Features of diagnosis and treatment of post-traumatic aneurysms of the arteries of the limbs resulting from explosive injuries

Аннотация

Peripheral vascular injury is still a serious pathology, even if the direct threat to life has already been overcome. Post-traumatic aneurysm is a rather rare phenomenon. The cause may be damage to the arteries of the limbs and blunt trauma, so the number of cases increases in wartime. Complications of aneurysms may include the formation of thrombosis, ischemia of the limb with trophic disorders with the need for amputation of the limb. The aim is to improve diagnostic algorithms, treatment results to reduce the recovery period in patients with limb injuries due to blast trauma, in whom aneurysms develop. We have considered and analyzed the features of diagnosis and surgical treatment of post-traumatic aneurysms of the arteries of the limbs based on 11 clinical cases as an example.Complications of aneurysms include rupture of the aneurysmal sac with profuse, life-threatening bleeding, thromboembolism, compression of the peripheral nerve with neuromuscular and sensory dysfunctions. An outbreak of infection and the development of phlegmon of the soft tissues surrounding the aneurysmal sac ("aneurysm suppuration") are possible. Most often, hemodynamic disorders and the formation of the "heart-artery-fistula-vein-heart" circulatory circuit bypassing the rest of the limb cause a steal syndrome and lead to limb ischemia. Simultaneous damage to the artery and vein leads to the formation of an arteriovenous fistula.Post-traumatic aneurysm of the peripheral arteries can lead to significant circulatory disorders, limb ischemia, neuropathy, and ultimately to trophic disorders of the limb. Radical surgical treatment of arteriovenous fistula guarantees improvement of systemic hemodynamics in the early postoperative period. Clinical observations indicate the need for further examination in patients with blunt trauma of the limbs.