Management of Delayed Vascular Complications of Gunshot Wounds Following Peripheral Vascular Trauma – A Case Series of Five Patients and Institutional Experience
Madavan Praveena, Devender Singh, Shalini AryalaAbstract
Objectives:
To describe the different presentations, evaluations, management and outcome of delayed vascular complications of gun shot wound following peripheral vascular trauma.
Materials:
A retrospective study of three years from January 2021 to December 2023. All the patients with peripheral vascular injuries following gun shot wound missed at the time of causative trauma were included. Patients with acute presentations were excluded. All the cases were evaluated with CT angiography and managed with various open vascular surgical techniques and their results were assessed.
Results:
Five patients with delayed vascular complications following gun shot wounds underwent vascular repairs. Age ranged from 25 - 40 yrs. One female and four were males. The time interval between injury and presentation ranged from 10 to 15 years. All the patients presented with high flow Arterio -venous fistula with extensive limb swelling. Also associated with giant venous aneurysms in three, nonhealing ulcers with venous hypertension in three and limb ischemia in one. Lower limb vessels were affected in 4 cases and upper limb in 1. Superficial femoral and popliteal arteries were more frequently involved. Ligation and excision of high flow a-v fistula with vein bypass was performed in all. In cases with giant venous aneurysm, tangential excision with lateral venorraphy was done. Postoperatively all the patients were on anticoagulation. Follow up showed good recovery.
Conclusions:
High flow A-V fistula is the commonest delayed presentation with extensive limb swelling following gun shot wound injury. In most cases it was found to be associated with giant venous aneurysms and venous hypertension. Open vascular surgical procedures provides durable long term results and should be considered as the first choice in these young patients.