Outcome in the Management of Penetrating Venous Injury

Abstract

The authors report on the management of 33 patients with penetrating venous injuries, 25 due to gunshot wounds and 8 due to stab wounds. During the period of this study we treated 35 venous injuries and two patients, both following femoral artery and vein repairs and limb salvage were lost to follow-up and are excluded. Thirty-two had associ ated thoracic, intraabdominal, or arterial injuries. Duplex imaging was performed in 14 patients and venography in 12. They assessed all 27 survivors for postoperative sequelae. Mean follow-up time was twenty months, ranging from three months to three years. Four patients had suprarenal inferior vena cava injuries. All 4 underwent repair and 2 survived. Seven others had infrarenal vena cava injuries. Three of 5 survived following repair and the other 2 survived after caval ligation. Three patients had iliac vein injuries. Two died after repair and 1 survived with ligation. Seventeen patients had injuries of the femoral vein. Thirteen underwent repair, 7 of whom remained patent. Four had ligations performed. There were 2 injuries of the popliteal vein; both were repaired, but neither remained patent. All 19 patients with femoral and popliteal vein injuries survived with limb salvage. Postoperative sequelae (persistent edema, skin discoloration) were observed in 4 failed venous repairs—2 femoral and 2 popliteal.

Ligation of the infrarenal vena cava and iliac veins, as compared with repair, yielded a greater patient salvage rate. There was no increased morbidity with ligation of the femoral veins, which was undertaken only on unstable patients.