ACUTE TRAUMA OF THE FEMORAL-ARTERY AND VEIN

Between 1974 and 1991, 233 patients were treated for 321 confirmed femoral vascular injuries. There were 112 patients (48%) with isolated arterial injuries, 36 (15%) with isolated venous injuries and 85 (36%) with combined arterial and venous injuries. Injury to the concomitant superficial or common vessels occurred in 27 (8.3%) and 9 (1.7%) patients, respectively. Associated extremity injuries included bone, 15%; soft tissue and muscle, 11%; and nerve, 7%. Sixty patients (26%) had fasciotomies. Arterial thrombosis occurred in five superficial repairs. Eighteen repaired veins thrombosed-eight of 61 simple (lateral venorrhaphy) and ten of 50 complex repairs. Thirty-four percent of patients with a repaired venous injury had clinical evidence of postoperative venous morbidity-deep vein thrombosis (DVT), edema, pulmonary embolus. Six patients (2.5%) had a documented pulmonary embolus-four in the 18 patients (22%) with clotted venous repairs. Eleven patients (4.7%) underwent an amputation. Five of the amputations were in patients with either inadequate or delayed fasciotomy. An inadequate fasciotomy was equally as deleterious as a delayed fasciotomy in terms of outcome. Six of 27 limbs (22%) with a femur fracture required an amputation. There were six deaths. Acute limb morbidity was related to the extent of associated limb trauma, i.e., soft-tissue, nerve, and bone damage. Chronic morbidity was related to neurologic deficits and venous sequelae. Vascular injury to the femoral vessels was associated with a high morbidity but low mortality.