Long-term results of lower-extremity venous injuries

K. M. Bermudez, M. M. Knudson, N. A. Nelken, S. Shackleford and C. L. Dean
Department of Surgery, University of California, San Francisco, USA.

OBJECTIVES: To compare the long-term venous function of ligated, simple, and complex repairs and to assess long-term patency in repaired veins. DESIGN: A cohort study of patients with lower-extremity venous injuries treated during a 7-year period. SETTING: A level I urban trauma center. PATIENTS: Twenty-one of the 79 patients with a history of lower-extremity venous injury identified via the trauma registry consented to outpatient evaluation. INTERVENTION: Participating patients underwent a through vascular examination that included color flow duplex venous imaging and air plethysmographic assessment. MAIN OUTCOME MEASURES: The patency of venous repairs, the incidence of chronic deep venous thrombosis, and evidence of chronic venous insufficiency. RESULTS: The venous injuries included 5 iliac, 10 femoral, and 6 popliteal. Six of these injuries were ligated, 11 injuries were simply repaired (lateral venorrhaphy or end-to-end), and 4 were repaired with complex interposition grafts. All repairs were patent, with no evidence of deep venous thrombosis by color flow duplex venous imaging. Seventeen of the 21 patients had symptoms, color flow duplex venous imaging findings, and air plethysmographic data consistent with chronic venous insufficiency, including significant mean differences (P < .03) in outflow fraction, outflow fraction with compression, venous filling index, and residual volume fraction, when compared with the uninjured extremity. The most profound changes followed complex repairs and perioperative fasciotomies. CONCLUSIONS: While the long-term patency of venous repairs is excellent, most patients demonstrate evidence of chronic venous insufficiency after either ligation or repair. Complex venous repairs and fasciotomy are associated with the most severe functional changes.