Surgical treatment of arterial lower-limb injuries by fire arms

Author(s): Bilel Derbel, Jalel Ziadi,Sobhi Mleyhi*, Rim Miri, Malek Ben Mrad, Faker Ghedira, Raouf Denguir

Background: Arterial ballistic injuries of the limbs are rarely encountered in civilian practice and the protocols of care are generally based on the experience gained during military conflicts. The aim of this study is to describe the medicosurgical management of the ballistic injuries of lower limbs with arterial damage and to develop a strategy for this type of rare lesions. Patients and Methods: It is a retrospective study of 11 male patients who underwent surgery for vascular lesions in the extremities caused by firearms. Results: The mean age was 33 years. The initial presentation in the emergency room was a hemodynamic shock in 5 patients, acute ischemia in 9 patients; externalized bleeding in 6 cases and one patient was seen at the aneurysm complication stage. Superficial femoral artery and popliteal artery were the most affected. Eight patients had also venous lesions and four patients had bone and nerve damage. All patients underwent arterial restoration by venous bypass surgery in 83.4% of cases and by end-to-end anastomosis in 16.6 %; simultaneously, 50 % of the venous lesions and 75% of the nerve lesions were repaired. Two patients were dead, one for bleeding shock and one for septic shock. The mean follow-up was 18 months. Three patients had surgical site infection and one patient had graft thrombosis. Conclusion: The management of vascular injuries caused by firearm requires surgical treatment by a multidisciplinary team with good results in the medium and long term essentially with isolated vascular injuries. Postoperative mortality and morbidity are directly related to hemodynamic status, surgical repair of vascular injuries and associated lesions in time, which leading to clear and rapid management.