If an artery, or a blood-carrying pipe in the body, gets damaged due to any reason, the oxygen supply to various organs of the body, including limbs, becomes jeopardized. This may result in the loss of your hand or foot. In our country, a lot of ignorance, apathy, and myths about vascular injury are prevalent among common people and even among a majority of physicians. According to one estimate, in the Indian subcontinent, 50 percent of patients receiving vascular injuries during accidents lose their foot or hand because of ignorance and lack of adequate treatment, whereas in developed countries, hardly 5% of cases of vascular injury undergo amputation of limbs. In our country, lack of awareness and carelessness play a significant role in the development of disability caused by vascular injury. Quite often, people and even attending general or orthopedic surgeons do not pay much attention to vascular injury received during a road traffic accident; this eventually results in amputation of a foot or hand and even the loss of a precious human life.
Vascular Injury May Cause Loss of Limb and Life as Well
In road-traffic accidents, stab injuries by knife and trishul, assault by sharp weapons like swords, and firearm injuries due to explosives like bombs and hand grenades, arteries are usually damaged, sometimes so severely that they are completely disrupted. This complete arterial disruption leads to massive bleeding and blood loss in the body. Because of this excessive blood loss, various organs like the kidneys, brain, heart, and lungs are deprived of essential oxygen, which is necessary for their vital functions and survival. In such a situation, the death of the patient is an eventual outcome if he is not shifted promptly to a large and modern hospital equipped with a 24-hour blood bank facility, angiography facility, and the availability of a full-time cardiovascular or vascular surgeon. Such patients need urgent operation; otherwise, loss of limbs, and sometimes of life as well, becomes inevitable.
Bone Fracture is the Major Cause of Vascular Injury in India
It has been observed that in cases of accidental fractures of upper and lower limb bones, the majority of the treating bone specialists, by and large, ignore co-existing vascular injuries. They pay more attention to bone injuries, and therefore treatment of vascular injuries gets delayed, resulting in irreparable damage to the wall of the artery. In such situations, delayed restoration of blood supply is almost impossible even after operation. Therefore, any person sustaining bone injury during a road traffic accident should consult, as a precautionary measure, both an Orthopedic Surgeon as well as a Vascular Surgeon, so that the treatment of the vascular injury, if present, is not unnecessarily delayed. If a patient, even after successful treatment of his previous bone fracture, continues to complain of tingling sensations or pain in the same limb, it may be indicative of a missed vascular injury. Such complaints should be taken seriously, and the active advice of a cardiovascular or vascular surgeon should be sought without delay.
Sometimes, in accidental bone fracture cases, instead of complete arterial disruption, only a part or side of the arterial wall is severely damaged. This condition of partial injury is often overlooked as blood flow is not totally cut off, and oxygen supply to limbs continues during the initial days. But later on, in subsequent months, without treatment, this damaged wall shrinks and leads to reduced blood flow. Sometimes this damaged and weak wall, instead of shrinking, bulges out due to the high pressure of the blood flow in the artery. This bulging assumes the size of a tumor, which is called, in medical terms, a vascular aneurysm. This may eventually burst if not treated in time and may lead to unsuspecting catastrophic bleeding and massive blood loss.
The Role of Wrongly Administered Intravenous Injection in Causing Vascular Injury
In our country, one of the important reasons for disability is the vascular injury caused by wrongly administered intravenous injection. Quite often, it has been observed that untrained and incompetent paramedical personnel or medical quacks, either due to ignorance or carelessness, wrongly administer what is supposed to be an intravenous injection into an artery in place of a vein. In such a situation, severe pain suddenly develops in the fingers and hand, followed by tingling sensations. Gradually, the skin color of the fingers and toes begins to turn black, and later on, the whole hand becomes dark black. To save the life of such a patient, amputation of the hand remains the only choice left. Therefore, never allow your physician or paramedical personnel to administer any intravenous injection on the front surface of your elbow. An intravenous injection should preferably be administered either on the hairy back of your hand or the forearm near the wrist, far below the elbow crease. Because on the back of the hand and forearm, the chances of inadvertent administration of an intravenous injection into an artery are very remote.
What to Do in Case of a Suspected Vascular Injury?
Quite frequently, it has been observed that people, after receiving an injury, go for a massage; this further damages an already injured artery, and in the process obviates any chance of a successful arterial repair. If a person, after sustaining limb injuries, continues to have pain, tingling sensations, and coldness of the hand or feet, or if red patches appear over the skin of the hands and feet, or he feels as if his fingers and toes have become powerless and dead, all these complaints are strongly indicative of a vascular injury.
For investigation of a vascular injury, Doppler study, conventional angiography, and digital subtraction angiography are very helpful. Without these specialized investigations or tests, it becomes almost impossible to assess the correct nature and extent of vascular injury. Doppler study only indicates and confirms the existence of an injured artery, but it is the angiography that correctly provides all the information required in a case of vascular injury. On the basis of angiographic results only, further management strategies are decided. Therefore, it is mandatory for a patient with vascular injury to go to a hospital where the facility for angiography is available, as the angiographic result decides the type of surgical management. However, in cases of dire emergency and to save precious time and a human life as well, an experienced vascular surgeon may perform vascular operations directly without angiography.
Due to the availability of modern investigations like angiography and free access to artificial tubes, bypass operations in cases of vascular injury have become very effective and successful. With modern surgical techniques, an injured artery is repaired or reconstructed. For arterial reconstruction, either a natural vein from another leg is taken out and grafted into the injured area, or artificial tubes are used instead of the patient’s natural vein. These artificial blood pipes (prosthetic grafts) are imported from the U.S. and Germany. If repair or reconstruction of the damaged artery is not possible by any means, another specialized surgical technique of arterial bypass is used.
The success of an operation in a vascular injury depends entirely upon how soon after injury you consult a vascular surgeon and the condition of the damaged muscles in the area of injury. If a patient, immediately after limb injury with suspected vascular trauma, reaches a cardiovascular or vascular surgeon in time, there stands a good chance of limb salvage. Delay in treatment results in the death of muscle because of prolonged lack of oxygen supply, and then surgical repair or reconstruction of the damaged artery becomes meaningless.
Dr. K.K. Pandey
Dr. K.K. Pandey is a Senior Consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi, India. He has worked previously as a consultant Cardiovascular & Thoracic Surgeon at Batra Hospital and Dr. Ram Manohar Lohia Hospital, New Delhi, India. He has also worked at the well-known Bakulev Institute of Cardiovascular Surgery, Moscow. He can be reached at dr********@***il.com