Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables

To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.

METHOD:

This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.

RESULTS:

The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.

CONCLUSIONS:

The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.

trauma; injuries of the vascular system; vascular surgical procedures; amputation

Age group (years)^a	(n=264)	Time before receiving hospital care^c	(n=264)
<15	16 (6.06)	< 1 hour	2 (0.75)
16-30	154 (58.33)	1-3 hours	23 (8.71)
31-46	71 (26.89)	3-6 hours	92 (34.85)
47-62	16 (6.06)	6-8 hours	3 (1.14)
63-78	6 (2.27)	> 8 hours	144 (54.55)
>79	1 (0.38)
Mechanism of trauma^b	(n=264)	Transportation^d	(n=264)
Firearm	110 (41.67)	SAMU emergency ambulance service	210 (79.55)
Cold weapon^†	65 (24.62)	Private transport	36 (13.64)
Traffic	42 (15.91)	Fire service	10 (3.79)
Workplace accident	13 (04.92)	Police patrol car	8 (3.03)
Blunt trauma	11 (04.17)	Level of amputation^e	(n=53)
Penetrating trauma^#	6 (02.27)	Finger	4 (07.69)
Fall	6 (02.27)	Hand	1 (01.92)
Burn	5 (01.89)	Forearm	6 (11.54)
Surgical procedure	4 (01.52)	Arm	4 (07.69)
Animal bite	1 (0.38)	Thigh	27 (51.93)
Snake bite	1 (0.38)	Leg	7 (13.46)
		Foot	2 (03.77)
		Toe	1 (01.92)

Site of injury^a	(n=264)	Structure injured^d	(n=264)
Lower limbs	120 (45.45)	Artery	102 (38.64)
Upper limbs	93 (35.23)	Vein	18 (6.82)
Thorax	19 (7.20)	Artery/Vein	72 (27.27)
Neck	16 (6.06)	Heart	3 (1.14)
Abdomen	13 (4.92)	Muscular Vessels	66 (25.00)
Face	1 (0.38)	Mesenteric Vessels	3 (1.14)
Pelvis	1 (0.38)
Penis	1 (0.38)
Description of vascular injury^b	(n=264)	Clinical presentation^e	(n=264)
Partial section	125 (47.35)	Active hemorrhage	154 (58.33)
Total section	51 (19.32)	Hematoma	48 (18.18)
Thrombosis	8 (3.03)	Ischemia	24 (9.09)
Arteriovenous fistula	1 (0.38)	Hypovolemic shock	20 (7.58)
Others (NID)	79 (29.92)	Compartment syndrome	16 (6.06)
		Cardiac tamponade syndrome	2 (0.76)
Types of surgery^c	(n=264)	Early postoperative outcomes^f	(n=264)
Ligature	80 (30.30)	Discharge	163 (61.74)
Vascular exploration	43 (16.29)	Amputation	37 (14.02)
Autologous graft	39 (14.77)	Death	28 (10.61)
Amputation	33 (12.50)	Infection	25 (9.47)
Anastomosis	17 (6.44)	Compartment syndrome	2 (0.76)
Fasciotomy	16 (6.06)	Functional limitation	3 (1.14)
Revascularization	15 (5.68)	Pseudoaneurysm	1 (0.38)
Pseudoaneurysm repair	12 (4.55)	Dehiscence	1 (0.38)
Suture	5 (1.89)	Fasciotomy	4 (1.52)
Pericardical window	2 (0.76)
Synthetic graft	1 (0.38)

Fractures^a	(n=264)	Surgery^d	(n=264)	Readmissionⁱ	(n=264)
Yes	188 (71.21)	Immediate	178 (67.42)	Yes	55 (20.83)
No	76 (28.79)	Not immediate	86 (32.58)	No	209 (79.17)

Length of stay	Hospital (n=264)^b	ICU (n=44)^c	Rehabilitation professionals	Yes	No
< 1 week	150 (56.82)	32 (72.73)	Physiotherapist^e	98 (37.12)	166 (62.88)
2-4 weeks	74 (28.03)	7 (15.91)	Psychologist^f	30 (11.36)	234 (88.64)
1-2 months	32 (12.12)	5 (11.36)	Occupational therapist^g	14 (05.30)	250 (94.70)
2-3 months	3 (01.14)	-	Speech and hearing therapist^h	3 (01.14)	261 (98.86)
> 3 months	5 (01.89)	-

Arteries involved^†	(n=264)	Veins involved^#	(n=264)
Common carotid	4 (1.52)	Internal jugular	1 (0.38)
External carotid	3 (1.14)	External jugular	4 (1.52)
Subclavian	9 (3.41)	Subclavian	4 (1.52)
Axillary	9 (3.41)	Superior vena cava	2 (0.76)
Brachial	26 (9.85)	Abdominal inferior vena cava	3 (1.14)
Radial	7 (2.65)	Axillary	3 (1.14)
Ulnar	18 (6.82)	Brachial	8 (3.03)
Radial and ulnar	6 (2.27)	Basilic	5 (1.89)
Abdominal aorta	2 (0.76)	Ulnar	2 (0.76)
Mesenteric	7 (2.65)	Common iliac	4 (1.52)
Common iliac	1 (0.38)	Common femoral	9 (3.41)
Internal iliac	1 (0.38)	Deep femoral	2 (0.76)
Common femoral	9 (3.41)	Superficial femoral	13 (4.92)
Superficial femoral	15 (5.68)	Great saphenous	5 (1.89)
Deep femoral	2 (0.76)	Popliteal	11 (4.17)
Popliteal	19 (7.20)	Tibial	5 (1.89)
Anterior tibial	7 (2.65)	Deep veins of lower limbs	114 (43.18)
Posterior tibial	8 (3.03)	No venous injuries	69 (26.14)
Anterior and posterior tibials	3 (1.14)	_	_
Fibular	1 (0.38)	_	_
Plantar	1 (0.38)	_	_
Muscular vessels	100 (37.88)	_	_
No arterial injuries	6 (2.27)	_	_

Mechanism of trauma	Anatomic Site						Total n (%)
Mechanism of trauma	Lower Limbs		Upper Limbs		FNTAP^†		Total n (%)
Wound by cold weapon	15	23.08^a	36	55.38^a	14	21.54^a	65 (24.62)
Wound by cold weapon	15	12.50^b	36	38.71^b	14	27.45^b	65 (24.62)
Firearm wound	60	54.55^a	24	21.82^a	26	23.64^a	110 (41.67)
Firearm wound	60	50.00^b	24	25.81^b	26	50.98^b	110 (41.67)
Traffic accident	31	73.81^a	5	11.90^a	6	14.29^a	42 (15.91)
Traffic accident	31	25.83^b	5	05.38^b	6	11.76^b	42 (15.91)
Others^#	14	29.79^a	28	59.57^a	5	10.64^a	47 (17.80)
Others^#	14	11.67^b	28	30.11^b	5	09.80^b	47 (17.80)
Total n (%)	120 (45.45)		93 (35.23)		51 (19.32)		264 (100.00)

Structure injured	Clinical presentation						Total n (%)
Structure injured	Active hemorrhage		Hematoma		Others^†		Total n (%)
Artery	67	65.69^a	25	24.51^a	10	9.81^a	102 (38.64)
Artery	67	43.51^b	25	52.08^b	10	16.13^b	102 (38.64)
Artery/ vein	38	52.78^a	8	11.11^a	26	36.11^a	72 (27.27)
Artery/ vein	38	24.68^b	8	16.67^b	26	41.94^b	72 (27.27)
Muscular vessels	37	56.06^a	9	13.64^a	20	30.30^a	66 (25.00)
Muscular vessels	37	24.06^b	9	18.75^b	20	32.26^b	66 (25.00)
Others^#	12	50.00^a	6	25.00^a	6	25.00^a	24 (9.09)
Others^#	12	7.79^b	6	12.50^b	6	9.68^b	24 (9.09)
Total n (%)	154 (58.33)		48 (18.18)		62 (23.49)		264 (100.00)

Description of vascular injury	Structure injured
Description of vascular injury	Artery		Artery/ vein		Muscular vessels		Others^†		Total n (%)
Partial section	67	53.60^a	35	28.00^a	11	8.80^a	12	9.60^a	125 (47.35)
Partial section	67	65.69^b	35	48.61^b	11	16.66^b	12	50.00^b	125 (47.35)
Total section	17	33.33^a	22	43.14^a	8	15.69^a	4	7.84^a	51 (19.32)
Total section	17	16.67^b	22	30.56^b	8	12.12^b	4	16.67^b	51 (19.32)
Others^#	18	20.46^a	15	17.05^a	47	53.41^a	8	9.09^a	88 (33.33)
Others^#	18	17.65^b	15	20.83^b	47	71.21^b	8	33.33^b	88 (33.33)
Total n (%)	102 (38.64)		72 (27.27)		66 (25.00)		24 (9.09)		264 (100.00)

Types de surgery	Early postoperative outcomes
Types de surgery	Discharge		Amputation		Infection		Death		Others^†		Total n (%)
Amputation	2	6.06^a	24	72.73^a	6	18.18^a	1	3.03^a	0	0.00^a	33 (12.50)
Amputation	2	1.23^b	24	64.87^b	6	24.00^b	1	3.57^b	0	0.00^b	33 (12.50)
Pseudoaneurysm repair	8	66.67^a	0	0.00^a	2	16.67^a	1	8.33^a	1	8.33^a	12 (4.55)
Pseudoaneurysm repair	8	4.91^b	0	0.00^b	2	8.00^b	1	3.57^b	1	9.09^b	12 (4.55)
Autologous graft	30	76.92^a	2	5.13^a	2	5.13^a	2	5.13^a	3	7.69^a	39 (14.77)
Autologous graft	30	18.41^b	2	5.41^b	2	8.00^b	2	7.14^b	3	27.27^b	39 (14.77)
Vascular exploration	30	69.77^a	0	0.00^a	3	6.98^a	8	18.61^a	2	4.65^a	43 (16.28)
Vascular exploration	30	18.41^b	0	0.00^b	3	12.00^b	8	28.57^b	2	18.18^b	43 (16.28)
Fasciotomy	10	62.50^a	2	12.50^a	3	18.75^a	0	0.00^a	1	6.25^a	16 (6.06)
Fasciotomy	10	6.13^b	2	5.40^b	3	12.00^b	0	0.00^b	1	9.09^b	16 (6.06)
Ligature	52	65.00^a	6	7.50^a	7	8.75^a	13	16.25^a	2	2.50^a	80 (30.30)
Ligature	52	31.90^b	6	16.22^b	7	28.00^b	13	46.43^b	2	18.18^b	80 (30.30)
Anastomosis	12	70.59^a	2	11.76^a	1	5.88^a	2	11.76^a	0	0.00^a	17 (6.44)
Anastomosis	12	7.36^b	2	5.40^b	1	4.00^b	2	7.14^b	0	0.00^b	17 (6.44)
Revascularization	12	80.00^a	1	6.67^a	1	6.67^a	0	0.00^a	1	6.67^a	15 (5.68)
Revascularization	12	7.36^b	1	2.70^b	1	4.00^b	0	0.00^b	1	9.09^b	15 (5.68)
Others^#	7	77.78^a	0	0.00^a	0	0.00^a	1	11.11^a	1	11.11^a	26 (3.41)
Others^#	7	4.29^b	0	0.00^b	0	0.00^b	1	3.57^b	1	9.09^b	26 (3.41)
Total n (%)	163 (61.74)		37 (14.01)		25 (9.47)		28 (10.61)		11 (4.17)		264 (100.00)

Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Rua Estela, 515, bloco E, conj. 21, Vila Mariana, CEP04011-002 - São Paulo, SP, Tel.: (11) 5084.3482 / 5084.2853 - Porto Alegre - RS - Brazil
E-mail: secretaria@sbacv.org.br

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[1] *Correspondence Ludmylla Teixeira Soares Universidade do Estado do Pará, Hospital Metropolitano de Urgência e Emergência Travessa do Chaco, 1320 - Marco CEP 66085-451 - Belém (PA), Brazil Tel: +55 (91) 98154.1574 E-mail: ludmylla_19@hotmail.com