The Belfast approach to managing complex lower limb vascular injuries

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
A A B Barros D'SaE McIlrath

Abstract

Complex lower limb vascular injuries (CLVIs) in high-energy penetrating or blunt trauma are associated with an unacceptably high incidence of complications including amputation. Traumatic ischaemia and ischaemia-reperfusion injury (IRI) of skeletal muscle often lead to limb loss, the systemic inflammatory response syndrome (SIRS) which affects remote organs and even the potentially fatal multiple organ dysfunction syndrome (MODS). Surgical care of CLVIs everywhere, including Northern Ireland until 1978, was governed by an anxiety to restore arterial flow quickly often using expedient and flawed repair techniques while a damaged major vein was frequently ligated. A new policy centred on early intraluminal shunting of both artery and vein, restoring arterial inflow and venous outflow, respectively, was introduced at the Regional Vascular Surgery Unit of The Royal Victoria Hospital, Belfast in 1979. It imposed a disciplined one-stage comprehensive approach to treatment involving a sequence of operative manoeuvres in which all damaged anatomical elements receive meticulous and optimal attention unshackled by time constraints. Comparisons drawn between the pre-shunt period of unplanned treatment (1969-1978) and the post-shunt period...Continue Reading

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Citations

Dec 7, 2013·World Journal of Emergency Surgery : WJES·Antonio KrügerDietrich Doll
Feb 11, 2014·TheScientificWorldJournal·Vijay Langer
Jun 30, 2014·Journal of the American College of Surgeons·Roy Spence, Robert Spence
Nov 16, 2010·The Surgical Clinics of North America·Habeeba ParkAdrian Barbul
Mar 21, 2009·Seminars in Vascular Surgery·Vincent L RoweFred A Weaver
Oct 13, 2009·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Günter KöhlerAlfred O Mueck
Sep 14, 2018·The Journal of Trauma and Acute Care Surgery·Jordan R WlodarczykMargaret M Moore
Sep 24, 2016·Annals of the Royal College of Surgeons of England·M J Ramdass, P Harnarayan
Oct 3, 2020·Curēus·Mobeen K QureshiAhmad Khaled
Aug 5, 2017·Frontiers in Surgery·Adham N Abou AliEfthymios D Avgerinos

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