The Pattern and Outcome of Civilian Vascular Injury in a Teaching Hospital over a 7-Year Period

Background: The exact incidence of vascular injuries in Nigeria as a country especially south-east zone of Nigeria is unknown on account of under reporting and uncoordinated management of victims. Aim: To determine the pattern and outcome of common civilian vascular injuries managed in a teaching hospital in the south-east zone of Nigeria. Method: This is a retrospective study from January, 2007 to December, 2013. All case records of common civilian vascular injuries presenting at the accident center and those referred to the clinics as well as operation register and data banks of managing surgeons, were retrieved and analysed. Results: The age range of 12 - 75 years was rec-orded for the 26 patients. In this spectrum, age range of 21 - 30 years (19.2%) was the highest while the age range, 61 - 70 years (0%) was the lowest. One female (3.9%) and twenty five males (96.1%) were recorded, giving a female to male ratio of 1:25. In the upper extremity, brachial artery 6 (23.1%) was the most involved vessel while in the lower extremity, the most involved was the femoral artery 9 (34.6%). The patterns of presentation were isolated bleeding 10 (38%), arterivenous fistula 1 (3.5%) and pseudoaneurysm 8 (30%). 23 (88%) had good outcome. Conclusion: The incidence is about 4 cases per year. 23 (88%) had good outcome. The shortcoming of lattending physicians was because they were not conversant with hard and soft signs of vascular injuries with attendant limb loss and death of one of the victims. This short coming can be averted by training and retraining of doctors.

Treatment of membranous Budd-Chiari syndrome: analysis of 480 cases

BACKGROUND: Budd-Chiari syndrome (BCS) presents a kind of disease resulted from the occlusion of hepatic vein and/or the intrahepatic inferior vena cava. Its different pathological types were proposed. According to our expe- rience , the membranous type takes a large part of it, and we tried to explore the best treatment of membranous BCS through the analysis of 480 cases retrospectively. METHOD: The operative results of 480 patients with mem- branous BCS were analysed retrospectively. RESULTS: Patients after Kimura's finger rupture, inter- ventional treatment and membrane resection were followed up with rates of 84.62%, 86.55%, and 87.37%, respective- ly. The effective rates of the three methods were 61.4%, 91.7%, and 90.4%, respectively, and the recurrence rates of the disease after the 3 procedures were 38.6%, 8.3% and 9.6%, respectively. The long-term effects of interventional treatment and resection were significantly better than those of Kimura' s finger rupture (P <0.05). CONCLUSION: Balloon dilatation is the choice for mem- branous BCS. Patients with extensive lesion, thick mem- brane or recurrence after percutaneous transhepatic angio- graphy should undergo membrane resection.

Surgical treatment of posttraumatic foreign bodies in the heart or great vessels

Posttraumatic foreign bodies in the heart or great vessels is rare, which may cause cardiac tamponade, bleeding, shock, infection, embolism, arrhythmia, valve dysfunction, etc.13 The foreign bodies can be removed by surgery or percutaneous intervention.4 In this report we reviewed our experience in managing posttraumatic foreign bodies in 13 patients at our institution from 1992 to 2002.

Surgical treatment of infected arterial injuries of the major limb

To analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department. Methods： After a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient＇s condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases. Results ： 1 case （ 4.8 % ） died during the treatment. 5 cases （ 5/21, 23.8 % ） underwent amputations. Blood supply reconstruction was successful in 15 cases （15/21, 71.4%）. 93.3% （14/15） of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case （ 1/15, 6.7 % ） and a sound result was obtained after a second operation. Conclusions： Radical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.

Surgical treatment for traumatic transection of left common carotid artery

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality.1 Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass （CPB）, improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome.2-6 However, there exists controversies about it.7-9 In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.

Surgical treatment of multivessel lesions in Takayasu arteritis

Takayasu arteritis （TA） is a chronic progressive nonspecific vasculitis that involves the aorta and itsmain branches, resulting in luminal stenosis in the large vessels. Steroid therapy is the foundation for TA treatment and the guarantee of surgery. When a patient presents with uncontrolled symptoms, surgical treatment is the only measure that may be adopted to prevent greater risk to life. However, surgical repair for extensive arteriopathy requires an ingenious design to avoid morbidity in response to the complexity of the pathophysiology of TA. A 41-year-old woman presented with pulselessness, recurrent dizziness, and visual disturbance for the past 23 years. The patient had been diagnosed with TA 13 years ago and had received steroid therapy. However, the symptoms of dizziness and visual disturbance had increased in intensity and duration over the last 2 years. Upon admission, physical examination revealed that pulse in both arms were absent. Her blood pressure was 98/63 mmHg （1 mmHg=0.133 kPa） in the left arm,