SURGICAL TREATMENT OF PATIENTS WITH GREAT VEIN INJURIES

N.U. Usmanov, A.D. Gaibov, D.D. Sultanov, A.N. Kamolov
Chair of Hospital Surgery, Abuali Ibn Sine Tadjik State Medical University, Republican Centre of Cardiovascular and pulmonary Surgery,
Dushanbe, Tadjikistan

The results of surgical treatment of 64 patients with great vein injuries are analysed. There were 59 men (92.2%) and 5 women (7.8%). The mean age was 22.4 years. Isolated injuries accounted for 40.6% and associated injuries for 59.4% including vein and artery injuries (18.7%), injuries of the large nerve trunks (7.8%), and tubular bone fractures (9.3%). 11% of the patients had different combinations of the above-listed injuries. Concomitant injuries of the viscera were identified in 12.6% of the patients. The majority of the patients were admitted to the hospital from 40 minutes to 6 hours after injury. All the patients were admitted in a state of shock of varying degree. The surgical policy depended on the shock severity, etiology and site of injury. Reconstructive operations (lateral and circular closure, autologous vein grafting, autologous vein lateral repair) were performed in 55 (85.9%) patients and vein ligation was accomplished in 9 (14.1%) cases. The authors hold that restoration of venous blood flow is an operation of choice in patients with great vein injuries in the hemodynamically significant areas. In view of the peculiarities of venous circulation the primary closure of vein defect is considered to be a most effective variant, used in 71.8% of the patients. Six (9.3%) patients developed thrombosis of the repaired vein in the short-term postoperative period. Four of the six patients were reoperated. There was one death (1.6%) caused by pulmonary embolism. The follow-up of 42 patients has revealed that 5 patients developed the signs of chronic venous insufficiency.

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