Publication details

Intimal dissection of arteries of the limbs

Title in English Intimal dissection of arterie of the limbs
Authors

VEVERKOVÁ Lenka REŠKA Michal KÁBELA Martin KONEČNÝ Jan ČAPOV Ivan PROCHÁZKOVÁ Ivana

Year of publication 2009
Type Article in Proceedings
Conference CEVJ Vol8 No1
MU Faculty or unit

Faculty of Medicine

Citation
Field Surgery incl. transplantology
Keywords Injury intimal dissection
Description Introduction: An artery is dissected by a rupture in its intima or media and blood subsequently flows in between individual layers of the arterial wall. The damage to the intima results from pressure and stretching and is connected to ischemic complications. Sample: Between 2004 and 31.12.2007 we operated on a total of 1,551 trauma patients out of whom only 2 suffered from the above described intimal lesion. In both cases the patients were involved in car accidents and the damage was caused when they were suddenly hit by a blunt object – the steering wheel and the seat. In both cases the resulting ischemy of the limb was treated after a delay due to the complicated rescue of the patients from their cars. In the first case the delay was 150 minutes while in the second 300. The patients did not suffer any fractures on the affected limb. The 25year old woman suffered an intimal lesion in AFC l. sin. and the 36year old man in AP l. dx. Results: In the first case the diagnosis was based on the gradually developed ischemy and the conducted AG. In the second case it was based on clinical examination and a spiral CT. We renewed the continuity of the arteries using an autologous venous graft. The flow of the reconstructed artery was assessed using doppler. In the first case this happened within six months as a foreigner was involved and further checks were impossible. In the second case the flow was uninterrupted even within 14 months and the residual neurological damage that resulted from the ischemy improved. Discussion: The literature describes intimal dissection as a result of accidents, including car accidents. The damage mechanism is often linked to hyperextension of a limb or the neck, however, in our cases a compressive mechanism was involved. The delay in the treatment was not caused by inappropriate healthcare provision but by the complicated rescue of the injured from their vehicles. With an increasing number of accidents we should expect more of these, thus far not very frequent, arterial injuries of the limbs.
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