Abstract:
Objective: To analyze errors in primary treatment of vascular injuries and delayed presentations of missed vascular injuries
as a surrogate indicator of need for improved vascular surgical training of upcoming general surgeons.
Materials and methods: This retrospective observational study was carried out at vascular surgery department of two
tertiary care hospitals of Armed Forces from Jan 2012 to June 2017. Hospital records of all patients with vascular trauma
were analyzed for presence of pitfalls in primary treatment and delayed presentation of missed vascular injuries which
resulted in redo surgeries or adverse outcomes.
Results: Out of 256 patients with vascular injury sequel 41 had either a problem in primary treatment or presented with
delayed complications of missed injuries. The omissions can be divided into: missed injuries (24/41), technical errors in
initial repair (12/24), reperfusion of mangled Extremity (3/41) and non availability of a surgeon capable of undertaking
vascular repair. The commonest operative fault was failure to debride the vessel adequately and vascular repair under
tension. The commonest primary assessment problem was failure to timely appreciate hard signs of vascular injury.
Conclusion: With better training and emphasizing the need of thorough clinical examination outcome of vascular trauma
can be improved.