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• W2053562497 abstract "Conclusions: Venous ligation for severe venous injury results in no significant sequelae of chronic venous insufficiency and has no detrimental effect on associated arterial repair. Summary: It is recommended that repair of major venous injury be performed when feasible. However, primary repair may be impossible if there is extensive disruption of the vein or in an unstable patient. In such cases, ligation of the venous injury is recommended. The authors investigated the effects of venous ligation of major veins in the lower extremities when the vein was extensively lacerated from a traumatic injury. Between January 2001 and April 2004, there were 63 patients with grade 3 and 4 venous injuries treated with ligation who were then observed prospectively. Patients had venous ultrasound performed on the 5th day postoperatively prior to discharge and at 3 months to assess for the presence of deep venous thrombosis (DVT) and patency of any associated arterial repair. Patients with DVT were treated with sodium warfarin for three months with a target international normalized ratio of 2.0-3.0. Patients were also treated with Class II compression stockings for 1 year. Follow-up occurred at 1, 3, 6, and 12 months and at 6 month intervals thereafter. Fifty of the patients (79.4%) had combined arterial and venous injury. Pure venous injuries were present in 13 patients (20.6%). DVT developed in 49 patients (77.7%). The DVT was postoperative in 37 patients (58.7%) and developed late in 12 patients (19%). There were 3 arterial restenoses and one pseudoaneurysm of the superficial femoral artery observed. Five patients underwent prophylactic fasciotomy and 2 patients had late fasciotomy for compartment syndrome. Postoperative edema was present in 56 (88.8%) of the patients and wound infection occurred in 19 patients (30.1%) with 18/19 wound infections being superficial. There were 2 amputations. One patient died as a result of hemorrhagic shock. At 18 months, 25 patients were classified according to the CEAP classification. Three legs were CEAP class 0, 7 legs CEAP class 2, and 8 legs CEAP class 3. There were no instances of severe postthrombotic syndrome. Comment: The article suggests it is not necessary to repair severe lower extremity venous injuries. The data is restricted to patients that had essentially unreconstructable venous injuries. Only about 40% of the patients were available for follow-up to assess for possible postthrombotic syndrome. Cleary the data allow one to conclude that ligation of a severe venous injury in a lower extremities is safe. There are too few patients and too limited follow-up to justify a conclusion that postthrombotic syndrome is not a problem following ligation of major lower extremity veins for trauma." @default.
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• W2053562497 date "2008-06-01" @default.
• W2053562497 modified "2023-09-30" @default.
• W2053562497 title "Serious Lower Extremity Venous Injury Management With Ligation: Prospective Overview of 63 Patients" @default.
• W2053562497 doi "https://doi.org/10.1016/j.jvs.2008.04.034" @default.
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