Civilian Vascular Injuries in an Urban African Referral Institution

Abstract

Ojective: To evaluate the pattern of civilian vascular injuries, demonstrate any change in pattern and document management challenges in a resource challenged environment.
Design: A retrospective study.
Setting: The division of Thoracic and Cardiovascular Surgery of University College Hospital a major referral centre, not only for south-west Nigeria but for the whole country.
Subjects: All patients presenting with vascular injury through the division during the study period were recruited. There were no exclusion criteria.
Results: Males accounted for 85% of the study group. Mean age was 31.98 years (±14.94 S.D.) with peak in 20 – 29 years group (28.3%). Stab and gunshot injury were responsible in 36.7% and 30% respectively. Upper limb vessels were involved in 58.3%. Delayed presentation (>4hrs post injury) occurred in 58.3% and presentation-operation interval was four to six hours in 55% of cases. Specific diagnostic investigation was required in only 20%. Morbidity, amputation and mortality rates were 10.1, 3 and 6.7% respectively.
Conclusion: Penetrating vascular injuries are on the increase amongst civilian population. Poor transportation and lack of organised referral system contribute to delay in surgical intervention. Prompt evaluation for hard signs of vascular injury is of immense value in deciding for surgery in our environment where patients have financial challenges and resources are limited.