Elective vascular reconstruction after trauma.

Elective vascular reconstruction was performed to correct 135 vascular lesions at Walter Reed Army Medical Center in patients who had sustained earlier vascular trauma. This represents approximately 7 per cent of the operations performed from 1967 to 1974. Approximately three fourths of the lesions resulted from combat wounds and the remaining one fourth from civilian trauma. Of the 135 lesions, fifty-two were arteriovenous fistulas, thirty-five were false aneurysms, and the remaining forty-eight lesions involved thrombosis or stenosis. The popliteal artery was involved most frequently (nineteen lesions), closely followed by eighteen injuries to the superficial femoral artery and fourteen injuries to the brachial artery. In managing both false aneurysms and arteriovenous fistulas, repair of the arterial injury was the major objective. However, particular effort was made to repair larger veins in the arteriovenous fistula category. Patients with arterial thrombosis and stenosis who had symptoms interfering with their daily activity have had successful vascular reconstruction utilizing a variety of technics. No operative or related postoperative deaths occurred in this group of patients. There was only one early postoperative graft occlusion, (0.7 per cent of the operations) and two late graft occlusions (1.5 per cent). Subsequently, additional vascular reconstruction was successful.