Management of vascular injuries in the lower extremities.

: From 1981 through 1985, 220 consecutive patients with presumed vascular injuries in the lower extremities underwent operation at the Ben Taub General Hospital. More than 81% of injuries were due to penetrating wounds, and blunt and iatrogenic injuries accounted for the remainder. A preoperative emergency center arteriogram was performed in 63.2% of patients, and physical examination alone prompted operation in 36.8%. Eight patients underwent immediate amputation; the remaining 212 patients were found to have 225 arterial (63.9%) and 127 venous (36.1%) injuries. More than 50% of patients were noted to have both arterial and venous injuries. Arterial repair was most commonly accomplished by segmental resection with an end-to-end anastomosis (28.4%) or insertion of a graft (38.8%). Venous repair was most commonly accomplished by lateral venorrhaphy (48.8%), ligation (19.7%), or insertion of a conduit (18.1%). Postoperative infection in closed wounds, in wounds left open because of the magnitude of injury, and in adjacent fractured bone occurred in 13% of patients. Late amputations were necessary in only four patients, three of whom had infection as the cause.