Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 135-138

Missile vascular injuries: 19-year experience

Abdul Gani Ahanger, Mohd Lateef Wani, Reyaz A Lone, Shyam Singh, Zahur Hussain, Ishtiyak A Mir, Ifat Irshad, Hakeem Zubair, Abdul Majeed Dar, G N Lone, M A Bhat, M L Sharma
Sheri-kashmir Institute Of Medical Sciences Soura Srinager, India.

BACKGROUND
Missile vascular injuries have reached an epidemic proportion in Kashmir valley since the eruption of militancy. The present study was undertaken to analyze the mode, pattern, presentation, and management of missile vascular injuries.
METHODS
A retrospective study of patients with missile vascular injury from January 1990 to October 2008 was undertaken. Five hundred eighty patients with missile vascular injury were studied. All patients with vascular injury due to causes other than missiles were excluded from the study.
RESULTS
Most of the patients were treated by interpositional saphenous vein graft or end-to-end anastomosis. The most common complication was wound infection (22.7%) followed by graft occlusion (3.8%). The amputation rate was 3.3% and was higher in patients with a delay of >6 hours to revascularization and associated fractures.
CONCLUSION
Missile vascular injury requires prompt resuscitation and revascularization. Preoperative angiography is seldom necessary. Doppler study may sometimes be needed to aid in the diagnosis.

Keywords: End to end anastomosis, saphenous vein graft; vascular injuries.

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Mermi ile gerçekleþen vasküler yaralanmalar: 19 yýllýk deneyim

Abdul Gani Ahanger, Mohd Lateef Wani, Reyaz A Lone, Shyam Singh, Zahur Hussain, Ishtiyak A Mir, Ifat Irshad, Hakeem Zubair, Abdul Majeed Dar, G N Lone, M A Bhat, M L Sharma
Sher-ý-kashmir Týp Bilimleri Enstitüsü, Soura Srinager, Hindistan.

AMAÇ
Militanlýðýn patlak vermesinden itibaren mermi ile gerçekleþen vasküler yaralanmalar, Kaþmir vadisinde epidemik bir orana ulaþmýþtýr. Bu çalýþma, mermi ile gerçekleþen vasküler yaralanmalarýn tipi, mekanizmasý, baþvuru þekli ve tedavisini analiz etmek için yapýlmýþtýr.
GEREÇ VE YÖNTEM
Bu retrospektif çalýþmada, Ocak 1990 ile Ekim 2008 tarihleri arasýnda mermi ile gerçekleþen vasküler yaralanmasý olan hasta kayýtlarý incelendi. Mermi ile gerçekleþen vasküler yaralanmasý bulunan 580 hasta üzerinde çalýþýldý, bu tip yaralanmasý olmayanlar çalýþma dýþýnda tutuldu.
BULGULAR
Hastalarýn çoðu, safen ven interpozisyon grefti veya uç uca anastomoz yöntemi ile tedavi edilmiþtir. En yaygýn olarak karþýlaþýlan komplikasyonlar, enfeksiyon (%22,7) ile greft týkanýklýðý (%3,79) olmuþtur. Ampütasyon oraný %3,3 olmuþtur. Ampütasyon oraný, >6 saatlik bir gecikme ve eþlik eden kýrýklarla baþvuran hastalarda daha yüksek olmuþtur.
SONUÇ
Mermi ile gerçekleþen vasküler yaralanma, acil resüsitasyon ve revaskülarizasyon gerektirir. Ameliyat öncesi anjiyografi nadiren gerekir. Tanýya yardýmcý olmak üzere bazen Doppler incelemesi gerekli olabilir.

Anahtar Kelimeler: Uç uca anostomoz, safen ven greft; vasküler yaralanmalar.

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