A 52-yrs-old man is against a loading dock, severely injuri

Discussion in 'MRCS Forum' started by Lona., Dec 17, 2007.

  1. Lona.

    Lona. Guest

    A 52-yrs-old man is against a loading dock, severely injuring the right lower extremity, which is pulseless, pallid, and insensate. Angiography discloses a popliteal artery injury with obstruction. At surgery, the popliteal vein is also transected. The patient also has a fracture femur, a pelvic fracture, and a tender abdomen. His blood pressure is 85/60. The surgeon makes a determination to ligate the popliteal vein after arterial repair because -
    a- In severe popliteal vascular injuries, venous ligation leads to a decreased amputation rate following successful arterial reconstruction when compared with combined arterial and venous repair
    b- Venous ligation leads to a decreased incidence of chronic venous insufficiency when compared with venous repair
    c- Venous ligation leads to a decreased operative time in patients with multiple injuries or severe trauma when compared with venous repair
    d- In the presence of extensive associated soft tissue injury, venous return is already sufficiently impaired to render venous repair pointless
    e- Even though ligated veins thrombose, they often recanalize
  2. Lona.

    Lona. Guest

    Answer: c. (Sabiston, 15/e, p 333) In the past, ligation rather than repair of large veins in the extremities has been advocated in patients with multiple injuries or severe trauma. Venous repair adds to the operative time, often results in thrombosis and occlusion, and was thought to lead to an increased incidence of pulmonary embolization. Recent studies, including reviews of the Viet Nam Vascular Registry, indicate that the risk of pulmonary embolization is not increased with repair and that vein repair, in conjuction with arterial repair, increases limb salvage, particularly in popliteal injuries. Venous repair may also be necessary in the presence of extensive soft tissue trauma and an already severely compromised venous return. Long-term follow-up reveals that the sequelae of chronic venous insufficiency develop with increasing frequency in those patients who have had ligations of lower-extremity veins. Morbidity from chronic deep venous occlusion may be diminished even in those patients who develop thrombosis following repair, because recanalization often occurs. Ligated veins do not recanalize. For these reasons, it is currently recommended that large veins be repaired whenever clinically feasible.

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