining were neck or abdominal injuries. Associated injuries included fractures (16.38%), nerve injuries (25.42%), chest injures (5.93%), abdominal injuries (9.03%), and cervical spine or head injuries (1.41%). About 70% presented with haemorrhage and 80% with pulse deficit,. Injuries treated with end to end anastomosis (44%), vein graft (21.46%), prosthetic graft (6.49%), lateral suture (16.66%), ligation (5.36%), thrombectomy (4.51%) and primary amputation (2.25%), Group "A" had higher mortality than group "B") (16% vs. 5%) with amputation rate of (7.86% vs 10.48%) and infection rate of (32% vs 14.65%). The higher mortality in those arriving within 8 hours of injury reflects, their more severe injuries. Early recognition and prompt referral to vascular surgery centre may save life and limbs in vascular trauma patients.