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Lower limb arterial injuries—etiology, presentations, management and outcome: A center's experience
Ahmed M.E.E. Osman1, Saif Eldin Mohammed Ali Ibrahim2, Ashraf Mohammed Mokhtar3, Ghofran Mahgoub Hussien Mohamed4, Sara Mohammed Yassin Hassan1, Tasneem Elrayah Ramli Ahmed1, Abubakr Hashim Elrofaie Sayed Ali1
1MBBS, Resident, Unit of Vascular and Endovascular Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan.
2MD, MRCS (Eng.), D.MAS, F.MAS, F.Vasc/Endovasc (MAL), Head, Unit of Vascular and Endovascular Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan; 3MD, General Surgery, Unit of Vascular and Endovascular Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan; 4MBBS, MRCS, Resident, Unit of Vascular and Endovascular Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan.

Article ID: 100004C04AO2015
doi:10.5348/C04-2015-4-OA-3

Address correspondence to:
Dr. Ahmed Mohamed Elhassan Elfaki Osman
Ward 17, Unit of Vascular and Endovascular Surgery,
Department of Surgery, Ibn Sina Specialized Hospital
Alamarat, Khartoum
P.O. Box: 12217, Sudan
Phone: 00249-911718227

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How to cite this article
Osman AMEE, Ibrahim SMA, Mokhtar AM, Mohamed GMH, Hassan SMY, Ahmed TER, Ali AHES. Lower limb arterial injuries—etiology, presentations, management and outcome: A center's experience. Edorium J Cardiothorac Vasc Surg 2015;2:8–18.


Abstract
Aims: Vascular injuries are encountered in a vast number of settings, ranging from stab wounds and bullet injuries, to causes as small as arterial blood sampling procedures. Surgery for vascular repair is sometimes indicated without angiography. Broadly speaking, options for repair after assessment of vasculature include simple vessel wall repair, venous patching; resection with end-to-end anastomosis or with interpositioning graft, bypass graft, ligation or amputation. General objective of this study is to identify the etiology, presentations, management and outcome of lower limb arterial injuries in Khartoum, Sudan, From September 2013 to September 2014.
Methods: Retrospective hospital based study and the study population included all patients who present to the vascular surgery clinic and emergency department. Thirty patients had lower limb arterial injuries (LLAI). Data was collected using a structured checklist and analyzed using the SPSS program.
Results: Twenty-seven (90%) were male and three (10%) were females. The most common age at presentation was 16–25 years old (43.3%), followed by 26–35 (26.7%). The most common artery injured was the superficial femoral artery (SFA), 53.3% followed by the popliteal artery (6 patients; 20%). Bullet injuries were the highest cause for LLAI, with an incidence rate of 36.7%, while stab wounds presented at 23.3%. Limb salvage rate was 76.7%, partially salvaged limb (forefoot amputation) rate was 16.7% and amputation rate was 6.6%.
Conclusion: Amputation rate was the highest in patients with SFA injuries. Appropriate intervention and rapid restoration of blood flow is crucial to have a good outcome and is key to successfully salvage the injured limb.

Keywords: Lower limb arterial injuries, Presentations, Management, Outcomes, Sudan

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Author Contributions:
Ahmed M.E.E. Osman – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Saif Eldin Mohammed Ali Ibrahim – Conception and design, Acquisition of data, Critical revision of the article, Final approval of the version to be published
Ashraf Mohammed Mokhtar – Conception and design, Drafting the article, Final approval of the version to be published
Ghofran Mahgoub Hussien Mohamed – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Sara Mohammed Yassin Hassan – Conception and design, Drafting the article, Final approval of the version to be published
Tasneem Elrayah Ramli Ahmed – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Abubakr Hashim Elrofaie Sayed Ali – Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Ahmed M.E.E. Osman et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Ahmed Mohamed Elhassan Elfaki Osman has been a Vascular and Endovascular Surgery Resident at Sina specialized hospital in Khartoum, Sudan, since September 2013. He earned his undergraduate (MBBS) degree from the National Ribat University in Sudan. He intends to pursue a vascular surgery integrated residency in the US as well as a research career in vascular biology and tissue regeneration in the future



Saif Eldin Mohammed Ali Ibrahim [MD, MRCS (ENG); D.MAS; F.MAS; F. Vasc/Endovasc (MAL)] is a Consultant Vascular and Endovascular Surgeon as well as the Head of the unit of Vascular and Endovascular Surgery at Ibn Sina Specialized Hospital in Khartoum, Sudan. He earned MBBS degree from the University of Khartoum, Sudan and postgraduate (MD) degree from Sudan. Dr. Ibrahim obtained his Vascular and Endovascular Surgery fellowship from Malaysia. He also completed fellowships in Minimal Access Surgery as well as Robotic Surgery.



Ashraf Mohamed Mokhtar Ali is a General Surgeon and a Vascular Surgery Specialist at Vascular and Endovascular surgery unit, Ibn Sina Specialized Hospital in Khartoum, Sudan. He earned his undergraduate degree (MBBS) from university of Gezira, Sudan, and postgraduate MD in general surgery from Sudan.



Ghofran Mahgoub Hussien Mohamed is a Vascular and Endovascular Surgery Resident at Ibn Sina Specialized Hospital in Khartoum Sudan. She obtained her MBBS degree from the University of Khartoum in 2012. She will be starting a general surgery MD this year in Sudan and intends to pursue a career in Vascular and Endovascular surgery in the future.



Sara Mohammed Yassin Hassan has been a vascular and endovascular surgery resident at Sina specialized hospital in Khartoum, Sudan, since June 2013. She earned undergraduate (MBBS) degree from the Khartoum College of Medicine in 2011. She intends to pursue a career in vascular surgery focused mainly on endovascular interventions.



Tasneem Elrayah Ramli Ahmed has been a Vascular and Endovascular surgery resident at Ibn Sina Specialized Hospital since April 2014. She obtained MBBS degree from Upper Nile University in Sudan.



Abubakr Hashim Elrofaie Sayed Ali is a Resident of Vascular and Endovascular Surgery unit, Ibn Sina specialized Hospital in Khartoum, Sudan. He earned MBBS degree from the National Ribat university in Sudan. He intends to pursue clinical career in vascular and cardiothoracic surgery as well as educational and research position in the future.