Surgery of traumatic peripheral arterial injury with delayed transfer during the Ethio-Eritrean War - 1997-2000

Background: The traditional approach to severe vascular injuries in Ethiopia has been ligation. This paper presents the results of an alternative approach in which Ethiopian surgeons with some basics of vascular reconstruction techniques used vein patch-repair, whenever possible, during the Ethio-Eritrean war between 1997-2000. Patients and methods: The population study consisted of 13 military and 7 civilian patients with vascular injuries. The superficial femoral and the brachial arteries were involved each in eight patients respectively. Four victims each sustained injury to the deep femoral, radial, ulnar and anterior tibial arteries respectively. Intra-operative findings revealed arteriovenous fistulae and false aneurysms each in nine patients. Results: Vein Patch reconstruction was undertaken in 12 patients. In eighteen Patients, a perfect or near perfect functional result was achieved. Surgery failed in two cases. The two failures may have been due to extraordinarily concomitant injury or late presentation. Conclusion: Our result suggests that; repair rather than ligation represents the "gold-standard" and that it can be achieved in the absence of "high tech" vascular facilities. This is because viability of the limb has been maintained by the development of an A-V fistula, false aneurysm, or through an alternative arterial source on those whose limb survives during the several days required to transport them to an appropriate facility