Peri-Operative Systemic Anticoagulation in Vascular Trauma: A Prospective Study
Abstract
From Jan 2016 to Dec 2019, 53 patients with 73 vascular
injuries underwent vascular repair at this center. All isolated
arterial and mixed (arterial and venous both) prospectively
received a fixed dose of intraoperative and post-operative
infusion of Unfractionated heparin. Patients with
vascular injuries in conjunction with other injuries; abdominal,
thoracic and head injuries were also included
in the study. Patients who presented with class III limb or
with primary traumatic amputation and isolated venous
injuries were not included in this study. Methods of repair
included autologous conduit, synthetic interposition
graft and primary repair. Primary end point was defined
as vessel patency during index hospitalization, defined
as absence of clinical or radiographic evidence of vessel
thrombosis. Secondary endpoints included limb salvage,
return to the operating room for bleeding and mortality.
All patients were healthy males in the age group of 21 to
47 years with no known comorbidities. Nineteen patients
were cases of isolated vascular trauma while 34 patients
had some concomitant injury in form of orthopedic, abdominal,
thoracic or head injury. Of patients with arterial
injuries, 36 patients underwent RSVG (reversed saphenous
vein bypass graft), 03 patients underwent primary
repair, 01 patient underwent vein patch repair while one
patient with Axillary artery transection underwent PTFE
interposition graft. There were three amputations (2 transtibial
and 1 transfemoral).
Nineteen cases had clinical and biochemical evidence
of reperfusion injury in the form of foot wrist drop. 16
cases had foot drop while 03 cases had wrist drop. No
patient had any evidence of intracranial or any bleeding
at any other site. Only three patients, who had associated
abdominal and thoracic trauma required massive perioperative
transfusion due to extensive intraoperative blood
loss. Limb salvage rate was 92.68%. There were 03 mortalities.
Two patients had Acute kidney injury, while one
patient, who had concomitant splenic, kidney and aortic
injury died on 7th post of day due to sepsis and multiorgan
dysfunction.
