Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries

Complications

United States Department of Defense

The most serious of the common complications after repair of arterial injuries are infection and hemorrhage Infection of a wound harboring an arterial repair frequently results in disruption of the suture line or degeneration of the conduit used for revascularization. Either may result in lifethreatening hemorrhage Secondary repair should not be attempted within the infected wound site. Occasionally it may be possible to bypass the infected wound and revascularize the extremity using an extraanatomic route. In other instances, this will not be possible, and proximal and distal arterial ligation with removal of the infected conduit will be required. This will, of necessity, result in a high percentage of amputations.

Thrombosis at or distal to the vascular repair is another potential complication. It may be necessary to perform a second operation in the early postoperative period if thrombosis occurs and viability of the limb is threatened. However, if limb viability is maintained by collaterals, additional operations in the combat zone should be avoided, as repeated operations under field conditions are followed by a higher incidence of infection which jeopardizes life as well as limb. If chronic arterial insufficiency develops, secondary vascular operations should be performed electively at a higher echelon of care.

A limb that is profoundly ischemic after arterial injury may develop ischemic contracture. This complication can be prevented if perfusion is restored within a reasonable period of time. When circulation is restored, muscle groups may swell, necessitating fasciotomies to prevent compartment syndrome and small vessel occlusion, which can cause myonecrosis even in the presence of a successful arterial repair. These changes are most prone to occur in the flexor compartment of the forearm and in. the anterior compartment of the leg. Under some circumstances, prophylactic fasciotomies, as discussed earlier, may be indicated to prevent delayed development of compartment syndrome.

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Operational Medicine 2001

Health Care in Military Settings

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