CIVILIAN ARTERIAL INJURIES

A series of 45 arterial injuries, including patients who arrived in hospital with irreversibly ischæmic limbs, is reported. It emerges that arterial injury is a disease of young men, and that, in the civilian practice of this Australian hospital, blunt injury predominates. Iatrogenic injuries accounted for 20% of the series. There was one amputation amongst 14 patients suffering injury to the arteries of the upper limb, and four amputations amongst the 21 patients suffering injury to the arteries of the lower limb. Three amputations followed fracture‐associated arterial injuries. Traumatic thrombosis, intimal rupture and complete transection of arteries occurred with approximately equal frequency. Critical ischæmia, with threatened tissue loss, occurred in over half the cases as a presenting feature. Hæmorrhage, either revealed or contained, was the presenting problem in less than half the cases. About one patient in three was shocked at the time of presentation to the hospital. Every effort was made to restore arterial continuity, when this was appropriate. Vein grafts were used to cope with extensive arterial loss. Fractures were preferably stabilized by internal fixation. Fasciotomy was used three times. A series of eight carotid injuries is reported, with restoration of blood flow in four instances. Seventy‐three per cent of patients achieved a good functional result. Arterial continuity was preserved or restored in 69%. Angiography was undertaken in 22 of the 45 cases, and was more useful in the examination of patients presenting 24 hours or more after injury. There was no difference between the results of management according to whether the patient presented within the first 24 hours or after that time.