Experience with 115 Civilian Venous Injuries

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Abstract
Retrospective analysis of 115 patients with venous injuries managed in a 7-yr period disclosed a total mortality of 15%. Retrohepatic caval injury was uniformly fatal; infrarenal caval injury was not. Of victims of truncal venoarterial injuries, 56% died. Isolated venous injury of the extremity was never lethal. Ligation of injured veins of the neck and upper extremities was well tolerated. Ligation of external iliac, or common femoral, or superficial femoral veins resulted in edema in 50% of the patients compared to 7% after repair (P < 0.05). Venoarterial injuries of iliac or femoral-level veins resulted in 37% incidence of compartment syndrome against 5% in isolated arterial injuries (P < 0.01). Therapeutic fasciotomy after the onset of clinically evident compartment syndrome did not prevent foot drop in any patient. All major veins of the lower extremities should be repaired with the same care as arterial injuries. Prophylactic fasciotomy for all patients with iliac or femoral venoarterial injuries should be considered as strongly as with popliteal venoarterial injuries. The caliber and patency of repaired veins must be assessed by venography at operation, and again before discharge from the hospital.

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